• Vulgaris
• Standard
  
• Excoriee
• Scratched
• Conglobata
• Fulmigans
• Scarring
• Secondary infection
• Death
  
• Infantile
  

• Open
• Sebum oxidation => Blackhead
  
• Closed
• Accumulation => Inflammation
• Infection (Propionibacterium acnes)

Treatments

• Topical
• Retionoids - Good for comodomal acne
  
• Adapalene
• Retinoic acid
• Azelaic acid
• Antimicrobials - Good for inflammatory acne
  
• Benzoyl peroxide (cf bleaching)
  
• Antibiotics
• Clindamycin
• Erythromycin
  
• Combination creams
• Duac
• Benzamycin
• Isotrexin
• Epiduo
• Acnisal
• Oral antibiotics
  
• Combine with topical retinoid
• Tetracyclins
• Lymecycline
• Oxytetracycline
• Doxycycline
• Minocycline
• Erythromycin
• Hormones
• Dianette
• Cyproterone acetate (anti-androgen/progestogen) and ethinylestradiol
• As effective as COCP, but never used just for contraception
  
• COCP
• Isotretinoin (Roacutane)
  
• Only dermatologists can prescribe
• Give 120 mg/kg total dose, over 4 months
• Side effects
• Pregnancy category X
• Dry skin (everywhere)
• Photosensitivity
• Joint pain
• Nosebleeds
• Can make acne worse initially
• => Acne fulmigans
  
• Cover with low-dose pred.
  
• ? Depression (no evidence but be careful)

• Diet
• Generally no
• ? Low glycaemic index may help
• ? Milk / Fatty foods
• Stress
• Doesn't trigger new eruptions
• Facial hygiene
• Wash OD, non-oily
  
• No more required
• Smoking
• No link established
• Sweating
• Exacerbates
• Premenstrual
• Exacerbates in 70% of women

Indications for patch testing

• Contact dermatitis
• Eczema not improving
• Hand/foot eczema
• Eczema unusual site
  

• Androgens
• Testosterone
• DHT
• Dehydroepiandrosterone sulfate (DHEAS)
• Suphate ester of DHEA - Major circulating form
  
• Made in Adrenals / Brain
  
• cf pre-pubertal acne
• Pilosebaceous
• Epidermal invagination
  
• Hair follicle, sebaceous gland, arrector pili muscle
• All treatments take a couple of months to work
• No COCP if migraines (thrombosis association)
  
• Check for causes of raised androgens
• PCOS - Any 2 of:
  
• Oligoovulation and/or anovulation
• Excess androgen activity
• Polycystic ovaries (by gynecologic ultrasound)
• Acne rosacea
• Not real acne
• Eryhthema
• Papular/Pustular rash
• No comidones (doesn't involve PSU)
• Perioral dermatitis
• From topical steroids
• Chronic idiopathic urticaria
• Appear to be allergic to everything
• Patch testing (Type IV) vs serum IgE testing (Type I)
• Garlic allergy