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Dermatology Diploma > Red & Spotty Face - ACNE > Flashcards

Red & Spotty Face - ACNE Flashcards

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1
Q

What is the hallmark of Acne and what is it stages of progression?

A

Comedone

Microcomedone–>closed comedone (whitehead) –> open comedone (blackhead) –> Inflammation due to neutrophil attraction and p. acnes.

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2
Q

What causes a microcomedone?

A

Hypercornification of the pilosebaceous duct along with a microcomedone.

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3
Q

What are the 4 main factors involved in the development of acne?

A
  1. Seborrhoea - increased sebum production due to androgens.
  2. Comedone formation
  3. Colonization of pilosebaceous unit w Proprionibactrium acnes
  4. Inflammation
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4
Q

How long does it take for a pustule to appear from a microcomedone?

A

10-12 weeks.

(Therefore there is no point in treating acne for less than this!)

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5
Q

What medication can cause acne?

A
  • Oral steroids
  • Antiepileptics
  • EGFR inhibitors
  • Occlusive agents
  • Dioxin exposure
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6
Q

What are the 5 specific features of Acne Lesions to look for?

A

Non-Inflammatory Lesions

  • (1) Comedones

Inflammatory Lesions

  • Superficial Inflammatory lesions
    • (2) Papules
    • (3) Pustules
  • Deep Inflammatory lesions
    • (4) Nodules/Cysts

(5) dScars

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7
Q

What are the 4 types of acne scars?

A
  1. Atrophic
  2. Boxcar
  3. Ice Pick
  4. Keloidal
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8
Q

In Acne Vulgaris, do you get telangelectasia?

A

No - this should alert you to Acne Rosacea

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9
Q

What are the grades of Acne?

A
  • Mild Acne
    • <20 comedones
    • <15 inflammatory lesions
    • Total lesion count <30.
  • Moderate Acne
    • 20-100 comedones
    • 15-50 inflammatory lesions
    • Total lesion count 30-125
  • Severe Acne
    • >5 pseudocysts
    • >100 comedones
    • >50 inflammatory lesions
    • Total lesions >125
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10
Q

Inflammatory Acne is better treated with (1)

Non-Inflammatory Acne (Comedones) are better treated with (2)

A

1 = Antibiotics

2= Retinoids.

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11
Q

How do you treat Mild Acne Vulgaris?

A
  1. Benzoyl Peroxide - inflammatory lesions
  2. Topical Retinoid - noninflammatory lesions
  3. Topical Antibiotics - against P. Acnes
    1. Topical Erythromycin, clindamycin.
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12
Q

What type of scarring is this?

A

Icepick scarring

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13
Q

What type of scarring is this?

A

Atrophic scarring

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14
Q

What type scarring is this?

A

Boxcar scarring

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15
Q

Tell me about Benzoyl Peroxide:

A
  1. As effective as oral antibiotic for mild -moderate acne.
  2. Better than topical retinoids for inflammed lesions.
  3. Skin irritation to start but this will settle - start EOD if this is a problem.
  4. Low strengths - OTC (2.5-5%) - less irritating and just as effective.
  5. Warn patients about their bleaching effect.
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16
Q

How do topical retinoids work?

A
  1. Act on abnormal keritanisation - comedones and prevent new formation.
  2. Anti-inflammatory (against inflammed lesions)
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17
Q

What are the 3 main types of topical retinoids used?

A
  1. Tretinoin
  2. Adapalene
  3. Tazarotene
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18
Q

Why are topical retinoids good in dark skinned people?

A

They reduce Post Inflammatory Hyperpigmentation (PIH)

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19
Q

What are some side effects/contraindications?

A
  • Dryness and peeling (less pronounced in adapelene)
  • Contraindication - pregnancy
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20
Q

What type of lesions are topical antibiotics good against?

A

Inflammed lesions

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21
Q

Combination treatments:

What does Duac (a.k.a. Benzaclin) contain?

A

Benzoyl Peroxide and Clindamycin

22
Q

What is contained in EPIDUO?

A

Adapalene (0.1%) and benzoyle peroxide (2.5%)

23
Q

What is the difference between EPIDUO and EPIDUO Forte?

A

EPIDUO Foprte is stronger.

It contains 0.3% adapalene.

(Rather than 0.1%)

But they both contain 2.5% BPO.

24
Q

What is Zineryt and what is it good for?

