Acne vulgaris Flashcards
(29 cards)
What is acne vulgaris?
a long-term skin condition in which hair follicles (= the sheath of cells and connective tissue that surround the root of a hair), becomes clogged with dead skin cells and oil, forming red pimples on skin, and occuring chiefly amongst adolescents, due to increased levels of androgens stimulating sebaceous glands to produce more oil, which along with dead skin cells and bacteria, clogs hair follicles, leading to acne.
What causes acne?
Chronic inflammation in the pilosebaceous unit ( = dimples in skin that contains a hair follicle and its associated sebaceous gland; pilus = hair; sebum = grease),
leading to increased sebum production,
keratin trapping,
(= keratinocytes lining hair follicle, produces excess keratin, excess keratin accumulates and clogs hair follicles, leading to harmless, small, rough, bumpy patches of skin, on upper arms and thighs)
both of which blocks these units with excess sebum and keratin.
What are pilosebaceous units?
Tiny dimples/pockets in the skin that contain hair follicles and sebaceous glands.
What is produced by sebaceous glands?
Natural skin oils and a waxy substance known as sebum.
What role do androgenic hormones play in acne?
They increase the production of sebum, exacerbating acne during puberty.
What are comedones?
(plural for comedo, from com- ‘altogether’ + edere ‘eat’. Formerly used as a name for parasitic worms, alludes to the sebaceous secretions resembling small worms that can be squeezed from blackheads.)
Skin colored lumps representing blocked pilosebaceous units/plug of sebum in a hair follicle.
Where does Propionibacterium acnes reside, how does it survive and what is it’s significance in acne?
P.acnes live deep within follicles and pores, although they are also found on the surface of healthy skin.
In these follicles, P. acnes bacteria use sebum, cellular debris and metabolic byproducts from the surrounding skin tissue as their primary sources of energy and nutrients.
Elevated production of sebum by hyperactive sebaceous glands/sebaceous hyperplasia or blockage of the follicle can cause C. acnes bacteria to grow, multiply and colonise the skin.
This bacteria secretes many proteins, including several digestive enzymes that digest sebum and other nutrients and destabilize cells that form walls of the follicle.
The cellular damage caused and metabolic byproducts produced by the rapid growth of C. acnes in follicles can trigger inflammation, leading to symptoms of acne developing.
What is the typical presentation of acne?
Red, inflamed, and sore spots on the skin, usually on the face, upper chest, and upper back.
Define macules in the context of acne.
Flat, distinct marks/areas of discoloration on the skin.
Define papules.
Small red/pink inflamed lumps on skin that form when a comedone/clogged hair follicle, ruptures due to excess oil producion and proliferating bacteria from inside the comedone/clogged hair follice, causing comedone to rupture, releasing bacteria into the layers of the skin; triggering inflammation.
There is no pus present in a papule, although most papules will become pustules, which do contain pus.
What are pustules?
Papules/red-pink inflamed lumps on skin, with a white or yellowish center, which is the pus, due to becoming infected.
What are blackheads?
Open comedones with black pigmentation in the center
(due to oxidation of tyrosine within melanocytes in skin, when it reacts with air, which stimulates melanin production, causing hyperpigmentation)
What are ice pick scars?
Small indentations in the skin remaining after acne lesions heal, that resemble a sharp metal spiky tool used to pick at ice.
What are hypertrophic scars?
Small, thick, raised/lumpy, red, and often itchy scar that remains after acne lesions heal, resulting from an overproduction of collagen during acne lesion healing process.
What are rolling scars?
Indentations in skin with sloping edges, hence having a wavy, uneven appearance, that form when acne lesions heal.
What is the aim of acne treatment?
To reduce symptoms, risk of scarring, and psychosocial impact of condition.
What may be an acceptable management option for mild acne?
No treatment.
What is the function of topical benzoyl peroxide?
Reduces inflammation, helps unblock skin, and is toxic to P. acnes bacteria.
What do topical retinoids do?
Slow the production of sebum.
What is the role of topical antibiotics like clindamycin, in acne management?
When prescribed with benzoyl peroxide, they help reduce bacterial resistance
How can the oral contraceptive pill assist female patients with acne?
It stabilizes hormones and slows the production of sebum.
What is isotretinoin used for?
effective last-line option for severe acne
What are the risks associated with isotretinoin?
Highly teratogenic (due to inducing apoptosis of cells of neural crest, a temporary population of cells in developing embryo that gives rise to diverse range of cell types)
requiring reliable contraception to prevent pregnancy (and hence birth of potentially deformed babies) and careful follow-up.
What is the most effective combined contraceptive pill for acne due to its anti-androgen effects?
Co-cyprindiol (Dianette)
