acne vulgaris Flashcards
causes acne ?
characterised by the obstruction of the pilosebaceous follicles with keratin plugs which results in comedones, inflammation and pustules
Comedones are due to a dilated sebaceous follicle
if the top is closed a whitehead is seen
if the top opens a blackhead forms
Acne classified
mild: open and closed comedones with or without sparse inflammatory lesions
moderate acne: widespread non-inflammatory lesions and numerous papules and pustules
severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring
mild to moderate acne tx
12-week course of topical combination therapy should be tried first-line:
=a fixed combination of topical adapalene with topical benzoyl peroxide
=a fixed combination of topical tretinoin with topical clindamycin
=a fixed combination of topical benzoyl peroxide with topical clindamycin
topical benzoyl peroxide may be used as monotherapy if these options are contraindicated or the person wishes to avoid using a topical retinoid or an antibiotic
people with moderate to severe acne
a 12-week course of one of the following options:
=a fixed combination of topical adapalene + topical benzoyl peroxide
=a fixed combination of topical tretinoin + topical clindamycin
=a fixed combination of topical adapalene + topical benzoyl peroxide + either oral lymecycline / oral doxycycline
a topical azelaic acid + oral lymecycline / oral doxycycline
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oral isotretinoin: only under specialist supervision
tetracyclines should be avoided
pregnant or breastfeeding women and in children younger than 12 years of age.
=Erythromycin may be used in pregnancy
only continue a treatment option that includes an antibiotic (topical or oral) for more than 6 months in exceptional circumstances
Topical and oral antibiotics should not be used in combination
a topical abx should always be paired with ?
(if not contraindicated) or benzoyl peroxide or retinoid should always be co-prescribed
reduce the risk of antibiotic resistance developing
alternative to oral antibiotics in women
combined oral contraceptives
=should be used in combination with topical agents
to reduce the risk of antibiotic resistance developing what should not be used to treat acne
monotherapy with a topical antibiotic
monotherapy with an oral antibiotic
a combination of a topical antibiotic and an oral antibiotic
referral should be considered in the following
mild to moderate acne has not responded to two completed courses of treatment
moderate to severe acne has not responded to previous treatment that includes an oral antibiotic
acne with scarring
acne with persistent pigmentary changes
acne is causing or contributing to persistent psychological distress or a mental health disorder
isotretinoin side effects
Do not get pregnant while taking this medication and for 1 month after stopping it.
Women must have 2 negative pregnancy tests before starting this medication and one each month during treatment, even if not sexually active.
Use 2 reliable forms of birth control for 1 month before, during, and for 1 month after stopping this medication.
Use birth control pills that contain estrogen
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notice any changes in your behavior, such as new or worsening depression, thoughts of harming yourself, anxiety, other unusual or disturbing thoughts, or memory loss, call your care team right away.
This medication can cause serious eye damage - anterior segment inflammation, dry eye syndrome, contact lens intolerance, altered refraction, photosensitivity, and reduced night vision
more sensitivity to sun
may experience a flare in your acne during the initial treatment period
need to see your doctor or care team monthly to get a new prescription and to check on your progress and for side effects.
Do not have cosmetic procedures such as waxing, dermabrasion, or laser therapy during and for at least 6 months after you stop taking this medication. These procedures can increase the risk of scarring
may increase blood sugar. Ask your care team if changes in diet or medications are needed if you have diabetes.
This medication can increase cholesterol and triglyceride levels and decrease HDL (the good cholesterol) levels. Your care team may check your cholesterol
common side effects of isotretinoin
arthralgia; back pain; cheilitis; dry eye; eye discomfort; eye inflammation; haemorrhage; headache; increased risk of infection; myalgia; nasal dryness; neutropenia; proteinuria; skin fragility
nose bleeds (caused by dryness of the nasal mucosa)
intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
photosensitivity
gov uk for isotretinoin
prescribers should assess patients’ mental health before prescribing isotretinoin including the use of patient-reported outcome measures
ask patients about any sexual function concerns before prescribing isotretinoin
initiation of isotretinoin treatment in patients under 18 years of age now requires agreement by 2 independent healthcare professionals that there is no other appropriate effective treatment before it is prescribed.
This means that isotretinoin should only be prescribed for severe acne that is resistant to adequate courses of standard therapy
review patients approximately 1 month after initiation of treatment in a face-to-face (in-person) appointment
monitor patients for side effects including mental health and sexual function side effects at each follow up appointment including objective mental health patient reported outcome measures
severe form nodulocystic acne affects ?
affecting the face and upper trunk,
characterised by nodules and cysts that typically resolve with scarring.
nodulocystic acne features
usually chronic and seen in men (especially African-Americans)
Solitary or multiple inflammatory nodules and pseudocysts
Firm, fluctuant, and/or tender
Involvement of the face, neck, and trunk
complications = Keloid, hypertrophic and atrophic scars
Pyogenic granuloma
