Acne

Question 1

ACNE VULGARIS
• Affects 80-85% of individuals between 11 and 30 years old in the US • Four mechanisms contribute to acne
– Sebaceous follicles become plugged with keratinous materials
– Colonies of P. Acnes grow deep in the follicle. M furfur can also be involved
– Overproduction of sebum and androgen production increases, expanding the follicle – Inflammation occurs and pustules form

Answer 1

Info

Question 2

HISTORY & PHYSICAL
• History
– Family history
– Stage of pubertal development and menstrual history
– Facial and hair products used
– Medications
– Current and previous acne treatment
– Sports participation
– Jobs
– Other medical conditions
• Physical
– Lesions are mostly found on the face, back and chest
– Noninflammatory
• Microcomedone- follicular plug
• Open comedone (blackhead)
• Closed comedone (white head)
– Inflammatory
• Occur secondary to rupture of the noninflammed lesion
• Can include papules, pustules, excoriation, lesions, crusting, nodules, cysts, and scars

Answer 2

Info

Question 3

CLASSIFICATIONS
• Mild acne
– < 20 comedones
– < 15 inflammatory lesions
– < 30 total lesions • Moderate acne
– 20 to 100 comedones
– 15 to 50 inflammatory lesions – 30 to 125 total lesions
• Severe acne – > 5 cysts
– Total comedones > 100
– Total inflammatory lesions >50 – >125 total lesions

Answer 3

Info

Question 4

TREATMENT
• Patient must understand that acne often worsens before improving • Wash face twice a day with mild soap
• Avoidscrubbing,pickingorsqueezing
• Apply hot soaks to pustules
• All products should be labeled noncomedogenic
• Discontinue use of aggravating substances such as any oil based products
• Identifyaggravatingfactors-stress,hot,humidweather,jobsinvolvingfryingoil • Results can take months and that adherence to treatment is essential

Answer 4

Info

Question 5

MEDICATIONS
• Benzoyl peroxide cream
– Antibacterial against P. acnes
– Available in 2.5% to 10%
• Tretinoin
– Taper off slowly
– Long term or repeat therapy is often needed
• Combined estrogen-progestin hormonal contraceptives
– Keratolytic- decreases cohesion between epidural cells, increases epidermal cell turnover, anti- inflammatory
effect. –
– Expect redness and dryness with initial use
– Expect 6 weeks of therapy before noting improvement
– Photosensitizing
• Topical antibiotics
– Clindamycin, erythromycin, dapsone
– Often used in combination with Benzoyl peroxide and tretinoin
• Oral antibiotics
– Doxycycline, minocycline, erythromycin, Bactrim
– Usually added when topical treatment has been insufficient
– Takes a 3 months to see full effects
Full effect is not noted for 3 months • Isotretinoin (Accutane)
–
Causes reduction in androgen levels, decreases sebum production
– Treatment for severe cystic acne that does not respond to other treatments
– Usual course of treatment is 4-6 months- can reduce nodule count by 70%
– Females must use 2 forms of birth control
– ipledge program
– Photosensitivity
– Careful monitoring for mood destabilization and/or suicidal thoughts

Answer 5

Info

Question 6

WHERE TO START
• Mild
– Topical retinoid
– Consider adding topical antibiotic and/or benzoyl peroxide • Moderate
– Oral antibiotics with topical retinoid • Severe
– Oral antibiotic with topical retinoid. Accutane if ineffective

Answer 6

Info