Y5 - Acne vulgaris

Question 1

Answer 1

acne vulgaris

Question 2

def

Answer 2

a skin disease affecting the pilosebaceous unit

-characterised by comedones, papules, pustules, cysts

Question 3

epi

Answer 3

most common in adolescents

• boys>girls in adolescence
• girls>boys in adulthood

Question 4

what do lesions in acne vulgaris consist of

Answer 4

non-inflammatory comedones (whiteheads and blackheads), inflammatory papules, pustules, cysts

Question 5

four main pathogenetic factors:

1. sebaceous gland hyperplasia and excess sebum production
2. abnormal follicular differentiation
3. cutibacterium acnes colonisation
4. inflammation and immune response

Answer 5

aetiology

Question 6

what stimulates sebaceous glands to enlarge and produce more sebum

Answer 6

androgens (puberty)

Question 7

what happens to keratinocytes in acne vulgaris

Answer 7

karatinocytes are retained and accumulate

Question 8

what sort of bacteria is cutibacterium

Answer 8

gram positive non-motile rods

Question 9

what does cutibacterium stimulate

Answer 9

the production of pro-inflammatory mediators and lipases

Question 10

what happens in inflammation and immune response in acne vulgaris

Answer 10

inflammatory cells and mediators efflux into the disrupted follicle causing development of papules, pustules, and cysts

Question 11

what external factors may contribute to acne

Answer 11

1. mechanical trauma
2. cosmetics
3. corticosteroids
4. hyperandrogenism

Question 12

pathophysiology

Answer 12

1. formation of the microcomedo
   - follicular keratinocytes with increased cohesiveness do not shed normally and lead to accumulation
   - androgens stimulate enlargement of sebaceous glands and increased sebum production
   - pressure build-up occurs and whorled lamellar concretions develop
2. proliferation of c acnes
   - capable of metabolising triglycerides and releasing FFAs
   - activates complement and pro-inflammatory mediators
3. microcomedo ruptures due to increased pressure and recruitment of inflammatory mediators

Question 13

signs and symptoms

Answer 13

RFs
skin tenderness

Question 14

RFs for acne vulgaris

Answer 14

adolescence

genetic predisposition

greasy skin/ increased sebum production

Question 15

what medications can increase risk of acne vulgaris

Answer 15

androgens, corticosteroids, antiepileptics

Question 16

investigations

Answer 16

clinical diagnosis

Question 17

management for mild acne vulgaris

Answer 17

topical retinoid (tretinoid) or salicyclic acid

Question 18

management for mild acne vulgaris with inflammation

Answer 18

topical retinoid (tretinoin) and topical antibiotic (clindamycin/erythromycin)

Question 19

management for moderate acne

Answer 19

topical retinoid (tretinoin)

Question 20

management for moderate acne vulgaris with inflammation

Answer 20

topical retinoid and oral antibiotic (tetracycline or minocycline)

Question 21

management for severe or resistant acne vulgaris

Answer 21

oral retinoid (isotretinoin)

Question 22

management for hormone related acne vulgaris

Answer 22

COCP

Question 23

management for pregnancy related acne vulgaris

Answer 23

clindamycin topical or erythromycin topical

Question 24

what is comedogenic

Answer 24

cause blackheads by blocking skin pores

Question 25

complications

Answer 25

scarring dyspigmentation

Question 26

what is used for scarring following acne vulgaris

Answer 26

fractionated CO2 and resurfacing with fractional laser therapy

Question 27

prognosis

Answer 27

typically improves after adolescence

Question 28

what are clogged skin follicles known as

Answer 28

comedones