Lecture 5: Acne and Rosacea

Question 1

acne vulgaris definition

Answer 1

• a chronic disorder of the skin affecting the pilo-sebaceous unit, in which there is blockage of the follice leading to comedones and inflammation.

Question 2

acne vulgaris epidemiology

Answer 2

Peak 15-18 years (90% incidence)
delayed onset in some females
+ve family history
M=F – but M more severe
psychological impact

Question 3

acne vulgaris risk factors

Answer 3

• hormonal changes e.g. puberty, menstrual cycle, PCOS
• increased sebum (oil) production
• blockage of hair follicles and sebaceous glands by keratin and sebum
• bacterial colonisation (Propionibacterium acnes)
• family history
• certain meds e.g. corticosteroids, hormonal treatments

Question 4

closed comedones are referred to as?

Answer 4

whiteheads

Question 5

open comedones are referred to as?

Answer 5

blackheads

Question 6

what are the different acne vulgaris classifications?

Answer 6

• non-inflammatory: comedonal > whiteheads and blackheads
• inflammatory: papules, pustules, and nodules (cysts)
• mild acne: predominantly non-inflammatory
• moderate acne: predominantly inflammatory
• severe acne: nodules (cysts), scarring, acne fulminans, and acne conglobata

Question 7

what are the topical treatment options for acne vulgaris?

Answer 7

• topical benzoyl peroxide
• topical antibiotics (clindamycin)
• topical retinoids (tretinoin/adapalene)
• azaleic acid
• nicatinamide gel

Question 8

which systemic medications can be used to treat acne vulgaris?

Answer 8

• antibiotics: tetracyclines, erythromycin, trimethoprim
• anti-androgens: COCP
• isotretinoin (Roaccutane)
• UVB
• dapsone

Question 9

what are the side effects of isotretinoin?

Answer 9

• teratogenic
• dry skin, lips
• epistaxis
• dry brittle hair
• nail dystrophy
• reduced night time vision
• myalgia
• mood disturbance
• skin sensitivity
• photosensitivity
• headaches

Question 10

describe acne fulminans and its clinical features

Answer 10

• sudden onset acneform eruption
• systemic symptoms: feverish and unwell, joint pains

Question 11

acne fulminans treatment

Answer 11

start low dose isotretinoin but cover with prednisolone

Question 12

what are the treatment options for acne scarring?

Answer 12

If had isotretinoin usually should wait 1 year before looking into treatment:
- depends on type of scarring
- intralesional steroid
- excision of ice pick scars
- laser
- dermabrasion
- chemical peels

Question 13

acne rosacea definition

Answer 13

Acne rosacea is a prevalent skin condition characterized by episodic or persistent facial flushing, with a notable predisposition towards women aged between 30 and 60 who have fair skin.

Question 14

list the different subtypes of acne rosacea

Answer 14

• Erythemato-telangiectatic subtype
• Papulo-pustular rosacea
• Rhinophymatous rosacea
• ocular rosacea

Question 15

what are the topical treatments for acne rosacea?

Answer 15

• metronidazole - rosex, metrogel
• azaelic acid - Finacea
• Ivermectin - Soolantra
• Brimonidine - Mirvaso

Question 16

what are the systemic treatment options for rosacea?

Answer 16

• oral antibiotics: tetracyclines and erythromycin
• isotretinoin - low dose
• light based treatments
• laser

Question 17

describe hidradenitis suppurativa

Answer 17

• a skin condition that causes recurrent boils and abscesses, particularly in the axillae, groin and perineum, submammary.

Question 18

what is the treatment for hidradenitis suppurativa?

Answer 18

follicular occlusion tetrad:
- lifestyle modification
- topical wash
- tetracycline
- topical
- dapsone
- adalimumab
- ciclosporin