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Flashcards in Red & Spotty Face - ACNE Deck (51)
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What is the hallmark of Acne and what is it stages of progression?


Microcomedone-->closed comedone (whitehead) --> open comedone (blackhead) --> Inflammation due to neutrophil attraction and p. acnes.


What causes a microcomedone?

Hypercornification of the pilosebaceous duct along with a microcomedone.


What are the 4 main factors involved in the development of acne?

  1. Seborrhoea - increased sebum production due to androgens.
  2. Comedone formation
  3. Colonization of pilosebaceous unit w Proprionibactrium acnes
  4. Inflammation


How long does it take for a pustule to appear from a microcomedone?

10-12 weeks.

(Therefore there is no point in treating acne for less than this!)


What medication can cause acne?

  • Oral steroids
  • Antiepileptics
  • EGFR inhibitors
  • Occlusive agents
  • Dioxin exposure


What are the 5 specific features of Acne Lesions to look for?

Non-Inflammatory Lesions

  • (1) Comedones

Inflammatory Lesions

  • Superficial Inflammatory lesions
    • (2) Papules
    • (3) Pustules
  • Deep Inflammatory lesions
    • (4) Nodules/Cysts

(5) dScars


What are the 4 types of acne scars?

  1. Atrophic
  2. Boxcar
  3. Ice Pick
  4. Keloidal


In Acne Vulgaris, do you get telangelectasia?

No - this should alert you to Acne Rosacea


What are the grades of Acne?

  • Mild Acne
    • <20 comedones
    • <15 inflammatory lesions
    • Total lesion count <30.
  • Moderate Acne
    • 20-100 comedones
    • 15-50 inflammatory lesions
    • Total lesion count 30-125
  • Severe Acne
    • >5 pseudocysts
    • >100 comedones
    • >50 inflammatory lesions
    • Total lesions >125


Inflammatory Acne is better treated with (1)


Non-Inflammatory Acne (Comedones) are better treated with (2)

1 = Antibiotics

2= Retinoids.


How do you treat Mild Acne Vulgaris?

  1. Benzoyl Peroxide - inflammatory lesions
  2. Topical Retinoid - noninflammatory lesions
  3. Topical Antibiotics - against P. Acnes
    1. Topical Erythromycin, clindamycin.


What type of scarring is this?

Icepick scarring


What type of scarring is this?

Atrophic scarring


What type scarring is this?

Boxcar scarring


Tell me about Benzoyl Peroxide:

  1. As effective as oral antibiotic for mild -moderate acne.
  2. Better than topical retinoids for inflammed lesions.
  3. Skin irritation to start but this will settle - start EOD if this is a problem.
  4. Low strengths - OTC (2.5-5%) - less irritating and just as effective.
  5. Warn patients about their bleaching effect.


How do topical retinoids work?

  1. Act on abnormal keritanisation - comedones and prevent new formation.
  2. Anti-inflammatory (against inflammed lesions)


What are the 3 main types of topical retinoids used?

  1. Tretinoin
  2. Adapalene
  3. Tazarotene


Why are topical retinoids good in dark skinned people?

They reduce Post Inflammatory Hyperpigmentation (PIH)


What are some side effects/contraindications?

  • Dryness and peeling (less pronounced in adapelene)
  • Contraindication - pregnancy


What type of lesions are topical antibiotics good against?

Inflammed lesions


Combination treatments:

What does Duac (a.k.a. Benzaclin) contain?

Benzoyl Peroxide and Clindamycin


What is contained in EPIDUO?

Adapalene (0.1%) and benzoyle peroxide (2.5%)


What is the difference between EPIDUO and EPIDUO Forte?

EPIDUO Foprte is stronger.

It contains 0.3% adapalene.

(Rather than 0.1%)

But they both contain 2.5% BPO.


What is Zineryt and what is it good for?

A combination of a topical antibiotic and zinc.

It is good for reducing inflamed spots.


How do you treat moderate Acne Vulgaris?

Mainstay is oral antibiotics +/- dianette/yasmin + Topical Treatment.


At how many months is about 60% of the acne cleared up?

3 months


At how many months is 80-90% of the acne cleared up?

6 months.


Which is why the course has to be continued for atleast 6 months.



If there is no improvement with the oral antibiotic at 3 months, what should you do?

Change to a different oral antibiotic.


What topical treatment should you consider in moderate acne?

Topical retinoid or BPO.


What often happens upon stopping antibiotics?

The patient's ACNE relapses.


If this happens a more prolonged course might be needed.