Acneiform Eruptions

Question 1

What portion of the body is affected by chronic inflammation in acne vulgaris?

Answer 1

Chronic inflammation of the pilo-sebaceous unit - affects the face, chest and the back

Question 2

How does sebum excretion rate change in acne?

Answer 2

There is increased sebum excretion rate

Sebum excretion rate increases at puberty

Question 3

What are the two types of comedones?

Answer 3

Open comedones (blackheads)

Closed comedones (whiteheads)

Question 4

What are blackheads?

Answer 4

Dilated keratin filled follicles which appear as black papules due to the keratin debris

Question 5

What are whiteheads?

Answer 5

Accumulation of sebum and keratin deeper in the pilosebaceous ducts

Question 6

How does inflammation occur in acne?

Answer 6

Pilosebaceous duct becomes blocked, following this there is bacterial colonisation of the duct which causes the release of inflammatory mediators

Question 7

What can arise from comedones?

Answer 7

Inflammatory papules, nodules and cysts

Question 8

What is the most common peak of acne vulgaris?

Answer 8

15 - 18 years (incidence as high as 90%)

Question 9

Is there a genetic component to acne?

Answer 9

Yes, there may be a positive family history

Question 10

What colonises the pilosebaceous ducts?

Answer 10

Propionibacterium

Causes inflammation, hypercornification and occlusion of pilosebaceous ducts

Cornification - when squamous epithelium develops into tough protective layers

Question 11

What is the TOPICAL treatment for acne vulgaris?

Answer 11

• retinoids
• benzoyl peroxide (BPO)
• anti-biotics : clindamycin

tetracycline

erythromycin

•others

Question 12

What is the NON-TOPICAL treatment for acne vulgaris?

Answer 12

•anti-biotics : tetracyclines

erythromycin

(trimethoprim)

• anti-androgens : oral contraceptives/Dianette (androgens and progestogens increase sebum production)
• isotretinoin/Roaccutane
• (light based treatments)

Question 13

Who prescribes isotretinoin?

Answer 13

Skin specialists

Question 14

Is isotretinoin effective?

Answer 14

•most effective treatment for severe/stubborn acne

Question 15

What is the prescription regimen for isotretinoin?

Answer 15

Single monotherapy - single daily dose

clearance and 60-70% cure rate

1 mg / kg / day for 16 weeks

Question 16

What are the drawbacks for isotretinoin?

Answer 16

Highly teratogenic (pregnancy prevention programme)

Many potential side effects

Dry skin (muco - cutaneous junctions)

Hair loss, mood swings, depression, suicide, abnormal LFT’s, hypertriglycerideaemia

Expensive

Question 17

What does acne rosacea affect?

Answer 17

Central face

Question 18

What does acne rosacea consist of?

Answer 18

Flushing

Erythema

Papules

Pustules

Telangiectasia

It is unusal to see acne rosacea on non-facial sites

NO COMEDONES

Question 19

Who does acne rosacea often affect?

Answer 19

Ages 30-50 years

Females more than males

Fair skinned indivisuals

Question 20

What exacerbates acne rosacea?

Answer 20

Heat

Sunlight

Alcohol

Question 21

What are the subtypes of acne rosacea?

Answer 21

• erythemato-telangiectatic
• papulo-pustular
• phymatous (M>>>F) - rhinophyma is the soft tissue overgrowth of the nose
• Ocular

Question 22

What is the TOPICAL treatment of acne rosacea?

Answer 22

• anti-biotics – metronidazole
• azeleic acid
• ivermectin
• brimonidine

Question 23

What are the non-topical treatments for acne rosacea?

Answer 23

•anti-biotics – tetracyclines

(erythromycin)

(metronidazole)

•isotretinoin

light based treatments

Question 24

May be worth reading about these

Answer 24

• infantile acne
• acne conglobata
• acne fulminans
• pyoderma faciale/rosacea fulminans
• acne inversa/hidranitis suppurativa