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Flashcards in Acne Deck (27)
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1

What causes acne vulgaris

Chronic inflammation in polo-sebaceous units (contain hair follicles and sebaceous glands)
Kertatinocytes / increased sebum stick together leading to blocked follicles = COMEDONES
Propionibacterium acnes builds up in comedones
Hormonal - increased androgen

2

What are the symptoms of acne vulgaris

Non-inflammatory = mild
- Comedones due to dilated sebaceous follicle
- Causes white head (closed comedones) and black head (open)
<30 lesion

Inflammatory = mod-severe
Macules
Papules
Pustules
Cysts
<30-125 lesion

Severe
Hypertrophic scarring
>125 lesion

3

Where is affected by acne vulgaris

Pilo-sebaceous unit of face / chest + back

4

Who is affected by acne vulgarisms / RF

15-18 y/o
Common in puberty as increased sex hormones increase sebaceous glands production of sebum (why anti-androgen helps)
Males have it more severe
FH
PCOS = known cause
Diet / Stress = very little affect
Can get steroid induced which is usually monomorphic pustules

5

What is Acne Rosacea

Chronic inflammation
Unknown aetiology

6

Where does acne rosacea present

Ace of club distribution over face
Non-facial sites
Flushing - emotion / spice / alcohol
Later develop persistent erythema with papule and pustules
Tenagiectasia
NO COMEDONE

7

Who is affected by acne rosacea

30-50 y/o
F>M
M more severe
More common in fair skinned / sensitive skin

8

What does ocular involvement cause

Plebharitis

9

What exacerbates

Sunlight
Alcohol
Spice
Emotion

10

How do you treat acne rosacea

Ax
Topical brimonidine
Roacccutane for severe
Regular high factor sun screen
Laser Rx of telangiectasia = most effective

11

What Ax

Topical metronidazole if mild
Oral oxytetracycline if more severe

12

What is topical brimonidine used for

Prominent flushingn
No telangiectasia

13

What do you do if failure of maanegemnt

Refer to derm if think rhinopehyma (severe form)
If need roaccutane (isotretinon)

14

What is topical treatment / 1st line for acne vulcaris for mild

Asses anxiety and depression
Treatment needs to be continued for 6 weeks to see effect
Topical benzyl peroxide if mild
Topical retinoid if mild
May be in combination
Topical Ax - clindamycin
+ benzyl peroxide if mild

15

What is non topical Rx for mod-severe

Oral Ax - tetracycline / doxycycline
Anti-androgen in female - COCP as alternative to Ax
Oral retinoid - Isotretinon

16

What Ax and why

Used to control bacteria
Tetracycline
Doxycycline
Use for 3 months

17

What should always be prescribed with Ax

Topical retinoid - benzyl peroxideto prevent resistant

18

What Ax if pregnancy

Erythromycin

19

What is isotretinonin

Oral retinoid used in severe
Reduces sebum, inflammation and bacterial growth
Only prescribed by dermatology

20

What are complications

Highly teratogenic so requires contraception if female as vit A
Dry skin / lipids and mouth = most common
Photosensitivity
Raised triglyceride
Abnormal LFT
Hair loss
Nose bleeds
Visual disturbance
Low mood - screen prior to Rx
Intra-cranial hypoertension
SJS / TENS = rare

21

What do you require if female

Contraception x2
Pregnancy test monthly and 5 weeks post Rx
Avoid pregnancy for 2-3 years after

22

What can you not combine roaccutane with

Tetracycline due to risk of hypertension

23

Complication of acne rosecea

Rhinophyma
- Hypertrophy of pilosebaceous gland of noce
- Leads to an enlarged red bulbous nose

24

What are complications of acne vulcaris

Post inflammatory hyperpigmentation
Scarring
Deformity
Psychological

25

When do you refer for oral retinoid

Severe acne
Moderate acne starting to scar or significant hyperpigmentation
Associated psychological

26

What SE of Ax

Photosensitivity
IIH

27

What do you have to make sure before COCP

No CI - VTE / smoker / bP