Acneiform Eruptions

Question 1

Two types of acne

Answer 1

Acne Vulgaris

Acne Rosacea

Question 2

What is acne vulgaris?

Answer 2

Disease of the pilo-sebaceous unit (PSU)

Question 3

Where does acne vulgaris effect?

Answer 3

Face
Chest
Back

Question 4

Pathology of acne vulgaris

Answer 4

“Sticky” keratinocytes + increased sebum viscosity
Formation of keratin plug causing obstruction of pilosebacous follicle
Blocked follicles called comedones
Changes in commensal bacterial behaviour (Propionibacterium acnes) = inflammation

Question 5

Presentation of acne vulgaris

Answer 5

Papules
Pustules
Nodules
Cysts
Scars
1. Comedones (due to dilated sebaceous follicle)
- top closed = whitehead 
- top open = blackhead 
2. Inflammatory lesions form when follicle bursts releasing irritants - papules, pustules 
3. Excessive inflammatory response may result in nodules or cysts 
4. Can cause scarring
- ice pick scars
- hypertrophic scars

Question 6

Peak age to get acne vulgaris

Answer 6

15 - 18 years old (90% incidence)

Question 7

Which gender may have delayed onset of acne vulgaris?

Answer 7

Females

Question 8

Which gender gets acne vulgaris?

Answer 8

M = F

But males more severe

Question 9

Does acne run in families?

Answer 9

Yes

Question 10

What is acne roasacea?

Answer 10

Chronic inflammation of

• PSU
• Cutaneous vasculature

Question 11

Distribution of acne roasacea

Answer 11

Ace of clubs distribution

Nose, cheeks and forehead

Question 12

What age gets acne roasacea?

Answer 12

30 - 50 y/o

Question 13

Which gender gets acne roasaecea?

Answer 13

F > M

But male more severe

Question 14

Who gets acne rosaecea?

Answer 14

Fair skinned / celts

Question 15

Presentation of acne rosaecea

Answer 15

Flushing
- alcohol 
- spices
- emotion 
- hot drinks 
"Sensitive Skin"

Question 16

Subtypes of acne rosacea

Answer 16

Erythemato-telangiectatic
Papulo-pustular
Phymatous (M»>F)
Ocular

Question 17

Do you get comedones in acne rosacea?

Answer 17

NO

Question 18

Do you get comedones in acne vulgaris?

Answer 18

Yes

Question 19

What are comedones?

Answer 19

Skin coloured small bumps (papules) frequently found on the forehead and chin on those with acne
A single lesion is a comedo

Question 20

What are open comedones?

Answer 20

Blackheads

Question 21

What are closed comedones?

Answer 21

Whiteheads as the follicle is completely blocked

Question 22

In blackheads, what causes the black colour?

Answer 22

Surface pigment (melanin)

Question 23

Treatment of acne vulgaris

Answer 23

Topical 
- retinoids
- benzoyl peroxide (BPO)
- Antibiotics (clindamycin, tetracycline, erythromycin)
Antibiotics 
- tetracyclines
- erythromycin 
Anti-androgens
- oral contraceptives
- dianette
Isotretinoin/roaccutane

Question 24

What is the most effective treatment for severe/stubborn acne?

Answer 24

Isotretinoin

Question 25

What type of drug is isotretinoin?

Answer 25

Retinoid

Question 26

What is the cure rate for isotretinoin?

Answer 26

60-70%

Question 27

Side effects of isotretinoin

Answer 27

``` HIGHLY teratogenic Dry skin (muco-cutaneous junction) Hair loss Mood swings/depression/suicide Abnormal LFTs Hypertriglyceridemia ```

Question 28

Treatment for acne rosacea

Answer 28

``` Topical - antibiotics (metronidazole) - azelaic acid - ivermectin - brimonidine Antibiotics - tetracyclines Isotretinoin Light based treatments Daily application of high factor suncream Laser - if prominent telangiectasia ```

Question 29

Can acne roasacea be cured?

Answer 29

No

Question 30

Presentation of acne roseacea

Answer 30

``` Flushing (often 1st symptom) Telangiectasia Later - persistent erythema with papules and pustules Ocular involvement - blepharitis Rhinophyma ```

Question 31

What is rhinophyma?

Answer 31

Development of a large, bulbous nose associated with granulomatous infiltration, commonly due to untreated rosacea

Question 32

Adverse effects of isotretinoin

Answer 32

Teratogenicity (2 forms of contraception) Dry skin, lips, eyes and mouth Low mood Raised triglycerides Hair thinning Nose bleeds (due to dryness of nasal mucosa) Intracranial HTN (not to be used with tetracyclines) Photosensitivity

Question 33

What is the most common side effect of isotretinoin?

Answer 33

Dry skin, eyes and lips/mouth

Question 34

First line treatment of moderate - severe acne rosacea

Answer 34

Oxytetracycline

Question 35

Treatment of mild acne rosacea

Answer 35

Topical metronidazole

Question 36

What is the bacteria known to contribute to the development of acne?

Answer 36

Propionibacterium acnes