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Yr 2 Dermatology > Acne > Flashcards

Flashcards in Acne Deck (25)
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1
Q

What are the type sof Acne?

A

Acne Vulgaris

Acne Rosacea

2
Q

Who is most effected by Vulgaris and rosacea?

A

Acne Vulgaris peaks at 15-18yrs although many women have a delayed onset. M=F but M is more severe

Acne Rosacea peaks at 30-40yrs. F>M but M is more severe. Almost always fair skinned caucasians

3
Q

Explain the pathogenesis of Acne Vulgaris?

A

A disease of the Pilo-sebaceous unit:

1) Keratinocytes at the follicle top become sticky and aggregate instead of shedding forming a comedone (Plug)
2) Sebum becomes more viscous and so harder to clear

Sometimes commensal bacteria cause inflammation

4
Q

What bacteria is most responsible for inflammation in acne vulgaris?

A

Propionobacterium acnes

5
Q

Explain the formation of whiteheads, blackheads and papules/pustules/cysts/scars etc

A

White heads - Closed Comedones, aka the skin has closed over the comedone

Black head - Open comedone, aka the plug is so big the skin cant close and its visible. (Black because of melanin not dirt)

Papules/pustules/cysts/nodules - due to bacterial inflammation

Scars form after inflammation, especially if the spots are picked or popped

6
Q

What are the main types of Acne scars?

A

Atrophic scar- Common, indented, due to loss of collagen during healing

Hypertrophic scar - Uncommon, protruding, due to excess collagen from abnormal healing

Keloid scar - Rare, similar to hypertrophic but extend beyond the margins of the injury

7
Q

Qiuck list of the treatments for Acne Vulgaris?

A

Topical:
Retinoids (Vit A derivatives)
Benzoyl Peroxide (BPO)
Anti-biotics

Non-topical:

  • Anti-biotics
  • Anti-androgens (OCP Dianette)
  • Isotretinoin
  • Light based therapies (not on NHS)
8
Q

How do retinoids help acne vulgaris?

A

Vit A Derivatives applied topically can unstick comodones

Often combined with BPO

9
Q

How does Benzoyl Peroxide help acne vulgaris?

A

Has an anti-inflammatory effect

Hence often combined with Retinoids anti-comodone effect

10
Q

What anti-biotics are used for Acne Vulgaris?

A

Topically

  • Erythromycin
  • Tetracyclines
  • Clindamycin

Non-topical:

  • Erythromycin
  • Tetracyclines
11
Q

How do you prevent resistance to acne anti-biotics?

A

Use somewhat sparingly and combine with BPO

12
Q

What is dianette?

A

A Combined Oestrogen & Progesterone pill with an anti-androgen added

Used for women with acne Vulgaris

13
Q

What is isotretinoin?

A

Trade name Roaccutane
Its an expensive non-topical retinoid (Vit A derivative) prescribable only by specialists.

1mg/kg/day for 16 wks (generally given in smaller doses to reduce dry skin side effects)

14
Q

Pros and cons of isotretinoin?

A
  • Best treatment available for stubborn/severe acne
  • Permanently cures 60-70% of Acne Vulgaris Patients
  • Easy to take (swallowed 1/day with a main meal)

Highly teratogenic (+1 month after stopping)
Expensive
Causes severe dry skin

15
Q

Describe the pathogenesis of Acne Rosacea?

A

Chronic inflammation of the PSU (Pilo-sebaceous unit) and cutaneous vasculature.
Unlike Vulgaris, rosacea lacks comodones

16
Q

What are the subtypes of Rosacea?

A
  • Erythemato-telangectasic Rosacea
  • Papulo-pustular Rosacea
  • Phymatous rosacea (Big red swollen nose, mainly men)
  • Ocular rosacea

Generally they overlap & they’re mostly treated the same

17
Q

How does ocular rosacea occur?

A

Rosacea affects the meibomian glands in the eyelids, reducing tear film causing dry gritty eyes. It eventually leads to sight loss if not treated.

18
Q

How is does rosacea look?

A

Ace of clubs distribution
Rarely appears off face

Many patients get pronounced flushing on alcohol, hot drinks, emotion and spicy foods

19
Q

Quick list of rosacea treatments

A

Topical:

  • Anti-biotics
  • Azeleic Acid
  • Ivermectin
  • Brimonidine

Non-topical:

  • Anti-biotics
  • Isotretinoin
  • Light based therapies
20
Q

what Anti-biotics are used for rosacea and why?

A

Metronidazole topically
Tetracyclines systemically

They’re used for their anti-inflammatory effect rather than anti-bacterial

21
Q

How is isotretinoin different for rosacea?

A

Its used in smaller doses as rosacea patients already suffer from dry skin

It doesn’t cure it so needs to be kept on long-term

22
Q

what subtypes of rosacea have special treatments?

A

Erythemato-telangectasic Rosacea is best treated with light therapies

23
Q

How does azeleic acid work?

A

It kills acne bacteria and inhibits keratin production

Used for Acne Rosacea

24
Q

How does Ivermectin work?

A

Kills parasitic mites which are believed to be part of the pathogenesis of acne rosacea

25
Q

How does brimonidine work?

A

Causes vasconstriction thus reducing the redness of rosacea.

Its used when someone has a night out or important event they want to minimise their rosacea for, not an everyday treatment