What are causes of facial rashes?
- Acne vulgaris
- Rosacea
- Seborrhoeic eczema
- Atopic eczema
- Contact eczema
- Dermatomyositis
- Perioral dermatitis
- Photosensitivity
- Sarcoidosis
- SLE
What is acne vulgaris?
Characterised by pilosebaceous units that are blocked by dark plugs of keratin, called comedones or blackheads. These blocked follicles become infected and swell up to form the characteristic pustules which may discharge on to the skin surface or rupture into the dermis, with resultant scarring
What is acne vulgaris a disorder of?
Pilosebaceous follicles
What is the pathogenesis of acne vulgaris?
Development is dependent on circulating testosterone which is converted to the active hormone by enzymes contained in the pilosebaceous system itself.
Processes involved include increased sebum production, obstruction of outflow, leakage into surrounding dermis, and excessive colonisation
What organism is often implicated in acne?
Proprionibacterium acnes
What are features of acne vulgaris?
- Three cardinal features:
- Open comedones (blackheads) or closed comedones (whiteheads)
- Inflammatory papules
- Pustules
- Seborrhoea
What are the main clinical variants of acne?
- Infantile acne
- Steroid acne - 2o to steroid use
- Oil acne - industrial disease
- Acne Fulminans - necrotic, crusted acne
- Acne conglobata
- Acne excoriee
- Follicular occlusion triad
If you saw someone with acne looking lesions, what would your differential diagnosis be?
- Acne vulgaris
- Acne rosacea
What are the “5 pillars of acne”?
- Basal keratinocyte proliferation in pilosebasceous follicles
- Increased sebum production
- Propionibacterium acne colonisation
- Inflammation
- Comodones
How would you manage mild acne vulgaris?
Topical agents - benzoyl peroxide, topical retinoids
How would you manage moderate acne vulgaris?
Antibiotic with topical treatment - e.g. doxycycline/minocycline + benzoyl peroxide
How would you manage severe acne vulgaris?
Oral retinoid drug (isotretinoin)
If you put someone on oral retinoids, what would you need to monitor?
- Triglycerides
- AST/ALT
- Cholesterol
- FBC
What are side effects to isotretinoin?
- Teratogenic
- Dry skin
- Deprssion
- Myalgia
- Headache
- Hepatitis
- Increased lipids
How do retinoid drugs work?
Synthetic vitamin A analogues that affect cell growth and differentiation. They are very teratogenic
What is mandatory in females of child-bearing age who are being started on oral retinoid drugs?
. A pregnancy test, contraceptive advice and signed consent
How long after therapy should women avoid pregnancy when they have been treated with isoretinoin?
1 month
What is acne rosacea?
A chronic relapsing/remitting disorder of blood vessels and pilosebaceous units in central facial areas typically in fair-skinned people
What is the cause of rosacea?
Unknown
What is the most common age of onset of rosacea?
Middle age
Who does rosacea most commonly affect?
Women
What skin mite has been implicated in the development of acne rosacea?
Demodex
What are the features of acne rosacea?
Affecting nost, forhead and cheeks
- Facial flushing/erythema
- Inflammatory papules
- Pustules (without comodones)
- Telangiectasia
- Blepharitis
- Keratitis
- Sebaceous gland hypertrophy
What things can exacerbate/trigger flushing attacks in rosacea?
- Stress/blushing
- Alcohol
- Spices
- Hot drinks
- Prolonged topical Steroids
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History, examination and classification of skin lesions23
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Psoriasis35
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Eczema/Dermatitis46
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Urticaria/Angioedema14
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Bullous disease24
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Skin tumours50
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Cutaneous signs of systemic disease60
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Erythroderma8
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Facial Rashes26
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Skin infection122
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Lichen planus10
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Acute and Emergency Dermatology58
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Common problems4
