WK 11- Acne and Rosacae Flashcards
What is the presentation of rosacae
Symmetrical flushing followed by erythema and telangiectasia and potential discrete dome shaped papules/pustules
- occurs over nose, chin, centre of forehead and cheeks
- NO COMEDONES
Who is most commonly affected by rosacae
Most common in 30-40’s
-mainly occurs in fair skin people
What is the tx of corticosteroid induced rosacae
Oral tetracyclines ie doxycycline
What are the complications of rosacae
Corticosteroid induced rosacea, blepheritis, conjunctivitis, rhinophyoma (hyperplasia of sebaceous glands and CT), lypmhedema (on forehead and under eyes)
What are the aggravating factors of rosacae
Alcohol, extreme temps, spicy food, coffee/tea, sun exposure, hot showers, corticosteroids
What is the tx of rosacae
Mild= clindamycin, erythromycin--> topical antibiotics Moderate/severe= topical tx may not work so can use oral antibiotics (erythromycin and doxycycline)
What is corticosteroid induced rosacae
Corticosteroid induced rosacea–> causes peri-oral dermatitis (patchy erythema with nodules/papules around the mouth and at the sides of the nose and chin
-occurs due to corticosteroid application to the face–> will be partially suppressed by the corticosteroid but flare up when you stop applying it
What are the potential differentials for rosacae
- Sun damage
- Acne= though normally have comedones
- Emotional flushing
- Seborrhoeic dermatitis-> though normally no telangiectasia
- Lupus-> though normally no papules
What drug should not be given with Isotretinion?
Tetracyclines. The combination can result in benign intracranial hypertension.
How do keratolytics work? Give an example.
Keratolytics are substances that reduce the overproduction of keratin that blocks the pilosebaceous unit, causing comedones.
-A typical prescription would be: Salicylic acid 2-5% in ethanol 70% with water to 100%
What are the common side effects of Isotretinoin?
- Skin, mucosal and eye dryness
- Photosensitivity
- Epistaxis
- Myalgia, arthralgia and sport intolerance
- Headaches
- Increase in serum lipids
- Lethargy
Does Acne have a genetic component?
It is familial and is genetically determined. Acne is more severe in males, but more persistent in females in whom acne can continue until menopause.
How do you classify acne into severe, moderate and mild
-Mild acne= superficial pustules, papules and minor comedones on the face and upper trunk.
=Moderate acne= inflammatory and incorporates deeper lesions, large pustules and comedones.
-Severe (or nodulocystic) acne= deep nodules, pustules, cysts and large comedones and is usually associated with significant scarring. This scarring can be either hypertrophic (raised scars, cheloids) or atrophic (depressed scars).
What are the 4 major components involved in acne formation
- Seborrhoea= increased production of sebum (often due to high levels of androgens) which is normally cleared from the pilosebacceous unit, but instead occludes the duct
- Comedone= blockage of duct due to keratinocytes and sebum-> can be open or closed
- Colonisation= colonisation of gram neg priopionibacterium acnes
- Inflammation= due to T cells and neutrophils
What is a comedone
Comedones are the skin-coloured, small bumps (papules) frequently found on the forehead and chin of those with acne. A single lesion is a comedo. Open comedones are blackheads; black because of surface pigment (melanin), rather than dirt. Closed comedones are whiteheads; the follicle is completely blocked
-they are caused by the blockage of a hair follicle/sebacceous gland due to keratinocytes and sebum
