Acne

Question 1

Describe the aetiology of acne

Answer 1

• keratin and thick sebum blockage of sebaceous gland
• androgenic stimulated increased sebum production and viscosity (thicker and harder to eradicate)
• proprioni bacterium causes inflammation

Question 2

Describe the clinical features of acne

Answer 2

• papules (small raised red bumps)
• pustules
• comedones (black/white heads)
• all 3 for diagnosis
• erythema
• cysts
• scarring

Question 3

Describe the distribution of acne

Answer 3

• face
• chest
• back and shoulders
• occasionally legs and scalp

Question 4

List the subtypes of acne

Answer 4

• papulopustular
• nodulocystic
• comedonal
• steroid-induced
• acne fulminans (serious, sudden onset, inflammatory)
• acne rosacea
• hidradenitis (acne inversus = in folds/inverted areas of skin, affecting apocrine glands in axilla and groin)

Question 5

What are the treatment aims and options for acne?

Answer 5

• reduce plugging (topical retinoid, topical benzoyl peroxide)
• reduce bacteria (topical antibiotics = erythromycin/clindamycin, oral antibiotics = tetracyclines/erythromycin, benzoyl peroxide reduces bacterial resistance)
• reduce sebum production (hormones, anti-androgen)
• dietary modification (reduce dietary/glycaemic load eg. Chocolate/milk)

Question 6

What are the possible side effects of acne treatment?

Answer 6

• topical (irritant, burning, peeling, bleaching)
• oral (gastro-upset)
• OCP (clot risk)

Question 7

Describe oral isotretinoin treatment for acne

Answer 7

• for severe acne vulgaris
• concentrated form of vitamin A
• reduces sebum, plugging and bacteria
• 16 week course
• side effects = liver dysfunction, raised lipids, mood disturbance, teratogenicity
• pregnancy prevention programme (not dispensed without negative pregnancy test + OCP prescription)