Acne Flashcards
3 targets in acne treatment
Microcomedone phase (reduce hypercornification and follicular occlusion)
Bacteria + inflammation
Hormonal (women only)
What treatments can be given to target the microcomedone phase?
Topical retinoids (eg. Isotretinoin)
Combined with oral antibiotics (eg. Erythromycin)
Topical salicylic acid wash
Oral retinoids
Side effects of oral retinoids
Teratogenic
Depression risk
Can raise lipids
Can derange LFTs
Dry skin, lips, mucosa etc
Skin fragility
What medications can target bacteria and inflammation?
Antibiotics - topical or systemic
Antibiotics with benzoyl peroxide (kills anaerobes by oxygen release in follicular environment)
Describe mild acne and it’s treatment
Mainly comedonal/non-inflammatory:
Topical retinoids: adapalene, tretinoin, isotretinoin
Azalaic acid
Inflammatory:
Topical benzoyl peroxide, antibiotics, azaleic acid, retinoic acid
Moderate acne treatments
Oral treatments +/- topical
Antibiotics
Hormones
How long should it take to see improvements with oral antibiotics?
Within 6 weeks
If not, consider alternative antibiotic
Severe acne treatment
Oral isotretinoin (Roaccutane)
- reduces sebum, comedogenesis, and has anti-inflammatory actions
- needs pregnancy prevention plan
Causes of failure to respond to treatment for acne
Compliance
P.Acnes resistance
Gram negative follicular is
Incorrect diagnosis
When should you refer a patient with acne to a dermatologist (NICE guidelines)?
Acne fulminans (severe and causes patient to become systemically unwell) or gram negative folliculitis
Severe acne requiring isotretinoin
Dysmorphophobia
Risk of severe scarring (eg. Keloid scars)
Moderate acne unresponsive to 2 courses if antibiotics, 3 months each
Endocrine cause for acne (eg. PCOS)
Uncertain diagnosis
Rosacea symptoms
Older patient
No comedones
No nodules
No cysts
No scarring
May see rhinophyma
Associated flushing
Perioral eczema symptoms
Pruritis
Dry skin
No comedones
Spares vermillion border
Can be side effect of too strong topical steroids on face
What can milia be confused with and where is it seen?
Can be confused with closed comedones
Infraorbital location
What causes gram negative folliculitis?
Complication of long term antibiotic therapy for acne
Hair follicles infected with gram negative organisms
Describe acne conglobata
Severe nodulocystic acne
Interconnected abscesses with sinuses in between
Scars badly
