Acne Flashcards
(8 cards)
History in Acne
age of onset and duration menstruation in women and anabolic steroids (make worse) prior and current treatments hirsutism, obesity, menstrual irregularities - PCOS other meds - topical and systemic steroids can cause acne effects on social interactions/work/life FH what other parts of body affected periods of flushing or very red face? acne vulgaris
presentation
papules pastules open and closed comedones cysts commonly affects face, chest, upper back
severity of acne
Mild - open and closed comedones Moderate: comedones, papules and pustules Severe: nodules and cysts, papules, pustules, comedones, scars
Acne vulgaris
inflammatory condition - lesions develop from sebaceous glands around hair follicles on skin of face, chest, back and anogenital regions typically starts as teenager but often self limiting psychological impacts are main concern
Rosacea
inflammatory papules, pustules and erythema no comedones
Isotretinoin recommended when:
patient has acne causing inflammatory papules and comedones and fails to respond to topical retinoid and oral AB for 3 months moderate acne -unresponsive to conventional therapy or relapsing severe acne acne scaring psychological effects resulting from acne and scarring unusual form of acne
Acne advice:
- dont wash more than twice a day
- use a mild cleanser and lukewarm water
- dont use vigorous scrubbing
- dont attempt to clean blackheads
- ideally avoid excessive makeup
- dont pick spots
Managment of acne
Mild:
- single topical treatment - benzoyl peroxide first line (then topical retinoids, then azelaic acid)
- consider COP in women
Moderate
- if acne limited and unlikely to scar same as above
- topical AB combined with topical benzoyl peroxide or a topical retinoid
- consider oral AB if wide spread and risk of scarring
Severe
- refer for specialist treatment
- oral AB in combination with topical steroid given whilst waiting for appointment
- COPs
- dianette only considered when topical treatment or systemic AB failed
