My face is really bothering me

Question 1

Hx

Answer 1

Age of onset
Which part of body affected 
Exacerbating factors - menstruation, anabolic steroids
Prior and current tx
Other health problems - hirsutism? irregular periods?
FH 
Other meds
Effects on life

Question 2

Types of acneiform rash

Answer 2

Pyoderma faciale
Acne gongloblata
Acne rosacea
Acne vulgaris 
Acne exoriee

Question 3

Acne Vulgaris

Answer 3

Usually occurs in adolescence
Comedones (dilated sebaceous follicles), inflammation leading to papules and pustules (nodules and cysts is excessive)

Can ultimately lead to scarring - icepick scars, hypertrophic scars

Question 4

Acne fulminans

Answer 4

Very severe acne associated with systemic upset

Hospital admission often required - condition usually responds to oral steroids

Question 5

Grading Severity

Answer 5

Several systems

Leeds scoring system

Question 6

Tx

Answer 6

Mild: adapalene and oxytetracycline, comedones require retinoids

NOT APPROPRIATE TO PRESCRIBE TOPICAL AND ORAL ABx AT THE SAME TIME

Question 7

Oral retinoids

Answer 7

Moderate unresponsive acne
Severe acne
Acne scarring
Psychological effects
Unusual form of acne

Question 8

Mild

Answer 8

Single topical tx - topical retinoid or benzoyl peroxide (papules, pustules)
Azelaic acid if both ^ poorly tolerated
Consider COCP in women

Question 9

Moderate (papules and pustules predominate)

Answer 9

Single topical for limited unlikely to scar
Combined - topical retinoid / benzoyl peroxide with topical abx (where possible limit topical abx to 12w)
Consider oral abx if moderate on back shoulders / significant risk of scarring
Consider COCP in women

Question 10

Severe (nodules and cysts present)

Answer 10

Specialist assessment
Oral abx whilst awaiting apt
Consider COCP in women