A

A combination of a topical antibiotic and zinc.

It is good for reducing inflamed spots.

25
Q

How do you treat moderate Acne Vulgaris?

A

Mainstay is oral antibiotics +/- dianette/yasmin + Topical Treatment.

26
Q

At how many months is about 60% of the acne cleared up?

A

3 months

27
Q

At how many months is 80-90% of the acne cleared up?

A

6 months.

Which is why the course has to be continued for atleast 6 months.

28
Q

If there is no improvement with the oral antibiotic at 3 months, what should you do?

A

Change to a different oral antibiotic.

29
Q

What topical treatment should you consider in moderate acne?

A

Topical retinoid or BPO.

30
Q

What often happens upon stopping antibiotics?

A

The patient’s ACNE relapses.

If this happens a more prolonged course might be needed.

31
Q

What oral antibiotics are used in moderate ACNE?

A
  1. Tetraceyclines - first line.
    • Doxycycline 100mg OD.
    • Lymecycline 408mg OD
  2. Erythromycin 500mg - alternative - useful if female/pregnant.
  3. Trimethoprim - 200mg BD - useful especially if gram negative colonisation.

(NOTE: Dermatologists use trimethoprim a lot - Course Director gives trimethoprim when she wants to give isotretinoin but patients refuse)

32
Q

10% of patients who take Trimethoprim will develop…… ?

A

A Rash.

33
Q

What should you warn patients about avoiding whilst taking tetracyclines and why?

A

Pregnancy (Risk of staining of teeth)

34
Q

Give 2 reasons as to why oestrogen is useful in controlling acne?

A
  1. It suppresses sebaceous gland activity.
  2. Decreases the formation of ovarian and adrenal androgens.
35
Q

What range of the light spectrum is good at killing P ACNES?

However, what effect does it have on skin and eyes?

A

Blue light.

It is part of HEV (High Energy Visible Light) spectrum which is also harmful light like UV.

It can cause AMD and delay barrier function repair.

But it does not induce premature photoaging.

36
Q

Severe ACNE - use Roaccutane.

But what is the recommended dose for Roaccutane?

A

1mg/kg/day for 1`6 weeks

37
Q

1mg/kg/day is hard to tolerate.

In reality, what doses are usually used?

A

20mg one or twice weekly at a low dose

Titrated up according to response.

38
Q

What are the 5 issues to consider when prescribing Isotretinoin?

5 B’s

A
  1. Teratogenicity (Birth Defects)
  2. Neuropsychiatric effects (Blues)
  3. Mucocutaneous side-effects (Bleeds-nose/gums)
  4. Blood Monitoring
  5. GI Disease (Bowel Problems)
39
Q

For how long before taking Isotretinoin and for how long after, should pregnancy be avoided?

A

1 month before taking Isotretinoin and 1 month after.

40
Q

What should female patients have that are taking Isotretinoin?

A

Monthly pregnancy tests.

41
Q

What 2 things should all female patients do before taking Isotretinoin?

A
  1. Sign a Pregnancy Prevention Program Consent form.
  2. Start Contraception 1 month before starting Roaccutane.
42
Q

What should male patients avoid who are taking Isotretinoin? (aprt from sun exposure)

A

Subtle spermatogenic effects.

Therefore avoid conception whilst taking.

43
Q

What does blood monitoring for Oral Isotretinoin consist of?

A

Pre-treatment LFTs and Lipids.

Repeat at 4-6 weeks into treatment.

44
Q

What GI disease is now associated with Roaccutane (even though this is still controversial)

A

IBD

45
Q

What drug should be avoided with roaccutane due to the risk of benign intracranial hypertension?

A

Tetracyclines

46
Q

What is the difference between icepick, rolling or box car scars

AND

Hypertrophic or keloid scars?

A

Icepick, rolling or box car scars are due to decreases dermal collagen.

Hypertrophic/Keloid scars are due to icnreased collaged.

47
Q

What can be used to treat hypertrophic scars?

A

Cryotherapy or triamcinalone.

48
Q

What can be used for scars due to loss of collagen?

A

1/ Chemical peels

2/ Collagen injections.

3/ Dermabrasion.

4/ Excision/Subcision.

5/ Retin A

6/ Laser resurfacing - but unpredictable results.

49
Q
A
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51
Q
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Dermatology Diploma (39 decks)

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