Acneiform Eruptions Flashcards
(23 cards)
What conditions cause an increased risk of acne vulgaris?
XYY genotype
Poly cystic ovary syndrome
Hyperandorgenism
Hypercortisolism
What are the four physiological processes that cause acne vulgaris?
Sebaceous gland hyperplasia and excess sebum production
Abnormal follicular differentiation
Cutibacterium acnes colonisation
Inflammation and immune response
What are the characteristics of mild acne?
<20 comedomes
<15 inflammatory lesions
OR
Total lesion count <30
What are the characteristics of moderate acne?
20-100 comedomes
15-50 inflammatory lesions
OR
Total lesion count 30-125
What are the characteristics of severe acne?
>5 pseudocysts >100 comedomes >50 inflammatory lesions OR Total lesion count >125
What are the characteristics of acne fulminans?
Abrupt onset of nodular and suppurative acne with systemic manifestations (fever, artralgias, myalgias, hepatosplenomegaly)
What are the characteristics of drug induced acne?
No comedomes
Seen as a side effect of many medications (Steroids, phenytoin, litium)
What are the characteristics of acne excoriee?
Acne that has been neurotically picked leaving crusted lesions that may scar
What should you ask about when taking a history regarding acne vulgaris?
Sex Age Occupation Previous treatment Cosmetic usage Menstrual history Medications
What should you look for when examining acne?
Skin type Skin colour Lesion morphology Scarring Postinflamatory pigmentation
What is the first line and adjunct treatment of mild acne?
Without inflammation- first line is topical retinoid or salicylic acid
With inflammation- topical retinoid AND topical antibiotic
Add topical benzoyl peroxide
Add topical azelaic acid
What is the first line and adjunct treatment of moderate acne?
Without inflammation- topical retinoid
With inflammation- topical retinoid AND oral antibiotic
Add topical benzoyl peroxide
Add topical azelaic acid
What is the treatment of severe acne?
Oral retinoid
Add oral corticosteroid
What is the treatment of hormone related acne?
Start with oral hormone therapy then proceed with adjuncts as normal
How can acne be treated in pregnancy?
Topical antibiotic
What are the main differences between acne vulgaris and rosacea?
Acne vulgaris is more common in younger populations, is constant and can be present on the back or chest as well
Acne rosacea is more common in slightly older populations, tends to stay on the centre of the face and is episodic. Also, itching is more common in rosacea
What are the risk factors for rosacea?
Lighter skin type
Exposure to triggers (temperature extremes, sunlight, alcohol, emotional stress)
3rd/4th decade of life
What are the symptoms of rosacea?
Flushing Erythema Papules and pustules Telangiectases (superficial capillaries) Ocular manifestations Plaque formation Facial distribution- mainly present on convex areas of the face (nose, cheeks, chin and forehead)
What are the characteristics of vascular rosacea?
Recurrent blush
Telengiectases begin to form at nasal and spread
What are the characteristics of inflammatory rosacea?
Small pustules and papules to occasional deep cystic nodules
Absence of comedomes
Deeper red colour than acne
Soft or solid facial oedema
What are the characteristics of phymatous rosacea?
Overgrowth of sebaceous glands
Skin becomes swollen and smoother with more apparent pores
Gradually a lumpy surface develops
What are the symptoms of ocular rosacea?
Range from dry eyes to oedema, tearing, pain, chalazia (stye) and corneal damage
Describe the management of rosacea?
Avoid obvious irritants Following may be useful: -Metronidazole cream/gel -Azelaic acid cream/gel -Ivermectin cream Tetracyclines most common oral medication Surgery for rhinophymas
