Acne

Question 1

What is acne vulgaris?

Answer 1

A chronic inflammatory condition of the pilo sebaceous with an onset around 14-20 y/o and normally resolves within 4 to 5 years

Question 2

What’s does acne affect?

Answer 2

Face, neck, chest, back, arms, legs and buttocks

Question 3

What is stage 1 acne?

Answer 3

Minor pimples

Blackheads and milia

Whiteheads

No inflammation

Question 4

What is stage 2 acne?

Answer 4

More blackheads/milia

Papules and pustules

Slight inflammation

Acne breakout may spread from face to other parts of the body

Question 5

What is type 3 acne?

Answer 5

Significant inflammation

Severe papules and pustules

Cystic nodules present

High risk for scarring and post inflammatory hyperpigmentation

Question 6

What causes acne?

Answer 6

1. Excessive sebum production - testosterone levels are normal
2. Abnormal follicular keratinisation - keratinising epithelium and increased production of corneocytes
3. Proliferation of propionibacterium acnes - anaerobic bacteria
4. Triggers - hormones, stress, hot humid conditions, airborne grease/oils, greasy cosmetics and restrictive clothing
5. Papules, pustules, cysts and nodules
6. Hyperpigmentation

Question 7

What drugs can induce acne?

Answer 7

Lithium, phenytoin, steroids, hormones, iodides and bromides

Question 8

How do you treat acne in primary care?

Answer 8

1. A fixed combination of topical adalapene and topical benzoyl peroxide - applied od in the evening
2. A fixed combination of topical tretinoin and topical clindamycin - applied od in the evening
3. A fixed combination of topical adalapene and topical benzoyl peroxide - applied od in the evening together with either oral lymecycline 408mg or doxycycline 100mg od
4. Topical azelaic acid (15 or 20%) applied bd in the evening together with either oral lymecycline 408mg or doxycycline 100mg od

Question 9

How do topical retinoids work for the treatment of acne?

Answer 9

1. Increase epithelial turnover
2. Reduce keratinius plug formation
3. Increases sebum drainage
4. C/I in pregnancy
5. S/E skin irritation and peeling

Question 10

How does systemic isotretinoin work?

Answer 10

See slide