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Acne vulgaris (Pathogenesis (Increased sebum Sebeceous glands become more…
Acne vulgaris
Pathogenesis
Increased sebum
Sebeceous glands become more sensitive to androgens
and increase sebum production
Bacterial colonisation
Propionibacterium acnes colonises sebacious glands
Keratinocyte proliferation
Basal proliferation in follicles due to androgen production
Comedones
Inflammation of infected sebaceous glands causing open (black) comedones and closed (white (comedones)
Hormones
Androgens and CRH increase
Progression
Papules, nodules, cysts, scarring, pigmentation
Often spontaneously improves with time
Clinical
presentation
Comedones (black/white)
Papules and pustules
Nodules and cysts
Scarring
Diagnosis
Examination
Derm
Comedones, papules, pustules, nodules, cysts, scarring
Areas affected - face, back, shoulders
Severity
classification
Moderate
Comedones, papules and pustules
Severe
Nodules, cysts, scars, papules, pustules
Mild
Comedones only
History
DH
Medications, allergies (abx)
FH
Acne
PMH
Previous skin problems
SH
Smoking, alcohol, occupation,
impact on school/work, social impact
PC/HPC
Comedones, papules, pustules, nodules, cysts
Areas affected, treatments tried, impact on QoL
Check mood, self-image, suicidal ideation
Epidemiology
Common
Teenagers, can persist into adult life
Management
Conservative
Information (not due to poor hygeine, not contageous,
diet doesn't seem to affect it)
Advice (avoid picking, regular washing with acne soap)
Support (check about body image and mood)
Referral to dermatologist if severe
Medical
Topical
Keratolytic agent
Indication: 1L mild acne; 1L moderate acne plus abx/retinoid
E.g. benzoyl peroxide (2.5, 5, 10%)
MOA: keratolytic agent; takes 8wk to effect
Antibiotic
Indication: 2L mild acne as an add on;
1L moderate plus BP and retinoid
E.g. erythromycin, clindamycin
MOA: kills bacterial infection of the sebaceous glands; use 12w
Retinoid
Indication: 2L mild acne as add on
E.g. isotretinoin, tretinoin
MOA: vit A antagonist, reducing keratinocyte proliferation
Systemic
Antibiotic
Indication: 1L moderate plus topical BP
E.g. tetracycline, oxytetracycline, doxycycline, lymecycline
MOA: kills bacterial colonisation of the sebaceous glands; use 4-6m
COCP
Indication: moderate acne and contraception needed
E.g. microgynon, yasmin, dianette
MOA: reduces androgen levels, reducing sebum production
Retinoid
Indication: severe acne (specialist use)
E.g. isotretinoin, acitretin
MOA: vit A antagonist, reduces sebum production
SEs: teratogenic, skin/mucosal dryness, depression
Definition
Skin condition characterised
by red pimples typically on
the face, due to inflamed/
infected sebaceous glands