HUD AAD

Question 1

Vad är en komedon?

Answer 1

En tilltäppt talgkörtel. Kan vara vita eller svarta.

Question 2

Hur ser patogenesen ut vid akne?

Answer 2

Pathogenesis
Four factors are involved in the formation of acne lesions
•Increase in sebum production (influenced by androgens)
•Keratin and sebum plug the hair follicle and accumulate leading to hyperkeratosis (comedone formation)
•P. acnes (bacteria) proliferates in the sebaceous follicle (releases enzymes and stimulates release of pro-inflammatory cytokines)
•
Inflammatory response

Question 3

Hur kan man klassificera akne?

Answer 3

Classification of acne is based on the morphology
–Comedonal: open and closed comedones
–Inflammatory: papules and pustules
–Nodulocystic: nodules and cysts
•It is equally important to describe the severity and the presence of scarring for each patient
–Each type can be mild to severe depending on the extent and density of acn

Question 4

Vad finns det för olika behandlings regimer vid akne?

Answer 4

a. Salicylic acid 2% facial wash (less effective than BP, combination therapy indicated for moderate acne)
b. Tetracycline oral antibiotic (oral antibiotic monotherapy is not recommended due to possibility of bacterial resistance)
c. Combination therapy with benzoyl peroxide and topical retinoid cream (topical antibiotic could also be added)
d. Combination therapy of oral isotretinoin and hormone therapy (these are used in refractory cases of moderate/severe acne, not first-line)

Question 5

Hur fungerar Topical Retinoids och vad har det för biverkningar, vad finns det för typer?

Answer 5

Mechanism:
– Topical retinoids are vitamin A derivatives that act by normalizing the desquamation of follicular epithelium to prevent formation of new comedones and promote the clearing of existing comedones
•Common Adverse Effects:
–Dryness, pruritus, erythema, scaling, photosensitivity
•Available forms:
–Tretinoin, Adapalene, Tazarotene

Question 6

Hur funkar benzoyl peroxide och vad har den för biverkningar?

Answer 6

Mechanism:
–Benzoyl peroxide is a topical medication with both antibacterial and comedolytic properties
–Acts via the generation of free radicals that oxidize proteins in the P acnes cell wall
Common Adverse Effects:
–Bleaching of hair, colored fabric, or carpet
–May irritate skin; discontinue if severe

Question 7

Hur funkar Topical Antibiotics och vad är viktigt att tänka på?

Answer 7

Mechanism
–
Reduce the number of P. acnes and reduce inflammation in inflammatory acne
•Available forms:
–Erythromycin 2% (solution, gel)
–Clindamycin 1% (lotion, solution, gel, foam)
Additional considerations:
–Often used with benzoyl peroxide (versus monotherapy) to prevent the development of antibiotic resistance in the treatment of mild-to-moderate acne

Question 8

Vad ska man tänka på om n ett barn kommer in med akne?

Answer 8


Acne between the ages of 1 and 7 years-of-age is called “Mid-childhood acne,” and it is very rare.
These features are all possible sequelae of excess androgens that warrant workup by a pediatric endocrinologist.
Possible causes include: adrenal tumors, gonadal tumors, congenital adrenal hyperplasia, Cushing syndrome, and precocious puberty.

Question 9

Vad är akne rosacea?

Answer 9

Acne Rosacea may look very similar to Acne vulgaris, however, it can be differentiated by an absence of comedones
•Morphology:
–May present with easy flushing, erythema, telangiectasias, papules and pustules, and/or phymatous changes
•Triggers:
–Alcohol, sunlight, hot beverages (heat), spicy food, emotional stress
–Unlike acne vulgaris, it is not related to hormones
•Additional Considerations:
–Many patients with rosacea have ocular involvement
•Treatment:
–Topical and oral treatments often improve the papules and pustules of rosacea, but will not reverse the underlying erythema and flushing
–All patients with rosacea should use sunscreen and avoid known triggers