Acne Vulgaris

Question 1

What is acne vulgaris?

Answer 1

A common skin disorder which often occurs in adolescence whereby obstruction of the pilosebaceous follicles with keratin plugs which causes comedones, inflammation and pustules

Question 2

What causes acne vulgaris?

Answer 2

• Positive family history associated
• Androgens stimulate sebaceous gland activity and sebum production
• Stress, diet and exposure to pollutants all play a part

Question 3

What is the pathophysiology of acne vulgaris?

Answer 3

• Follicular hyperkeratinisation
• Increased sebum production
• Propionibacterium bacteria colonization

Question 4

How does acne vulgaris present?

Answer 4

• Comedone (due to dilated sebaceous follicle): whiteheads and blackheads
• Papules and pustules
• Nodules and cysts
• Scarring

Question 5

How is acne classified?

Answer 5

Mild: whiteheads and blackheads with/without inflammatory lesions
Moderate: widespread non-inflammatory lesions with papules and pustules
Severe: Extensive lesions which may include nodules, pitting and scarring

Question 6

How is mild - moderate acne treated?

Answer 6

12 week course of topical combo therapy:
- topical adapalene with benzoyl peroxide
- topical tretinoin with clindamycin
- topical benzoyl peroxide with clindamycin

Question 7

How is moderate to severe acne treated?

Answer 7

• As above initially
• Topical adapalene with topical benzoyl peroxide + lymecycline/doxycycline
• COCP is an alternative to oral Abx in women
• Oral isotretinoin: only with specialist input

Question 8

What is C/I in pregnancy?

Answer 8

• Tetracyclines
• Erythromycin should be used instead
• isotretinoins: use contraceptives and avoid pregnancy for 1 month after stopping drug

Question 9

Referral criteria for dermatologist

Answer 9

• Patients with nodulo-cystic acne/conglobatr acne
• Mild to moderate acne has not responded to 2 courses of treatment
• Moderate to severe has not responded to Abx
• Acne with scarring
• Acne with psychological distress/MH disorder