Acne

Question 1

Acne vulgaris is a common skin disorder which usually occurs in adolescence. It typically affects

Answer 1

the face, neck and upper trunk

Question 2

Acne vulgaris pathophysiology

Answer 2

the obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules.

Question 3

Acne vulgaris Epidemiology?

Answer 3

affects around 80-90% of teenagers, 60% of whom seek medical advice
acne may also persist beyond adolescence, with 10-15% of females and 5% of males over 25 years old being affected

Question 4

Activity of sebaceous glands may be controlled by

Answer 4

androgen

Question 5

acne vulgaris has colonisation by which bacteria?

Answer 5

anaerobic bacterium Propionibacterium acnes

Question 6

Androgen levels are high in patients with acne vulgaris

Answer 6

false

levels are often normal in patients with acne

Question 7

Acne is a disease of which part of the skin?

Answer 7

pilosebaceous unit

Question 8

Comedones are due to a

Answer 8

dilated sebaceous follicle

Question 9

Comedones:
if the top is closed ? is seen
if the top opens ? forms

Answer 9

if the top is closed a whitehead is seen

if the top opens a blackhead forms

Question 10

In acne vulgaris Inflammatory lesions form when?

Answer 10

follicle bursts releasing irritants - papules and pustule formation
An excessive inflammatory response may result in: nodules, cysts

Question 11

What type of scars do you get in acne vulgaris?

Answer 11

ice-pick scars

hypertrophic scars

Question 12

Drug induced acne is associated with which drug

Answer 12

steroid use

Question 13

Drug induced acne is monomorphic/polymorphic

Answer 13

monomorphic

Question 14

What is acne fulminans?

Answer 14

very severe acne associated with systemic upset (e.g. fever).

Question 15

acne fulminans mx?

Answer 15

Hospital admission is often required and the condition usually responds to oral steroids

Question 16

Mild acne vulgaris?

Answer 16

mild: open and closed comedones with or without sparse inflammatory lesions

Question 17

Moderate acne vulgaris?

Answer 17

moderate acne: widespread non-inflammatory lesions and numerous papules and pustules

Question 18

Severe acne vulgaris?

Answer 18

severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring

Question 19

A simple step-up management scheme often used in the treatment of acne - describe

Answer 19

Single topical therapy
Topical combination therapy
Oral antibiotics/COCP
Oral Isotretinoin

Question 20

Diet is useful in controlling acne

Answer 20

false

There is no role for dietary modification in patients with acne.

Question 21

Examples of single topical therapy?

Answer 21

topical retinoids, benzoyl peroxide

Question 22

Examples of topical combination therapy?

Answer 22

topical antibiotic, benzoyl peroxide, topical retinoid

Question 23

Which oral antibiotics are useful in acne vulgaris?

Answer 23

tetracyclines: lymecycline, oxytetracycline, doxycycline

Question 24

Which antibiotic may be used in pregnancy?

Answer 24

erythromycin

Question 25

When should tetracyclines be avoided?

Answer 25

tetracyclines should be avoided in pregnant or breastfeeding women and in children younger than 12 years of age

Question 26

Why is minocycline is now considered less appropriate in mx acne v?

Answer 26

possibility of irreversible pigmentation

Question 27

a single oral antibiotic for acne vulgaris should be used for a maximum of

Answer 27

three months

Question 28

Why should a topical retinoid or benzoyl peroxide always be co-prescribed with oral antibiotics

Answer 28

to reduce the risk of antibiotic resistance developing.

Question 29

Topical and oral antibiotics should not be used in combination

Answer 29

true

Question 30

complication of long-term antibiotic use?

Answer 30

Gram-negative folliculitis

Question 31

mx Gram-negative folliculitis

Answer 31

- high-dose oral trimethoprim is effective if this occurs

Question 32

combined oral contraceptives (COCP) are an alternative to oral antibiotics in women acne vulgaris

Answer 32

true

Question 33

COCP can be prescribed alone in acne vulgaris

Answer 33

False | as with antibiotics, they should be used in combination with topical agents

Question 34

WHat is Dianette (co-cyrindiol)? It is sometimes used in acne vulgaris because?

Answer 34

COCP | used as it has anti-androgen properties.

Question 35

Dianette has an increased risk of?

Answer 35

venous thromboembolism compared to other COCPs

Question 36

When should dianette be used used?

Answer 36

it should generally be used second-line (COCP) only be given for 3 months women should be appropriately counselled about the risks

Question 37

oral isotretinoin should only under specialist supervision

Answer 37

true

Question 38

Contraindication retinoids?

Answer 38

pregnancy is a contraindication to topical and oral retinoid treatment

Question 39

Acne rosacea is a chronic skin disease of unknown aetiology.

Answer 39

true

Question 40

sx acne rosacea?

Answer 40

typically affects nose, cheeks and forehead flushing is often first symptom telangiectasia are common later develops into persistent erythema with papules and pustules rhinophyma ocular involvement: blepharitis

Question 41

What can exacerbate sx acne rosacea?

Answer 41

Sunlight

Question 42

Step wise mx of acne rosacea?

Answer 42

topical metronidazole/topical brimonidine gel systemic antibiotics e.g. Oxytetracycline laser therapy

Question 43

More specifically (in acne rosacea) when is topical metronidazole used?

Answer 43

may be used for mild symptoms i.e. Limited number of papules and pustules, no plaques

Question 44

More specifically (in acne rosacea) when is topical brimonidine gel used?

Answer 44

may be considered for patients with predominant flushing but limited telangiectasia

Question 45

More specifically (in acne rosacea) when is laser therapy used?

Answer 45

laser therapy may be appropriate for patients with prominent telangiectasia

Question 46

patients with a rhinophyma should be referred to dermatology

Answer 46

true

Question 47

recommend daily application of a high-factor sunscreen in acne rosacea

Answer 47

true

Question 48

Adverse effects retinoids?

Answer 48

``` teratogenicity dry skin, eyes and lips/mouth low mood raised triglycerides hair thinning nose bleeds intracranial hypertension Photosenstivity ```

Question 49

In severe acne. wo-thirds of patients have a long-term remission or cure following a course of oral isotretinoin.

Answer 49

true

Question 50

females should ideally be using one form of contraception if on retinoids

Answer 50

false | using TWO forms of contraception (e.g. Combined oral contraceptive pill and condoms)

Question 51

the most common side-effect of isotretinoin

Answer 51

dry skin, eyes and lips/mouth | can lead to nose bleeds

Question 52

isotretinoin treatment should not be combined with tetracyclines for what reason

Answer 52

intracranial hypertension