Acne

Question 1

What are the 5 pillars of acne?

Answer 1

1. basal keratinocyte proliferation in polisebaceous follicles
2. increased sebum production
3. propionibacterium acnes colonisation
4. inflammation
   5, comedones blocking secretions - hence papules, nodules, cysts and scars

Question 2

What are the different non-inflammatory lesions seen in acne?

Answer 2

1. open comedones - blackhead

2. closed comedones - white heads

Question 3

what are the different inflammatory lesions seen in acne?

Answer 3

1. papules + pustules - superficial raised lesions

2. nodules/cysts - deep palpable often painful

Question 4

what are the treatments for mild acne?

Answer 4

• benzoyl peroxide
• azelaic acid
• abx - clindamycin

Question 5

What are the treatments for moderate acne?

Answer 5

doxycycline + benzoyl peroxide (topical)
erythromycin if pregnant or <12yrs
Topical retinoids - isotretinoin

Question 6

What counts as moderate acne>?

Answer 6

inflammatory lesions, face +/- torso

Question 7

What counts as severe acne and what is the treatment?

Answer 7

nodules, cysts and scars
ISOTRETINOIN for 20weeks
alternative - co-cyprindiol (dianette)

Question 8

What are the side effects of isotretinoin?

Answer 8

teratogenic

dry skin, lips, mucosae, headache, depression, hepatitis

Question 9

What should be done for any patient placed on isotretinoin?

Answer 9

monitor triglycerides, AST, ALT, cholesterol and FBC often

Make sure any contraception is being used during and 1 month after rx

Question 10

When is isotretinoin indicated in the rx of acne?

Answer 10

severe acne
mod acne not responding to abx
presence of scarring and severe psychological problems

Question 11

What is acne rosacea?

Answer 11

chronic relapsing/remitting disorder of blood vessels and pilosebaceous units in convex central facial areas

Question 12

Who is mainly affected by acne rosacea?

Answer 12

fair skinned women 40-60s

Question 13

What are the pre-rosacea features?

Answer 13

flushing triggered by stress/blushing, alcohol and spices

Question 14

What are the clinical features of rosacea?

Answer 14

tends to affect nose cheeks and forehead
telangiectasia
later - persistent erythema w papules and pustules
rhinophyma - swelling and soft tissue overgrowth of nose

Question 15

What is the management of rosacea?

Answer 15

1. topical metronidazole for mild
2. more severe - systemic abx e.g. oxytetracycline, doxycycline if renal impairment
3. camouflage creams to conceal redness
4. daily high factor suncream recommended and avoid sun exposure

Question 16

What can be used to treat telangiectasia?

Answer 16

laser therapy

Question 17

what is acne vulgaris?

Answer 17

blockage and inflammation of the pilosebaceous unit (the hair follicle, hair shaft and sebaceous gland)
It presents with lesions which can be non-inflammatory, inflammatory or a mixture of both