T8: Acne and rosacea Flashcards
Acne vulgaris
Acne vulgaris
- common
- normal, NOT disease
- tx: improve QOL
- occurs during adolescence
think stress/mestruation - course
settles after 2-3 yrs
more prolonged = uncommon but can happen
Acne vulgaris
Infantile acne
- uncommon
- boys > girls
- 3-12m
- stops after 4-5 yrs
- flare in adolesence
- maternal hormones cause
-clears spontaneously
Acne vulgaris
Late onset
- > 20+ yrs
- women
- premenstrual flares
- PCOS
Acne vulgaris
Acne fulminans
- uncommon
- young men
- ulcerated acne
- fever, malaise, arthralgia
Acne lesions
Comedones
closed
- whiteheads
- small papules
- dilated blocked follicles +/- inflam
open
- blackheads
- small papules with black dot
- dilated blocked follicles +/- inflam
(black crust = oxidized keratin)
Acne lesions
Papules + Pustules
- develop from comedones
- red papules -> yellow pustules
- recurrent
- painful/itchy
Acne lesions
Nodules + Cysts
- develop from above de novo
- red nodules + cysts
- severe inflam
- last longer
- severe scarring + multilation
Acne lesions
Scars
atrophic
- ice pick
- rolled scars
- boxcar
keloidal/hypertrophic
- severe cystic acne
- chest, jawline, upper back, shoulders
Acne
Pathogenesis
- genetic susceptibility
- puberty causes oil production inflam reactions, bacterial change
- during puberty, sebaceous glands activate in hair follicle + testosterone stimulates glands to produce more oil
- infundibular hyperkeratosis occurs = causes plug in follicle
- plug + more oil causes follicle to block, follicle fills with oil
- microcomedone formed
microcomedone
- filled with oil, keratin, commensal flora
- bacteria grows and starts inflam reaction
- see inflam papule on skin -> pustule -> nodule/cyst
Acne
Grading
- open + closed comedones visible (mild)
- inflam papules (mild)
- pustules (mod)
- nodules/cysts (severe)
Acne
Tx
- mild = topical
- mod = topical + systemic
- severe = isotretinoin
Acne topical tx
Benzoyl-peroxide
- anti-bacterial
- local side effects
- combo: topical retinoids/systemic antibiotics
Acne topical tx
Retinoid
- targets + reduces infundibular hyperkeratosis
- anti-inflam
- don’t use during pregnancy
- don’t use during isotretinoin tx
- apply at night, more on outside thann inside
Acne topical tx
Antibiotics
- avoid due to resistance that can develop
Acne systemic tx
Systemic antibiotics
- targets proliferation of propionibacterium acne
- anti-inflam
- not taken on empty stomach
- contra-indicated under 12 yrs
- stopped after 3m
females
- combined contraceptives = anti-androgens
- target: blocks androgen stimulation of sebaceous gland
- combine with roaccutane
Acne systemic tx
Isotretinoin
- target: acts on pathogenisis aspects
- lowest dose = half of weight 0.5-1mg/kg - 120mg/kg
- side effects: dry skin + mucosae, mild alopecia, aches, pains, teratogenic
- bloods: pregnancy, LFTs, lipid profile, FBC, glucose
1 month after tx, then every 3m
roaccutane indications
- grade 4 acne
- scarring
- therapy failed (over 3m)
- dysmorphophobia
- gram neg folliculitis
nb info
- side effects
- warn against pregnancy
- no blood donation
- sun protection
- no vit a
Acne tx
Surgery
- avoid in acne
- remove comedones
- remove cysts
- dermabrasion
- laser
Acne
Secondary acne
- sign of systemic disease
- cause: increase anrogens
stimulate sebaceous glands - endogenic = PCOS
- if not mprove on isotretinoin then think endogenic cause
Acne
Hidradenitis suppurative
- recurrent boils/papules in skin folds (under arms, axillae)
- inflam
- poor QOL
- severe scarring
- tx: topical antibiotics + doxycycline for 3m
Rosacea
General
- sensitive, burning skin with flushing
- middle aged women
(also men any age) - cheecks, forehead, chin, glabella
- erythematous
- no comedones
- ask about steroid use (can be trigger)
Rosacea
Tx
- exclude topical steroid use
- sunscreen
- avoid triggers
- metronidazole gel = anti-inflam
- topical ivermectin
- doxycycline = anti-inflam
