Acne and Rosacea

Question 1

what is acne vulgaris

Answer 1

chronic inflammatory disease of the pilosebaceous unit

Question 2

define pilosebaceous unit

Answer 2

The structure consisting of hair, hair follicle, arrector pili muscles and sebaceous gland is an epidermal invagination known as a pilosebaceous unit.

Question 3

acne pathophysiology

Answer 3

thickening of keratin lining and obstruction of sebaceous duct results in closed and open comedones (white and black heads)

Question 4

what is the difference between white and black heads

Answer 4

none, black are open comedones

black colour due to melanin???

Question 5

what happens to sebum secretion in acne

Answer 5

increased

Question 6

what bacteria is increased in colonisation in acne

Answer 6

Propionibacterium acne (Corynebacterium)

Question 7

where does inflammation occur during acne

Answer 7

around sebaceous gland

Question 8

is acne more common in males or females

Answer 8

males

Question 9

spots seen in acne

Answer 9

• Several types of acne spots occur, often at the same time e.g. inflamed papules, pustules and nodules, or non-inflamed comedones and pseudocysts
  
  • Open and closed comedones are black and white heads
  • Pustules are white or yellow ‘squeezable spots’

Question 10

secondary lesions in acne

Answer 10

• Scars
• Excoriations (picked or scratched spots)
• Erythematous macules (red marks from recently healed spots, best seen in fair skin)

Question 11

mild acne

Answer 11

scattered papules and pustules, comedones

Question 12

moderate acne

Answer 12

numerous papules, pustules and mild atrophic scarring

Question 13

severe acne

Answer 13

cysts, nodules, significant scarring

Question 14

what beneficial effect do cleansers have on mild acne

Answer 14

dissolve the keratin plug of the comedones, mild acne may respond well to these

Question 15

topical treatment ladder for acne

Answer 15

• Benzoylperoxide – bacteriostatic effects
  
  • Keratolytic and anti-bacterial
• Topical vitamin A derivative (retinoid) – drying effect
  
  • Anti-inflammatory and comedolytic
• Topical antibiotics (with one of the above)
  
  • Antibacterial and anti-inflammatory
  • Clindamycin and erythromycin

Question 16

what is the effect of the topical vitamin A derivative

Answer 16

drying

Question 17

systemic treatment ladder for acne

Answer 17

• ABx - tetracycline
  
  • antibacterial and anti inflammatory
• isotretinoin (oral retinoid)
  
  • anti inflammatory and sebum reducing properties

Question 18

how long must oral tetracycline be taken for

Answer 18

6 months

Question 19

where does isotretinoin act on

Answer 19

sebaceous glands

Question 20

what is the effect of tetracycline

Answer 20

anti bacterial and also has an anti inflammatory effect after a few weeks

Question 21

side effects of oral retinoid (isoretinoin)

Answer 21

• initally aggravates acne
• severe dry skin and lips, dryness of eyes - conjuncivitis
• dryness of mucous membanes
• teratogenic - women must be on contaception

Question 22

what drugs can cause an exacerbation of acne

Answer 22

oral steroids

Question 23

rosacea

Answer 23

• Chronic rash involving the central face that most often affects those aged 30 to 60. It may be transient, recurrent or persistent

Question 24

what is rosacea characterised by

Answer 24

facial flushing, persistent erythema, pustules, oedema, inflammatory papules, telangiectasia

no comedomes

Question 25

aetiology

Answer 25

* Genetic, environmental, vascular and inflammatory factors * Skin damage due to chronic exposure to UV radiation is implicated * **Cathelicidins** are observed in high concentrations in rosacea

Question 26

what can happen in chronic rosacea

Answer 26

rhinophyma

Question 27

what is rhinophyma

Answer 27

skin texture become coarse resulting in gross thickening and hypertrophy commonly seen in men

Question 28

what mites are inc in number in rosacea

Answer 28

demodex mites in sebaceous ducts

Question 29

what are the pathological features of rosacea

Answer 29

vascular ectasia, patchy inflammation, pustules, perifollicular granulomas

Question 30

name some other associated features of rosacea

Answer 30

conjunctivitis, blepharitis, eyelid oedema

Question 31

what are some pre rosacea features

Answer 31

**flushing** may precede the other signs by some years – flushing is exacerbated by stress, alcohol and spices. As the disease progresses the flushing may be replaced by permanent redness.

Question 32

what are some topical therapies for rosacea

Answer 32

metronidazole, ivermectin (dermodex mite)

Question 33

what is the purpose of ivermectin

Answer 33

to reduce dermodex mite

Question 34

oral therapy for rosacea

Answer 34

tetracycline long term, isotretinoin low dose if severe

Question 35

what is the first line treatment for rosacea

Answer 35

topical metronidazole gel