Acne Vulgaris & Cold Sores

Question 1

What is acne?

Answer 1

inflammatory disease of the pilosebaceous follicles causing comedones, papules and pustules on the face, chest, upper back

Question 2

What occurs in response to increased testosterone in males?

Answer 2

sebaeceous glands become oversensitive to testosterone, they produce excess oil and the skin becomes greasy

Question 3

What causes acne?

Answer 3

Excess keratin and sebum causes the development of comedones as either blackheads (an open comedone) or whiteheads (a closed comedone beneath which inflammation occurs)

Question 4

What are symptoms of acne?

Answer 4

papules on the surface of the skin in mild cases and cysts in the deeper layers of the skin in more severe cases

Question 5

Which areas are most commonly affected?

Answer 5

face, neck, centre of the chest, upper back and shoulders

Question 6

When to refer a pt with acne?

Answer 6

1. Acne Rosacea - condition affecting mostly middle-aged or other pts and presents as reddening of cheeks and forehead alongside papules and pustules but is confined to the face only
2. Certain drugs may cause acne as an adverse effect e.g. lithium, phenytoin, progestogens, levonorgestrel and norethisterone
3. Symptoms unresponsive to 8 weeks tx

Question 7

What tx options are available for pts suffering from acne?

Answer 7

1. Benzoyl peroxide - ketatolytic effects (being mildly comedolytic) with antibacterial properties, and is generally used as a first-line tx.
2. Nicotinamide - alternative with anti-inflammatory properties but evidence of its usefulness in acne is limited

Question 8

What are side effects of the tx for acne?

Answer 8

• Stinging
• Drying
• Soreness
• Peeling of skin can occur especially during initial stages of tx
• Reducing frequency of application or strength of product can be tried

Question 9

How long should pts used benzoyl peroxide before seeing their GP?

Answer 9

should use for 6 weeks if no improvement

Question 10

If there is improvement with benzoyl peroxide, how long should you treat?

Answer 10

at least 4-6 months

Question 11

What are OTC preps can be given to pts with acne?

Answer 11

Acenecide
Freederm
Quinoderm

Question 12

What are some counselling points that can be given to a pt with acne?

Answer 12

tx takes a while to have an effect and regular use is required
Avoid greasy, oil-based cosmetics
Use water-based ones where possible
Sunlight is reported to reduce acne
No evidence that poor hygiene or certain food can cause acne

Question 13

What are cold sores?

Answer 13

infection caused by the herpes simplex virus around the mouth

Question 14

What are prodromal symptoms of cold sores?

Answer 14

Tingling, irritation in the skin 6-24 hours before appearance of any symptoms

Question 15

What occurs after the prodromal symptoms of cold sores?

Answer 15

minute blisters on top of red, inflamed skin develop and grow into blisters filled with white matter that break down to reveal a raw area underneath and crusting within 4 days

Most lesions heal within 1 week

Question 16

What are triggering factors that cause cold sores?

Answer 16

stress
ill health
sunlight 
viral infection 
menstruation

Question 17

When to refer a pt with a cold sore?

Answer 17

• painless lesions (may indicate cancerous)
• babies and young children
• sore lasting longer than 2 weeks
• eye affected
• immunocompromised pt

Question 18

What is first line for cold sores?

Answer 18

Aciclovir - most effective if started during prodromal phase - applied 5 times daily
Zovirax

Question 19

What other tx options are there for cold sores?

Answer 19

Hydrocolloid patch - used for its wound healing properties - compeed
Other creams - help to sooth and moisten which reduces risk of secondary bacterial infection

Question 20

What age can peniciclovir be used? (Fenistil)

Answer 20

pts >12 years

Question 21

What are counselling points you would offer pts that have cold sores?

Answer 21

• Wash hands thoroughly between applications of tx and avoid contamination to eye makeup as infection can be transferred to the eye
• virus can be transferred to avoid contact directly to the infected area
• sun-induced cold sores - put on spf