Transcript Acne
Acne Justin Walker October 2009
Classification
Mild to moderate Plugged pores Sebum collection Moderate to severe
Propionibacterium acnes
Inflammation, pustules Cysts, nodules, scarring Other causes PCOS Halogenated hydrocarbons
Differentials
Differentials
Rosacea Older age group Absence of comedones, nodules and scarring
Differentials
Differentials
Folliculitis Infected hair follicle, responds to abx.
NB demodex folliculitis caused by mites, pityrosporum folliculitis caused by yeasts.
Differentials
Differentials
Perioral dermatitis Distribution!
Associated with fluorinated steroids.
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
Poor hygiene Diet Stress Water intake Sunshine Cannot be cured
Myths
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.
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!
Topical Treatments
Topical antibiotics Erythromycin and clindomycin Good for inflammation but don’t 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.
Topical Treatments
Azelaic acid Unblocks pores, some reduction of inflamed acne Less effective than topical antibiotics or benzoyl peroxide
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.
Oral Treatments
Isotretinoin Suppresses sebum production Specialist initiation Teratogenic S/E dry skin/mucous membranes, nosebleeds, joint pains Minimum course 16 weeks.
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
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