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Dermatology Crash Course > Acne > Flashcards

Acne Flashcards

1
Q

What main 2 types of Acne are there?

A

Acne Vulgaris

Acne Rosacea

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2
Q

Any other types of Acne to be aware of?

A

Acne Fulminans

Infantile Acne

Also be aware of Hidradenitis Suppuritiva

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3
Q

What is Acne Vulgaris (AV)?

A

Disease of the pilo-sebaceous unit (PSU) – face, chest, back

Causes “sticky” keratinocytes + increased sebum viscosity

Blocked follicles = COMEDONES

Change in commensal bacterial behaviour (Propionobacterium acnes) = INFLAMMATION

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4
Q

How does AV appear?

A
  • Comedones – look like blackheads
  • Papulopustules – white filled
  • Nodular Cysts – large pink bumps
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5
Q

What portion of the body is affected by AV?

A

Face, chest, back

PSU

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6
Q

How does sebum excretion rate change in AV?

A

There is increased sebum excretion rate especially at puberty

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7
Q

What are the two types of comedones?

A

Open comedones (blackheads)

Closed comedones (whiteheads)

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8
Q

What are blackheads?

A

Dilated keratin filled follicles which appear as black papules due to the keratin debris

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9
Q

What are whiteheads?

A

Accumulation of sebum and keratin deeper in the pilosebaceous ducts

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10
Q

How does inflammation occur in acne?

A

Pilosebaceous duct becomes blocked, following this there is bacterial colonisation of the duct which causes the release of inflammatory mediators

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11
Q

What can arise from comedones?

A

Inflammatory papules, nodules and cysts

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12
Q

Who is most commonly affected by AV?

A

15 - 18 years (incidence as high as 90%)

M=F but Males often more severe

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13
Q

Is there a genetic component to acne?

A

May be a FH of acne

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14
Q

What colonises the pilosebaceous ducts?

A

Propionibacterium

Causes inflammation, hypercornification and occlusion of pilosebaceous ducts

Cornification - when squamous epithelium develops into tough protective layers

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15
Q

What is the TOPICAL treatment for AV?

A

Benzoyl peroxide (BPO)

Anti-biotics eg clindamycin, erythromycin

Retinoids

Others eg Azaleic Acid or Nicotinamide Gel

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16
Q

What is the NON-TOPICAL/SYSTEMIC treatment for AV?

A

Anti-biotics : tetracyclines, erythromycin, trimethoprim

Anti-androgens : oral contraceptives/Dianette (androgens and progestogens increase sebum production)

Isotretinoin/Roaccutane

Light based treatments eg UVB

17
Q

What is Isotretinoin?

A

A retinoid (Vitamin A analogue)

Has anti inflamm and anti cancer effects

18
Q

Who prescribes Isotretinoin?

A

Skin specialists - doctors and derms only

Very strong so not OTC

19
Q

Is Isotretinoin effective?

A

YES

Most effective treatment for severe/stubborn acne - reserved for worst cases which have failed to resolve with other treatments

20
Q

What is the prescription regimen for Isotretinoin?

A

Single daily dose

Clearance and 60-70% cure rate

1 mg / kg / day for 16 weeks - matched to weight of patient

21
Q

What are the drawbacks for Isotretinoin?

A

MANY SIDE EFFECTS

Highly teratogenic (pregnancy prevention programmea)

Dry skin and lips (muco - cutaneous junctions)

Hair loss, mood swings, depression, suicide, abnormal LFT’s, hypertriglycerideaemia

Expensive

22
Q

Do you do any form of monitoring on Isotretinoin?

A

YES

Regular bloods taken to look at FBC, LFTs and KFTs

23
Q

What is Acne Fulminans?

A
  • Sudden onset acne eruption, feverish and unwell, joint pains
  • Start on low dose Isotretinoin but cover with Prednisalone
24
Q

What is Acne Rosacea (AR)?

A

Chronic inflammation due to

PSU

Cutaneous Vasculature

25
Q

What does AR look like typically?

A

Ace of spades redness across face

Flushing

Erythema

Papules

Pustules

Telangiectasia

It is unusal to see acne rosacea on non-facial sites

NO COMEDONES

26
Q

Who does AR often affect?

A

Ages 30-50 years

Females more than males

Fair skinned individuals - “sensitive skin”

27
Q

What exacerbates AR?

A

Heat

Sunlight

Alcohol

Emotions

Hot drinks

28
Q

What are the subtypes of AR?

A

Erythemato-telangiectatic

Papulo-pustular

Phymatous (M>>>F) - rhinophyma is the red overgrowth of the nose

Ocular

Remember AR does NOT have Comadones

29
Q

What is the TOPICAL treatment of AR?

A

Anti-biotics – Metronidazole

Azeleic acid

Ivermectin

Brimonidine

30
Q

What are the SYSTEMIC treatments for AR?

A

Oral Anti-biotics – tetracyclines eg erythromycin or metronidazole

Isotretinoi

Light based treatments

Laser

31
Q

Treatment of Acne Scarring

A

Treat inflammation

Should wait 1 year after Isotretinoin…

  • Intralesional steroid
  • Excision of ice pick scars
  • Laser
  • Dermabraison
  • Chemical peels
32
Q

Infantile Acne

A
  • 3 months- 1 year
  • Comedome, papules, pustules and cysts
  • Same treatment as in adults
  • Need to treat to prevent scarring
  • If greater than 1 year look for signs of virilization

Dermatology Crash Course (11 decks)

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