Explain the aetiology of acne
- Accumulation of epithelial cells and keratin results in a plugged follicle
- The shed keratin and sebum accumulates (increased sebum production and viscosity by increased androgens)
- Proprioni bacterium proliferate and when in contact with oil causes inflammation
What are the clinical features of acne?
- Papules
- Pustules
- Comedones
- Erythema
- Nodules
- Cysts
- Scarring
What is likely to be seen in darker skin types with acne?
Hyperpigmentation
What is the normal distribution of acne?
- Face
- Chest
- Back/shoulders
- Occasionally legs, scalp
What are the subtypes of acne?
- Papulopustular
- Nodulocystic
- Comedonal
- Steroid induced
- Acne fulminans
- Acne rosacea
- Hidradenitis (acne inversus)
What are the targets for treating acne?
- to reduce plugging
- To reduce bacteria
- To reduce sebum production
What treatments aim to reduce plugging in acne?
- Topical retinoid
* Topical benzoyl peroxide
What treatments aim to reduce bacteria in acne?
- Topical antibiotics (erythromycin, clindamycin)
- Oral antibiotics (tetracyclines, erythromycin)
- Benzoyl peroxide reduce bacterial resistance so used in combo
What treatments aim to reduce sebum production in acne?
•Hormones
- anti-androgen i.e. Dianette or oral contraceptive pill
What are the common side effects of acne treatments?
- Topical agents - irritant, burning, peeling, bleaching
- Oral antibiotics - gastro upset
- Oral contraceptive pill - DVT risk
What dietary modification may help in those suffering from acne?
•Reduce glycaemic load e.g. dairy, chocolate
What is isotretinoin?
Concentrated vitamin A
What does isotretinoin do?
Reduces sebum, plugging and bacteria
What is the standard course of isotretinoin?
16 weeks, 1mg/kg
What are the side effects of isotretinoin?
- Dry lips, dry skin, nose bleed
- Myalgia
- Deranged liver function
- Raised lipids (cholesterol and triglycerides)
- Mood disturbance
- Teratogenicity
