Acne

Question 1

Acne is the

Answer 1

chronic inflammation of pilosebaceous units.

It produces comedones (blackheads), papules, pustules, scars and cysts

Question 2

What are the causes of acne?

Answer 2

• Hyper-responsiveness of pilo-sebaceous units in the skin to androgens, increasing sebum (oil) secretion
• Comedones form in follicles with an excess of keratinised epithelial cells
• Propionibacterium acnes may colonise these units
• Inflammatory mediators are also released

Question 3

Myths about acne

Answer 3

• Sunlight has little/ no benefit
• Picking doesn’t improve it
• It is not contagious
• Not due to diet
• Not due to poor hygiene/ washing too many times can cause aggravation
• Stress does not cause acne but rather acne causes stress

Question 4

Who gets acne?

Answer 4

• People of all ages and races
• Most common in adolescents and young adults
• 85% between 12-25
• Usually resolves around 25-30
• Persistent acne seen in patients in their 40s and 50s

Question 5

How is acne graded?

Answer 5

0 - no acne, clear
1 - mild acne, comedones, papules, few pustules
2 - moderate acne, comedones, multiple papules and pustules
3 - moderately severe, multiple comedones, papules, pustules, mild scaring
4 - severe acne, multiple comedones, papules, pustules, nodules, inflammatory cysts, scarring

Question 6

How is grade 1 acne treated?

Answer 6

• Topical retinoids

- Benzoyl peroxide/ Topical antibiotic

Question 7

How is grade 2/3 treated?

Answer 7

• Topical retinoids
• Benzoyl peroxide/ Topical antibiotic
• Oral antibiotic
• Hormone therapy (females only)

Question 8

How is grade 4 treated?

Answer 8

• Isotretinoin

OR

• Topical retinoids
• Oral antibiotics
• Hormone therapy (females only)

Question 9

What is given for maintenance of acne?

Answer 9

Topical retinoids +/- Benzoyl peroxide

Question 10

How does benzoyl peroxide work?

Answer 10

• Breaks down on contact with skin to benzoic acid and oxygen
• Comes as cream/ gel in 2.5%, 5% and 10%
• No evidence to show that >2.5% is more effective + less side effects
• Peeling agent that increases skin turnover + clearing pores; reducing bacterial count there as acting directly as an antimicrobials

Question 11

Alternative to Benzoyl Peroxide?

Answer 11

Azeliac acid

Question 12

What is azeliac acid?

Answer 12

An alternative to benzoyl peroxide. Patients claim less local irritation

Question 13

Topical antibiotic treatment?

Answer 13

e. g clindamycin 1% lotion
- use with benzoyl peroxide or a topical retinoid to limit development of bacterial resistance
- course limited to a max of 12 weeks

Question 14

What is the most important class of drugs used to treat acne?

Answer 14

Topical retinoids

Question 15

Topical retinoids

Answer 15

• most important class of drugs to treat acne
• topical Vit A derivative
• may take 8-12 weeks to work
• affects follicular keratinisation
• photosensitivity
• avoid in pregnancy
• s/es peeling, dry skin

Question 16

Systemics:

• oral antibiotic e.g
• hormone therapy
• isotretinoin

Answer 16

• Tetracyclines given for a min of 3-4 months
• dianette suitable for women only
• effective but only used in severe cases. Teratogenic and said to cause sudden depression in minority of patients.

Question 17

Hormone therapy e.g Dianette

Answer 17

• co-cyprindiol
• anti-androgen
• decreased sebum production
• helps female hirsutism
• risk of thrombosis

Question 18

Oral retinoids are used in severe cases

Answer 18

• They are 1st gen retinoids
• teratogenic
• psychiatric changes
• supervised by specialist

Question 19

Disadvantages of isotetrinoin

Answer 19

• can cause birth defects
• female patients must not get pregnant
• depression/ irritability
• dry mouth, lips, nose, skin, eyes
• changes in blood such as in increase in triglycerides and cholesterol or change in liver function

Question 20

What is Rosacea?
What are the main features?
Treated by?

Answer 20

A chronic inflammatory facial rash
Main features and redness and pustules
Tends to occur in middle age
Made worse by sunlight
Can lead to rhinophyma 
Responds to topical metronidazole or oral tetracycline

Question 21

Causes and risk factors of Rosacea?

Answer 21

Triggers: spicy foods, exercise
Genetics
H.pylori genes
Abnormalities in blood vessels