Lecture 11 Acneiform Eruptions

Question 1

What are the subtypes of acne

Answer 1

Acne vulgaris
Comedomal acne
Papulopustular acne
Nodular cystic acne

Question 2

What are the topical treatments for acne

Answer 2

Benzoyl peroxide
Antibiotic
Retinoids- reduce scarring and skin secretions
Combination- reduce inflammation
Azaleic acid
Nicatinamide gel

Question 3

What are the systemic treatments for acne

Answer 3

•	Antibiotics
–	tetracyclines
–	erythromycin
–	trimethoprim
•	anti-androgens : combined oral contraceptive pill, 
•	Isotretinoin (Roaccutane)
•	UVB
•	Dapsone

Question 4

What is Isotretinoin

Answer 4

• Retinoid medication - vitamin A derivative

* Reserved for treatment failure, evidence of scarring, severe acne, acne fuminans

Question 5

What are CI and side effects of Isotretinoin

Answer 5

Vitamin A supplements
• Dry skin, lips, epistaxis, dry brittle hair, nail dystrophy, reduction in night time vision , myalgia, mood disturbance, skin sensitivity, photosensitivity, headaches

Question 6

What is Acne Fulminans

Answer 6

• Sudden onset eruption
• Feverish
• Unwell
• Joint pains

Question 7

How is scarring treated

Answer 7

•	If had isotretinoin should wait 1 year before looking into treatment for scarring
–	Treatment depends on type of scarring
–	Intralesional steroid
–	Excision of ice pick scars
–	Laser
–	Dermabraison
–	Chemical peels

Question 8

What is Acne Rosacea

Answer 8

•	Chronic inflammation
–	PSU
–	Cutaneous vasculature
–	Ace of club- forehead and cheeks
–	Unusual on non-facial sites
•	Age 30-50 years
•	F > M – but M more severe
•	Fair skinned/Celts
•	Flushing – alcohol, spices, emotion, hot drinks
•	“Sensitive” skin

Question 9

What are the subtypes of acne rosacea

Answer 9

• Erythemato-telangiectatic
• Papulo-pustular
• Phymatous (M»>F)- uncontrolled acne over a long time- treatment is surgery
• Ocular
• No Comedones

Question 10

What is the topical treatment for acne rosacea

Answer 10

– Metronidazole- Rosex, Metrogel
– Azeleic acid- Finacea
– Ivermectin- Soolantra
– Brimonidine- Mirvaso

Question 11

What is the systemic treatment for acne rosacea

Answer 11

–	Tetracycline
–	Erythromycin
–	Isotretinoin- low dose
–	Light based treatments
–	Laser

Question 12

What is infantile acne

Answer 12

• 3months- 1year
• Comedome, papules, pustules and cysts
• Same treatment in adults
• Need to treat to prevent scarring
• If greater than 1 year look for signs of virilization

Question 13

What is Hidradenitis Suppurative

Answer 13

• Group of diseases in which hair follicles become blocked with keratin (scale) and then rupture, resulting in inflammatory skin disease. These conditions commonly coexist. They may be severe and difficult to treat
• Recurrent boils and abcesses
• Sinus tract formation
• Axillae, groin and pereneum, submammary
• Follicular occlusion tetrad

Question 14

Treatment of Hidradenitis Suppurative

Answer 14

–	Lifestyle modification
–	Topical wash
–	Tetracycline 
–	Topical 
–	Dapsone
–	Adalimumab
–	Ciclosporin