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acne is characterised by 2 things…?
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what are the main causes of acne? - disease process
- increased keratin causes obstruction of sebaceous glands results in comedone formation
- androgens induce sebaceous gland to produce more sebum
- the duct gets colonised with p-acnes due to altered environment
- inflammation
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how can the severity of acne be graded?
- 1. clinical appearance
- 2. how many spots
- 3. scarring
- 4. how long has it been there for
- 5. how much is it affecting life
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what is the most common type of acne?
acne vulgaris
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which areas of the body does acne affect?
- face
- back
- chest
- (the comedogenic areas)
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what is a comedone?
- plug of sebum and keratin over a hair follicle
- can be open = blackhead
- closed = whitehead (remains white as oxygen couldn't get in to oxidise it)
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who does acne vulgaris affect more?
- adolescents - puberty
- b>g
- can have familial tendency
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why should acne be treated promptly?
to avoid scarring and post inflammatory pigmentation
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what 4 aspects does acne treatment need to target?
- androgens
- p acnes
- seborrhoea
- scarring
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what are the 3 general topical Rx for acne?
- benzoyl peroxide: kills microorganisms and dries skin
- antibiotics: kills organs and reduce inflame response
- topical retinoids: normalise desquamation + reduce inflame response
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what are the 3 main categories of systemic Rx for acne?
- antibiotics
- anti-androgens
- isotretinoins
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what 4 ways can acne affect someone psychologicaly?
- low self esteem
- depression
- anxiety
- poor inter-personal relationships
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what are the 2 main classifications of acne?
- mild, mod, severe
- comedonal, inflammatory, mixed
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what is the 1st choice drug for comedonal acne?
- topical retinoids: vitamin A derivative that are anti-inflamm and comedolytic
- eg adapalene or tretinoin
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how does benzoyl peroxide work?
- anti microbial
- bacteriostatic
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what is Rx of mild papular-pustular acne - ie INFLAMMATORY
- topical retinoids eg adapalene
- and
- topical antimicrobial eg benzoyl peroxide or antibiotics eg erythromycin/clindamycin
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what is Rx of moderate inflammatory acne?
- topical retinoid
- and
- ORAL antibiotics eg tetracyclines - minocycline, lymecycline
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what 2 things do you have to remember with tetracycline?
- absorption reduced by milk and antacids
- can cause photosensitivity so use at night
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what is the alternative oral Rx for females with moderate acne?
- dianette - cyproterone acetate + oestradiol
- anti-androgen
- use if evidence of hyperandrogenism eg PCOS
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what is Rx of severe acne?
ORAL isotretinoin - roaccutane
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what are SE of oral isotretinoin?
- dry kin especially on the face
- dry eyes
- hoarse voice
- cheilitis
- headache
- arthritis, myalgia
- teratogenicity
- psychiatric effects
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what do you have to ensure when prescribing oral isotretinoin to a woman?
- ask if pregnant
- do pregnancy test
- must use both hormonal and barrier method of contraception
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what is rosacea? features
skin disorder characterised by facial FLUSHING, persistent erythema, inflammatory papules, pustules, oedema, telangiectasia
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what is rosacea associated with?
- conjunctivitis
- blepharitis
- rhinophyma after chronic - thick, hypertrophic nasal skin
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what exacerbates rosacea?
- heat, exercise
- hot drinks/food, spicy food, alcohol
- sunlight
- emotion
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what is Rx of rosacea?
- avoid triggers
- avoid soaps and cleansers
- topical metronidazole
- azelaic acid cream - finacea
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