Acne

1
Acne

• Justin Walker
• October 2009

2
(No Transcript)
3
Classification

• Mild to moderate
• Plugged pores
• Sebum collection
• Moderate to severe
• Propionibacterium acnes
• Inflammation, pustules
• Cysts, nodules, scarring
• Other causes
• PCOS
• Halogenated hydrocarbons

4
Differentials
5
Differentials

• Rosacea
• Older age group
• Absence of comedones, nodules and scarring

6
(No Transcript)
7
Differentials
8
Differentials

• Folliculitis
• Infected hair follicle, responds to abx.
• NB demodex folliculitis caused by mites,
  pityrosporum folliculitis caused by yeasts.

9
Differentials
10
Differentials

• Perioral dermatitis
• Distribution!
• Associated with fluorinated steroids.

11
What makes it worse?

• Progesterone only pill
• Hormone changes with periods
• Make up
• Picking and squeezing
• Humid environment/sweating
• Tight clothing
• Drugs phenytoin, steroid creams
• Anabolic steroids

12
(No Transcript)
13
Myths

• Poor hygiene
• Diet
• Stress
• Water intake
• Sunshine
• Cannot be cured

14
Topical Treatments

• Benzoyl peroxide
• Available over the counter
• Good for comedones infected lesions
• 2.5-10 available, start low and increase as
  tolerated
• Wash skin beforehand, wash off after several
  hours
• Start od, bd if tolerated.

15
Topical Treatments

• Topical Retinoids
• Adapalene, tretinoins and isotretinoin
• Unblock pores, reduce inflammation
• S/E skin redness and peeling, sun sensitivity
  apply at night and wash off in morning.
• Use lower strength if not tolerated.
• Avoid in pregnancy discuss contraception!

16
Topical Treatments

• Topical antibiotics
• Erythromycin and clindomycin
• Good for inflammation but dont unblock pores
• Local guidelines recommend topical for those who
  cannot tolerate oral.
• Can use with short courses benzoyl peroxide/
  azelaic acid
• Topical abx need to be used for 6 months.

17
Topical Treatments

• Azelaic acid
• Unblocks pores, some reduction of inflamed acne
• Less effective than topical antibiotics or
  benzoyl peroxide

18
(No Transcript)
19
Oral Treatments

• Antibiotics
• Reduce inflammation,
• Not good at unblocking pores may need
  concommitant topical bp/aa
• Local guidelines doxycycline, lymecycline,
  erythromycin
• Use for 3 months and review
• Tetracyclines not for under 12s, not in
  pregnancy discuss contraception. Women on cocp
  need additional precautioins for first 3 weeks.

20
Oral Treatments

• Isotretinoin
• Suppresses sebum production
• Specialist initiation
• Teratogenic
• S/E dry skin/mucous membranes, nosebleeds, joint
  pains
• Minimum course 16 weeks.

21
Oral Treatments

• Co-cyprinidol
• Cyproterone acetate with ethinylestradiol aka
  Dianette
• Contains anti-androgen
• Same effectiveness as oral broad spectrum
• Useful if a woman also requires oral
  contraception, although not licensed as a
  contraceptive.
• Increased risk of venous thromboembolism
• Use only in women with severe acne and hirsutism

22
When to Refer?

• Immediate referral
• Acne fulminans
• Urgent referral
• Severe/Nodulocystic acne and may benefit from
  oral isotretinoin
• Severe psychological/social problems
• Routine referral
• At risk of or are developing scarring despite
  therapy
• Moderate acne failing to respond (2 x 3 month
  courses abx)
• Possible underlying endocrinological cause eg PCOS

23
Acne fulminans
24
Thank you!