General Practise/Primary Care Flashcards
What is Acne Vulgaris?
characterised by?
most common bacterium
common areas affected
Chronic Inflammatory Dermatosis
increased sebum production
follicle hyperkeratinisation
inflammation
triggered by Propionibacterium acnes
face neck upper trunk
Aetiology of Acne Vulgaris
Age : adolescents
Environment: diet, stress, pollutants
Genetics: FHX
Hormones: Androgens: testosterone, dehydroepiandrosterone sulfate - stimulated sebaceous gland activity.
Pathophysiology of Acne Vulgaris
Increased sebum production by increased androgens
lipid rich environment of sebaceous glands favouring skin micro-organism proliferation and therefore follicular occlusion.
keratinocyte proliferation further follicular occlusion. differentiation within pilosebaceous unit.
overgrowth of P.acnes
inflammation - release of IL-1/8, tnf-a cause papules,pustules,nodules,cysts
List of different lesions in Acne Vulgaris
Macules - flat skin marks
Papules - small skin lumps
Pustules - small skin lump with yellow pus
Comedomes - skin coloured papules blocked pilosebaceous unit
Blackheads - open comedomes
Ice pick scars - small indents in skin after acne lesion heal
Hypertrophic scars - small skin lump after acne lesion heal
Rolling Scars - irregular wave like skin after acne lesion heal
tell me a little about comedomes - acne
due to dilated sebacous follicle
closed - white - obstructed completely
open - black - partially obstructed
non inflammatory lesion.
hyperkeratinisation caused increased sebum production.
Tell me about papules and pustules - acne
when the follicle bursts releasing irritants
inflammation around blocked follicle- papules
papule - papule with pus because of neutrophil infiltration.
tell me a little about nodules and cysts - acne
severe inflammatory response.
macrophages,lymphocytes, plasma cells and tissue destruction causing fibrosis.
nodules - firm lumps under skin
cysts - fluctuant due to liquified necrotic material in fibrous tissue.
what would you see in drug induced acne
monomorphic
pustules in steroid use
what acne fulminans
severe acne with systemic upset like a fever
hospital admission required
oral steroids - tx
How would you treat Acne Vulgaris
mild - open/closed comedomes with/without sparse inflammatory lesions
moderate - widespread non-inflammatory and papules/pustules
severe: extensive inflammatory lesions
mild-moderate: 12 week course of topical combo therapy 1st line
1. fixed combo - topical adapalene + topic benzoyl peroxide
2. fixed combo - topical tretinoin + topical clindamycin
3. fixed combo - topical benzoyl peroxide + topical clindamycin
could use benzoyl peroxide as monotherapy if contraindicated
moderate- severe: 12 week course of:
1. fixed combo topical adapalene + topical benzoyl peroxide
2. fixed combo - topical tretinoin + topical clindamycin
3. fixed combo - topical adapalene + topical benzoyl peroxide+ either oral lymecycline/doxycycline
4. topical azelaic acid+ either oral lymecycline/doxycycline
oral isotretinoin: not pregnancy - specialist supervision
who would you avoid tetracycline in and why?
pregnancy
breastfeeding women
children under 12.
use erythromycin instead in pregnancy.
side effect of minocycline - acne tx
possible irreversible pigmentation
why should you give topical retinoid with oral abx
reduce the risk of abx resistance developing.
dont combine topical and oral abx
complication of long term abx use
how would you treat
gram negative folliculitis
tx: high dose oral trimethoprim
name an alternative to oral abx in women for acne tx?
side effects
combined oral contraceptive
combine with topical agents
dianette (co-cyprindiol) - anti-androgen properties.
increased risk of vte - use 2nd line - only for 3 months.
rules for administering abx - acne
don’t combine topical and oral abx
monotherapy with oral abx
mono with topical abx
what is acne conglobate?
rare and severe of acne found mostly in men that presents with extensive inflammatory papules, suppurative nodules and cysts on the trunk.
side effect of tetracycline
teeth discoloration if used in children under 8 years or pregnant.
side effect of isotretinoin
its potent oral retinoid used for severe acne
teratogenicity
hyperlipidaemia
hepatotoxicity
side effects of isotretinoin
dry skin and lips
photosensitivity of skin to sunlight
depression, anxiety, aggression and suicidal ideation.
rarely Steven-Johnson syndrome and toxic epidermal necrolysis
tell me a little bit about isotretinoin
retinoid
reducing inflammation and reducing bacterial growth.
teratogenic.
stop it at least a month before becoming pregnant.
What is Acute Bronchitis?
leading cause
resolve time
chest infection
self-limiting
inflammation of trachea and major bronchi
associated with oedematous large airways and sputum production.
resolves in 3 weeks.
viral infection - leading cause
Clinical Features of Acute Bronchitis
cough - could be productive
sore throat
rhinorrhoea
wheeze
most have normal chest exam some have:
low grade fever
wheeze
how would you investigate acute bronchitis
clinical diagnosis
crp testing to guide whether to give abx.