Acne Flashcards
(32 cards)
What main 2 types of Acne are there?
Acne Vulgaris
Acne Rosacea
Any other types of Acne to be aware of?
Acne Fulminans
Infantile Acne
Also be aware of Hidradenitis Suppuritiva
What is Acne Vulgaris (AV)?
Disease of the pilo-sebaceous unit (PSU) – face, chest, back
Causes “sticky” keratinocytes + increased sebum viscosity
Blocked follicles = COMEDONES
Change in commensal bacterial behaviour (Propionobacterium acnes) = INFLAMMATION
How does AV appear?
- Comedones – look like blackheads
- Papulopustules – white filled
- Nodular Cysts – large pink bumps
What portion of the body is affected by AV?
Face, chest, back
PSU
How does sebum excretion rate change in AV?
There is increased sebum excretion rate especially at puberty
What are the two types of comedones?
Open comedones (blackheads)
Closed comedones (whiteheads)
What are blackheads?
Dilated keratin filled follicles which appear as black papules due to the keratin debris
What are whiteheads?
Accumulation of sebum and keratin deeper in the pilosebaceous ducts
How does inflammation occur in acne?
Pilosebaceous duct becomes blocked, following this there is bacterial colonisation of the duct which causes the release of inflammatory mediators
What can arise from comedones?
Inflammatory papules, nodules and cysts
Who is most commonly affected by AV?
15 - 18 years (incidence as high as 90%)
M=F but Males often more severe
Is there a genetic component to acne?
May be a FH of acne
What colonises the pilosebaceous ducts?
Propionibacterium
Causes inflammation, hypercornification and occlusion of pilosebaceous ducts
Cornification - when squamous epithelium develops into tough protective layers
What is the TOPICAL treatment for AV?
Benzoyl peroxide (BPO)
Anti-biotics eg clindamycin, erythromycin
Retinoids
Others eg Azaleic Acid or Nicotinamide Gel
What is the NON-TOPICAL/SYSTEMIC treatment for AV?
Anti-biotics : tetracyclines, erythromycin, trimethoprim
Anti-androgens : oral contraceptives/Dianette (androgens and progestogens increase sebum production)
Isotretinoin/Roaccutane
Light based treatments eg UVB
What is Isotretinoin?
A retinoid (Vitamin A analogue)
Has anti inflamm and anti cancer effects
Who prescribes Isotretinoin?
Skin specialists - doctors and derms only
Very strong so not OTC
Is Isotretinoin effective?
YES
Most effective treatment for severe/stubborn acne - reserved for worst cases which have failed to resolve with other treatments
What is the prescription regimen for Isotretinoin?
Single daily dose
Clearance and 60-70% cure rate
1 mg / kg / day for 16 weeks - matched to weight of patient
What are the drawbacks for Isotretinoin?
MANY SIDE EFFECTS
Highly teratogenic (pregnancy prevention programmea)
Dry skin and lips (muco - cutaneous junctions)
Hair loss, mood swings, depression, suicide, abnormal LFT’s, hypertriglycerideaemia
Expensive
Do you do any form of monitoring on Isotretinoin?
YES
Regular bloods taken to look at FBC, LFTs and KFTs
What is Acne Fulminans?
- Sudden onset acne eruption, feverish and unwell, joint pains
- Start on low dose Isotretinoin but cover with Prednisalone
What is Acne Rosacea (AR)?
Chronic inflammation due to
PSU
Cutaneous Vasculature
