Please enable JavaScript.
Coggle requires JavaScript to display documents.
Acne Vulgaris a chronic inflammatory skin condition affecting mainly the…
Acne Vulgaris a chronic inflammatory skin condition affecting mainly the face, back and chest - it is characterised by blockage and inflammation of the pilosebaceous unit (the hair follicle, hair shaft and sebaceous gland). It presents with lesions which can be non-inflammatory (comedones), inflammatory (papules, pustules and nodules) or a mixture of both.
Classes
Mild acne — predominantly non-inflamed lesions (open and closed comedones) with few inflammatory lesions.
-
Severe acne — widespread inflammatory papules, pustules and nodules or cysts. Scarring may be present
Diagnosis
Clinical Features
affects areas of the body with a high density of pilosebaceous glands such as the face, chest and back
-
non-inflammatory comedones and inflammatory papules, pustules, nodules and scarring must be present for diagnosis to be made
Assessment
Duration, type and distribution of lesions.
-
Exacerbating factors such as flares with menstruation, contraceptives, cosmetics, face creams or hair pomades.
Systemic features — some rare subtypes of acne (acne fulminans) can present with systemic features including fever, arthralgia, and myalgia.
-
Family history including endocrine disorders, polycystic ovarian syndrome, acne and other skin conditions.
-
Drug history — some medications can cause or exacerbate acneform rashes including androgens, corticosteroids, isoniazid, ciclosporin and lithium.
Hyperandrogenism — may present with irregular periods, androgenic alopecia or hirsutism in women.
Management/Treatment
Mild to moderate:
-
A topical retinoid (for example adapalene [if not contraindicated]) alone or in combination with benzoyl peroxide. Retinoids are contraindicated in pregnancy and breastfeeding.
A topical antibiotic (for example clindamycin 1%) — antibiotics should always be prescribed in combination with benzoyl peroxide to prevent development of bacterial resistance. Topical benzoyl peroxide and topical erythromycin are usually considered safe in pregnancy if treatment is felt to be necessary.
-
Moderate acne: If response to topical preparations alone is inadequate consider adding an oral antibiotic, a tetracycline, such as lymecycline or doxycycline (for a maximum of 3 months). Avoid erythromycin due to high levels of acne resistance
avoid over cleaning, picking and squeezing to reduce the risk of scarring. Treatment can take up to 8 weeks to be effective. Provide information leaflet
-
Referral to dermatology
They have a severe variant of acne such as acne conglobata or acne fulminans (immediate referral is indicated).
They have severe acne associated with visible scarring or are at risk of scarring or significant hyperpigmentation — primary care treatment should be initiated in the interim.
-
Significant psychological distress is associated with acne regardless of severity — primary care treatment should be initiated in the interim.
-
DDx
-
-
-
Drug-induced acne — some drugs can cause or exacerbate acneiform eruptions including dioxins (chloracne), corticosteroids, anti-epileptics (phenytoin and carbamazepine), lithium, isoniazid, vitamins B1, B6 and B12.
-
-