Acne Flashcards
(27 cards)
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
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
Where is affected by acne vulgaris
Pilo-sebaceous unit of face / chest + back
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
What is Acne Rosacea
Chronic inflammation
Unknown aetiology
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
Who is affected by acne rosacea
30-50 y/o
F>M
M more severe
More common in fair skinned / sensitive skin
What does ocular involvement cause
Plebharitis
What exacerbates
Sunlight
Alcohol
Spice
Emotion
How do you treat acne rosacea
Ax Topical brimonidine Roacccutane for severe Regular high factor sun screen Laser Rx of telangiectasia = most effective
What Ax
Topical metronidazole if mild
Oral oxytetracycline if more severe
What is topical brimonidine used for
Prominent flushingn
No telangiectasia
What do you do if failure of maanegemnt
Refer to derm if think rhinopehyma (severe form)
If need roaccutane (isotretinon)
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
What is non topical Rx for mod-severe
Oral Ax - tetracycline / doxycycline
Anti-androgen in female - COCP as alternative to Ax
Oral retinoid - Isotretinon
What Ax and why
Used to control bacteria
Tetracycline
Doxycycline
Use for 3 months
What should always be prescribed with Ax
Topical retinoid - benzyl peroxideto prevent resistant
What Ax if pregnancy
Erythromycin
What is isotretinonin
Oral retinoid used in severe
Reduces sebum, inflammation and bacterial growth
Only prescribed by dermatology
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
What do you require if female
Contraception x2
Pregnancy test monthly and 5 weeks post Rx
Avoid pregnancy for 2-3 years after
What can you not combine roaccutane with
Tetracycline due to risk of hypertension
Complication of acne rosecea
Rhinophyma
- Hypertrophy of pilosebaceous gland of noce
- Leads to an enlarged red bulbous nose
What are complications of acne vulcaris
Post inflammatory hyperpigmentation
Scarring
Deformity
Psychological
