Dermatology Flashcards
(10 cards)
Define Acne Vulgaris
Inflammation of the pilosebaceous unit of the skin
Aetiology of Acne Vulgaris
Increased producation and impared normal flow of sebum (Follicular hyperkeratinisation and obstruction of the pilosebaceous duct) results in imflammation and formation of closed or open comedones.
Also accociated with PCOS, cotisol excess (as seen in cushings syndrome), prolactinomas and puberty.
Bacteria that may be involved include: Propionibacterium acnes, staphylococcus epidermisis and pityrosporum yeast
Epidemiology of Acne Vulgaris
Ubiquitous.
Begins in puberty and tends to receed with age.
History of Acne Vulgaris
Usually self diagnosed. May be painful
Examination of Acne Vulgaris
- Open Comedones (Whiteheads: flesh coloured papules)
- Closed comedones (blackheads: black colour caused by oxidation of the melanin pigment)
- Papules- small tender red bumps
- Pustules- white or yellow “squeezable” spots
- Nodules- large painful red lumps
- Pseudo-Cysts: Cyst like fluctuant swellings
- Seborrhoea
may see secondary lesions
- Excoriations (picked or scratched spots)
- Erythematous macules (red marks from recently healed spots, best seen in in fair skin)
- Pigmented macules (dark marks from old spots, mostly affecting those with dark skin)
- Scars
Primarily affecting face, neck, upper torso and back
Define Seborrhoea
Oily Skin
Grading Acne
Acne may be classified as mild, moderate or severe1. Comedones and inflammatory lesions are usually considered separately.
Mild acne
5 pseudocysts
Total comedo count >100
Total inflammatory count >50
Or total lesion count >125
Investigations for Acne Vulgaris
Normally none required
May check LH as increase LH:FSH ratio in PCOS (or pelvic US), do a 24 hr urinary cortisol if suspect cushings
Management of Acne Vulgaris
Start early to prevent scarring
MILD/ MODERATE:
Over the counter preparations containing benzylperoxide and azelaic acid, lasers and lights
MODERATE/ SEVERE:
Topical antibiotics (clindamycin/ erythromycin)
Topical Vit A derivatives (Tretionoin)
SEVERE INFLAMMATORY: Oral antibiotics (Oxytetracycline, Minocycline, Erythromycin)
SEVERE:
Oral Vit A Derivative (isotretinoin): only available by specialist perscription.
S.E: Teratogenic and hyperlipidaemia
Females respond well to OCP
Complications of Acne Vulgaris
Facial Scarring
Hyperpigmentation
Secondary Infection
Psychological