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The Skin > T8: Acne and rosacea > Flashcards

T8: Acne and rosacea Flashcards

1
Q

Acne vulgaris

Acne vulgaris

A
  • common
  • normal, NOT disease
  • tx: improve QOL
  • occurs during adolescence
    think stress/mestruation
  • course
    settles after 2-3 yrs
    more prolonged = uncommon but can happen
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2
Q

Acne vulgaris

Infantile acne

A
  • uncommon
  • boys > girls
  • 3-12m
  • stops after 4-5 yrs
  • flare in adolesence
  • maternal hormones cause
    -clears spontaneously
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3
Q

Acne vulgaris

Late onset

A
  • > 20+ yrs
  • women
  • premenstrual flares
  • PCOS
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4
Q

Acne vulgaris

Acne fulminans

A
  • uncommon
  • young men
  • ulcerated acne
  • fever, malaise, arthralgia
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5
Q

Acne lesions

Comedones

A

closed
- whiteheads
- small papules
- dilated blocked follicles +/- inflam

open
- blackheads
- small papules with black dot
- dilated blocked follicles +/- inflam
(black crust = oxidized keratin)

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6
Q

Acne lesions

Papules + Pustules

A
  • develop from comedones
  • red papules -> yellow pustules
  • recurrent
  • painful/itchy
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7
Q

Acne lesions

Nodules + Cysts

A
  • develop from above de novo
  • red nodules + cysts
  • severe inflam
  • last longer
  • severe scarring + multilation
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8
Q

Acne lesions

Scars

A

atrophic
- ice pick
- rolled scars
- boxcar

keloidal/hypertrophic
- severe cystic acne
- chest, jawline, upper back, shoulders

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9
Q

Acne

Pathogenesis

A
  • genetic susceptibility
  • puberty causes oil production inflam reactions, bacterial change
  • during puberty, sebaceous glands activate in hair follicle + testosterone stimulates glands to produce more oil
  • infundibular hyperkeratosis occurs = causes plug in follicle
  • plug + more oil causes follicle to block, follicle fills with oil
  • microcomedone formed

microcomedone
- filled with oil, keratin, commensal flora
- bacteria grows and starts inflam reaction
- see inflam papule on skin -> pustule -> nodule/cyst

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10
Q

Acne

Grading

A
  1. open + closed comedones visible (mild)
  2. inflam papules (mild)
  3. pustules (mod)
  4. nodules/cysts (severe)
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11
Q

Acne

Tx

A
  • mild = topical
  • mod = topical + systemic
  • severe = isotretinoin
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12
Q

Acne topical tx

Benzoyl-peroxide

A
  • anti-bacterial
  • local side effects
  • combo: topical retinoids/systemic antibiotics
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13
Q

Acne topical tx

Retinoid

A
  • targets + reduces infundibular hyperkeratosis
  • anti-inflam
  • don’t use during pregnancy
  • don’t use during isotretinoin tx
  • apply at night, more on outside thann inside
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14
Q

Acne topical tx

Antibiotics

A
  • avoid due to resistance that can develop
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15
Q

Acne systemic tx

Systemic antibiotics

A
  • targets proliferation of propionibacterium acne
  • anti-inflam
  • not taken on empty stomach
  • contra-indicated under 12 yrs
  • stopped after 3m

females
- combined contraceptives = anti-androgens
- target: blocks androgen stimulation of sebaceous gland
- combine with roaccutane

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16
Q

Acne systemic tx

Isotretinoin

A
  • target: acts on pathogenisis aspects
  • lowest dose = half of weight 0.5-1mg/kg - 120mg/kg
  • side effects: dry skin + mucosae, mild alopecia, aches, pains, teratogenic
  • bloods: pregnancy, LFTs, lipid profile, FBC, glucose
    1 month after tx, then every 3m

roaccutane indications
- grade 4 acne
- scarring
- therapy failed (over 3m)
- dysmorphophobia
- gram neg folliculitis

nb info
- side effects
- warn against pregnancy
- no blood donation
- sun protection
- no vit a

17
Q

Acne tx

Surgery

A
  • avoid in acne
  • remove comedones
  • remove cysts
  • dermabrasion
  • laser
18
Q

Acne

Secondary acne

A
  • sign of systemic disease
  • cause: increase anrogens
    stimulate sebaceous glands
  • endogenic = PCOS
  • if not mprove on isotretinoin then think endogenic cause
19
Q

Acne

Hidradenitis suppurative

A
  • recurrent boils/papules in skin folds (under arms, axillae)
  • inflam
  • poor QOL
  • severe scarring
  • tx: topical antibiotics + doxycycline for 3m
20
Q

Rosacea

General

A
  • sensitive, burning skin with flushing
  • middle aged women
    (also men any age)
  • cheecks, forehead, chin, glabella
  • erythematous
  • no comedones
  • ask about steroid use (can be trigger)
21
Q

Rosacea

Tx

A
  • exclude topical steroid use
  • sunscreen
  • avoid triggers
  • metronidazole gel = anti-inflam
  • topical ivermectin
  • doxycycline = anti-inflam

The Skin (4 decks)

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