Acne

Question 1

History in Acne

Answer 1

age of onset and duration menstruation in women and anabolic steroids (make worse) prior and current treatments hirsutism, obesity, menstrual irregularities - PCOS other meds - topical and systemic steroids can cause acne effects on social interactions/work/life FH what other parts of body affected periods of flushing or very red face? acne vulgaris

Question 2

presentation

Answer 2

papules pastules open and closed comedones cysts commonly affects face, chest, upper back

Question 3

severity of acne

Answer 3

Mild - open and closed comedones Moderate: comedones, papules and pustules Severe: nodules and cysts, papules, pustules, comedones, scars

Question 4

Acne vulgaris

Answer 4

inflammatory condition - lesions develop from sebaceous glands around hair follicles on skin of face, chest, back and anogenital regions typically starts as teenager but often self limiting psychological impacts are main concern

Question 5

Rosacea

Answer 5

inflammatory papules, pustules and erythema no comedones

Question 6

Isotretinoin recommended when:

Answer 6

patient has acne causing inflammatory papules and comedones and fails to respond to topical retinoid and oral AB for 3 months moderate acne -unresponsive to conventional therapy or relapsing severe acne acne scaring psychological effects resulting from acne and scarring unusual form of acne

Question 7

Acne advice:

Answer 7

• dont wash more than twice a day
• use a mild cleanser and lukewarm water
• dont use vigorous scrubbing
• dont attempt to clean blackheads
• ideally avoid excessive makeup
• dont pick spots

Question 8

Managment of acne

Answer 8

Mild:

• single topical treatment - benzoyl peroxide first line (then topical retinoids, then azelaic acid)
• consider COP in women

Moderate

• if acne limited and unlikely to scar same as above
• topical AB combined with topical benzoyl peroxide or a topical retinoid
• consider oral AB if wide spread and risk of scarring

Severe

• refer for specialist treatment
• oral AB in combination with topical steroid given whilst waiting for appointment
• COPs
• dianette only considered when topical treatment or systemic AB failed