Acneiform eruptions Flashcards
what is Acne vulgaris?
disease of the pilo-sebaceous unit (PSU) – face, chest, back
“sticky” keratinocytes + increased sebum viscosity
blocked follicles = COMEDONES
change in commensal bacterial behaviour (Propionobacterium acnes) = INFLAMMATION
papules, pustules, nodules, cysts, scars
who is affected by acne vulgaris?
Peak 15-18 years (90% incidence)
delayed onset in some females
+ve family history
M=F – but M more severe
psychological impact
what is comedomal acne?
Comedonal acne is characterized by many small, flesh-colored papules that make the skin appear bumpy
what is papulopustular acne?
Papulopustular rosacea is defined as a skin disease with prolonged flush, persistent erythema and repeating papules or pustules accompanied with drying, itching and burning sensations of the affected skin.
what is nodular cystic acne?
Nodular acne is a severe type of acne. It causes hard lumps or knots (nodules) to develop deep under your skin. The nodules start below the surface and appear on the skin as red bumps. These bumps usually don’t have a whitehead or blackhead at the center.
what are topical treatments available for acne?
Benzoyl peroxide (BPO) Acnecide
Antibiotic : Clindamycin - Dalacin T lotion
Erythromycin – Zyneryt
Retinoids: Adapalene
Combination: Duac ( BPO and Clindamicin)
Treclin (Tretinoin and Clindamicin)
Epiduo gel – Adapelene and BPO
Others- Azaleic acid, Nicatinamide gel
what are systemic medications available for acne?
antibiotics : tetracyclines
erythromycin
trimethoprim
anti-androgens : combined oral contraceptive pill,
Isotretinoin (Roaccutane)
UVB
Dapsone
what is isotretinoin?
Retinoid medication - vitamin A derivative
most effective treatment
Reserved for treatment failure, evidence of scarring, severe acne, acne fuminans
Prescribed by Dermatologists and dispensed by hospital pharmacy
Weight based treatment- aim to achieve total cumulative dose 120mg/kg
60-70% clear and remain clear
Can have multiple treatment courses if needed
what are side effects of isotretinoin?
Multiple side effects
Counselling required prior to treatment
Teratogenic (pregnancy prevention programme- double method contraception)
Risk of low mood
Can raise triglycerides
many side-effects
Dry skin, lips, epistaxis, dry brittle hair, nail dystrophy, reduction in night time vision , myalgia, mood disturbance, skin sensitivity, photosensitivity, headaches
what is acne fulminans
Sudden onset acneform eruption, feverish and unwell, joint pains
Start low dose Isotretinoin but cover with prednisolone
what are different types of scars left by acne?
atrophic, boxcar, keloid, ice pick, hypertrophic, keloid
what treatment is available for scarring?
Treat inflammation first
If had Isotretinoin usually should wait for 1 year before looking into treatment for scarring
Treatment depends on type of scarring
Intralesional steroid
Excision of ice pick scars
Laser
Dermabraison
Chemical peels
what is acne rosacea?
chronic inflammation
PSU
cutaneous vasculature
ace of clubs distribution
unusual on non-facial sites
who is affected by acne rosacea?
age 30-50 years
F > M – but M more severe
fair skinned/Celts
flushing – alcohol, spices, emotion, hot drinks
“sensitive” skin
what are subtypes of acne rosacea?
erythemato-telangiectatic
papulo-pustular
phymatous (M»>F)
Ocular
