Classification- Vulgaris
- Excoriee
- Conglobata
- Fulmigans
- Scarring
- Secondary infection
- Death
- Infantile
Comedones- Open
- Sebum oxidation => Blackhead
- Closed
- Accumulation => Inflammation
- Infection (Propionibacterium acnes)
Treatments
- Topical
- Retionoids - Good for comodomal acne
- Azelaic acid
- Antimicrobials - Good for inflammatory acne
- Benzoyl peroxide (cf bleaching)
- Antibiotics
- 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)
Triggers- 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
- Sweating
- Premenstrual
- Exacerbates in 70% of women
Indications for patch testing
- Contact dermatitis
- Eczema not improving
- Hand/foot eczema
- Eczema unusual site
Notes- 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
- Chronic idiopathic urticaria
- Appear to be allergic to everything
- Patch testing (Type IV) vs serum IgE testing (Type I)
- Garlic allergy
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