13.03.07 Dermatology teaching - Acne

Classification

    • Vulgaris

      • Standard

    • Excoriee

      • Scratched

    • 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

        • 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)

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

      • 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

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

      • From topical steroids

    • Chronic idiopathic urticaria

      • Appear to be allergic to everything

    • Patch testing (Type IV) vs serum IgE testing (Type I)

    • Garlic allergy