Acne

Question 1

Acne Vulgaris

Answer 1

• inflammatory disease of the pilosebaceous follicles that are clogged with dead cells and oil
• the follicle becomes impacted with shed skin cells. The follicle may be blocked leading to comedone formation

Question 2

Acne Vulgaris Characteristics

Answer 2

Black heads, white heads, pimples, greasy skin, and scarring

Question 3

Epidemiology

Answer 3

• Typically presents at ages 8-12, peaks at ages 15-18, and resolves by age 25
• worse in males

Question 4

Causes

Answer 4

• Genetic predisposition
• Raised hormone levels, especially testosterone
• Thickening of follicular wall due to hyperproliferation leading to more dead cells
• Blockages in the follicles by dead skin cells
• Increased production of sebum by sebaceous glands to mix up with dead cells
• Bacteria in the follicles (Propionibacterium acnes) are involved: overgrowth of p. acnes
• Inflammation in the skin surrounding the follicles

Question 5

Factors that may exacerbate acne

Answer 5

• Emotional stress
• Premenstrual stress
• Mechanical Trauma
• Occlusive Clothing
• High humidity
• Harsh scrubbing of the skin
• Some cosmetic oils and topical products
• Various medications, especially steroids
• Psychological stress
• The role of diet is not clear

Question 6

Infant acne

Answer 6

• typically shows up after a few weeks
• appears on cheeks, forehead, chin, and even back
• no clear cause (possibly hormones that babies receive from their mother)
• may occur for up to 3 months
• Clears spontaneously

Question 7

Acne Vulgaris: The basics

Answer 7

• characterized by open & closed comedones, papules,pustules, cysts, nodules, and even scars
• primary sites are on the face, chest, back, and shoulders
• Severe acne should be treated to avoid permanent scars

Question 8

Non-inflammatory lesions

Answer 8

• clogged hair follicles by skin cells & sebum
• Open comedone (black head - filled w/ blackened keratin)
• Closed comedone (white head - follicle is completely blocked)

Question 9

Inflammatory Lesions

Answer 9

• Papules - elevated red bumps
• Pustules - elevated white pus bumps
• Nodules - elevated large and sometimes tender firm bumps
• “Cysts” - aka nodules, and if pus-filled called fluctuant nodule

Question 10

Scars

Answer 10

• Usually sharply punched out pits or deeper furros
• Hypertrophic and keloids
• can have Post-inflammatory hyperpigmentation

Question 11

Hypertropic Scars

Answer 11

thick scar same size as the lesion

Question 12

Keloid Scar

Answer 12

Scar larger than the original lesion;

Question 13

Post-Inflammatory Hyperpigmentation

Answer 13

Inflammation induces melanocyte to produce melanin

typically become lighter or go away in a few months

Question 14

Acne Classification

Answer 14

Based on the morphology and severity (number of acnes)

Question 15

Grade 1

Answer 15

Mild acne. The skin will display open and closed comedones and occasionally minor pimples. There is no inflammation.

Question 16

Grade 2

Answer 16

Moderate acne. Greater number of comedones. Papules and pustules are more frequently found.

Question 17

Grade 3

Answer 17

Moderate to severe acne. More inflammation present. Papules & Pustules are more numerous. Nodules are often present.

Question 18

Grade 4

Answer 18

Severe acne, many pustules, nodules and cysts. Comedones are numerous. Pronounced inflammation and breakouts likely extend to areas other than the face. Often called Cystic Acne

Question 19

Grade 1 Treatment

Answer 19

OTC treatments may be effective

Question 20

Grade 2 Treatment

Answer 20

OTC may be effective but if no improvement in 6-8 weeks, consult a physician

Question 21

Grade 3 Treatment

Answer 21

Referred to dermatologist

Question 22

Grade 4 Treatment

Answer 22

Must be treated by a dermatologist

Question 23

Four major treatment principles

Answer 23

• Correct follicular hyperkeratinization-comedolytics
• Decrease the follicular bacteria, particularly P. acnes population - antibiotics
• Produce an anti-inflammatory effect - antibiotics
• Decrease sebaceous gland activity - isotretinoin

Question 24

Mild Comedone Treatment

Answer 24

Topical Retinoid

Question 25

Mild papular/pustular Treatment

Answer 25

topical retinoid, topical antibiotics, topical benzoyl peroxide

Question 26

Moderate papular/pustular Treatment

Answer 26

oral antibiotics with topical retinoid and benzoyl peroxide

Question 27

Moderate nodular treatment

Answer 27

oral antibiotic with topical retinoid and topical benzoyl peroxide

Question 28

Severe nodular treatment

Answer 28

Oral isotretinoin

Question 29

Scarring and keloids treatment

Answer 29

oral isotretinoin