Acne Flashcards
(31 cards)
What factors can cause acne?
Stress
Diet
Exercise and weight
Medications
Hormones
Sweat
Bacteria
Summarise the four key processes involved in acne?
Inc sebum production = controlled by androgens
Follicular hyperkeratinisation = clogs or blocks pore –> microcomedo
Microbial colonisation = skin bact overgrowth Proprionibacteria acnes in pilosebaceous duct
Inflammatory process
How does P. acnes influence inflammation?
P acnes hydrolysis sebum into free fatty acids –> release of inflammatory mediators
Seen in papule, pustule, nodule
What are the different types of comedo?
Open = blockage close to skin surface –> oxidation –> blackhead
Closed = blockage further from skin surface –> whitehead
What is a papule?
small, red, inflamed bump
What is a pustule?
small, red, inflamed bump (same as papule)
contains pus (pimple)
What is a nodule or cyst?
deep pustular lesions which if become infected will be painful
What is considered mild acne?
Comedones (non inflammatory lesions), some papules and pustules (<10)
What is considered moderate acne?
Moderate no. papules and pustules (10-40), comedones present are more widespread (10-40)
May effect trunk, mild scarring
What is moderate/severe acne?
Numerous papuples and pustules present (40-100), occasional deeper nodular inflamed lesion (up to 5)
Widespread infection - face, chest, back
What is severe acne?
nodular abscesses and cysts
What are some differential diagnoses for acne?
Rosacea = no comedones, cysts, scars, inflammatory papules, affects face, erythema, usually after 30 yrs/age
seborrheic dermatitis = greasy scales with yellow-red papules
Drug-induced acne = seen with androgens, corticosteroids, oral contraceptives, lithium, phenytoin
Bacterial folliculitis = abrupt eruption, spread with scratching or shaving, distribution variable, onset after puberty
Perioral/periorbital dermatitis = papules/pustules confined to chin, nasolabial/ocular regions, clear around border, females between 20-45
Summarise some topical drugs for acne (S2)?
What type of acne are they used in?
Benzoyl peroxide = comedonal & mild acne
Azelaic acid =mild acne
Salicylic acid (beta hydroxy acid( & tea tree oil = mild acne
Discuss the use of benzoyl peroxide in acne treatment?
Antibacterial, mildly comedolytic
Can be used with oral agents EXCEPT retinoids
Begin at lower strength, can bleach clothes/towels/etc.
Discuss the use of azeleic acid in acne treatment?
less irritating than benzoyl peroxide
May cause hypopigmentation or photosensitisation
Discuss the use of salicylic acid/tea tree oil in acne treatment?
Antibacterial
Mildly comedolytic
Anti-inflammatory
What are the topical prescription medications for acne?
*all for moderate/severe acne
Clindamycin = add to topical retinoid
Erythromycin = add to topical retinoid
Tretinoin = treat for 6 wks, combine w/ other topical/oral treatments –> teratogen
Adapalene = treat for 6 wks, combine w/ other topical/oral treatments –> teratogen
List the systemic S4 drugs used in acne treatment
doxycycline
minocycline
erythromycin
COC = cyproterone, drospirenone, desogestrel, or gestodene
spironolactone
Elaborate on the hormonal drugs used for acne
(what line of treatment? what acne severity?)
- Moderate-severe acne, Improvement is slow = 6 months
COC = alternative to abx
Cyproterone = 1st line –> most likely to improve acne
Drospirenone = if cypro not tolerated
Desogestrel or gestodene = less androgenic, if cypro not tolerated
Discuss the use of spironolactone in acne treatment
For women, diuretic/anti-androgenic
Used if COC C/I
Taken once daily for 6 months
Can be combined w/ COC = inf efficacy
C/I in preg
When should acne treatment with minocycline be changed?
if no response after 3 months
Has more ADRs
When is erythromycin used to treat acne? How long until response?
3-6 months, can be longer until response
Last line when in comes to abx
Summarise the use of doxycycline in acne treatment
Works via anti-inflammatory action
Once daily for 6 months
How long does it take to see improvement with abx when treating acne?
4-8 weeks to see improvement
Change treatment if no response after 3 months
Good response = 3-6 months or longer
