Acne Vulgaris

Acne - Dr Robert Kelly St Vincent’s Hospital Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne Extremely common Often distressing Copyright Dr Robert Kelly - not to be reproduced without permission of the author Teenagers and acne Particularly vulnerable Appearance aware Social pressures Self confidence Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne .Potential to significantly impact on quality of life may lead to: .depression, anger .embarrassment, anxiety .isolation .social withdrawal Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne Physical Effects • Sore , tender, painful • scarring Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne - prevalence .12-24yrs- 85% .25-34yrs - 8% .35-44yrs - 3% Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne - Sex difference 18yrs: Male > Female > 23yrs: Female > Male Copyright Dr Robert Kelly - not to be reproduced without permission of the author Pathogenesis .follicular hyperkeratosis .increased sebum production .propionibacterium acnes .inflammation Copyright Dr Robert Kelly - not to be reproduced without permission of the author Hair follicle and Sebaceous Glands Copyright Dr Robert Kelly - not to be reproduced without permission of the author Clinical lesions Non inflammatory . closed comedone (whitehead) . open comedone (blackhead) Copyright Dr Robert Kelly - not to be reproduced without permission of the author Clinical Lesions Inflammatory .papule .pustule .cyst .resolving erythema Copyright Dr Robert Kelly - not to be reproduced without permission of the author other acneiform conditions Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne - differential diagnoses .Acne Rosacea .Perioral Dermatitis .Folliculitis .Staphylococcal .Pityrosporum Copyright Dr Robert Kelly - not to be reproduced without permission of the author Rosacea Chronic, recurrent Oral antibiotics tetracyclines erythromicin Topical antibiotics metronidazole erythromicin Azelaic acid Copyright Dr Robert Kelly - not to be reproduced without permission of the author Perioral Dermatitis Copyright Dr Robert Kelly - not to be reproduced without permission of the author Perioral Dermatitis Cause: potent topical steroids idiopathic Treatment: oral tetracyclines, erythromicin 4 to 6 weeks Copyright Dr Robert Kelly - not to be reproduced without permission of the author Staphylococcal Folliculitis Copyright Dr Robert Kelly - not to be reproduced without permission of the author Hidradenitis Suppurativa Copyright Dr Robert Kelly - not to be reproduced without permission of the author Copyright Dr Robert Kelly - not to be reproduced without permission of the author Hidradenitis Suppurativa .Chronic relapsing disease of apocrine gland follicles .Recurrent boils in groin, axillae and sub -mammary areas .Mild to severe Copyright Dr Robert Kelly - not to be reproduced without permission of the author Hidradenitis - treatment Antibiotics Hormonal therapy for females Roaccutane Immunosuppressive therapy eg cyclosporin Biologic therapy – TNF inhibitors Surgery Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne - exacerbating factors .oils, grease eg: moisturisers, occupational .humidity eg: tropical acne .drugs eg steroids .friction, pressure eg: straps, helmets .scratching/picking eg acne excoriee Copyright Dr Robert Kelly - not to be reproduced without permission of the author Chloracne – Ukraine exposure to chorinated aromatic hydrocarbons Copyright Dr Robert Kelly - not to be reproduced without permission of the author Steroid Induced Acne Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne Excoriée Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne fulminans Abrupt onset Severe cystic acne May be preceded by mild to moderate acne Fever, arthralgia’s, myalgia’s Males 13-16 yrs Scarring Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne - Myths .diet .water consumption .hygiene .infectious .adolescent problem only .manifestation of a systemic problem Copyright Dr Robert Kelly - not to be reproduced without permission of the author PCOS Amenorrhoea Acne Hirsutism Overweight Insulin resistance, hyperlipidaemia, infertility Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne - therapeutic principles .slow onset of action .prolonged duration of treatment .suppressive vs curative .combination therapy .compliance Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne - general measures .avoid greasy topical applications .avoid excessive scratching and picking .wash face two to three times per day .gentle soap if sensitive skin Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne - treatment .Topical applications .Antibiotics .Hormonal therapy .Isotretinoin Copyright Dr Robert Kelly - not to be reproduced without permission of the author Intra-lesional Steroids Copyright Dr Robert Kelly - not to be reproduced without permission of the author Topical Therapy .Retinoids eg Retin A, Differin .Benzoyl peroxide (BPO) .Combination of above – Epiduo Gel .Antibiotics .Erythromycin – Eryacne Gel .Clindamycin – Clindatech Lotion . Combination: Duac Gel (clindamycin + BPO) Copyright Dr Robert Kelly - not to be reproduced without permission of the author Topical Therapy .Keratolytics salicylic acid, glycolic acid (AHA)lotion .Nicotinamide .Azelaic acid .Topical antiseptics – triclosan, phisohex, sapoderm, clearasil Copyright Dr Robert Kelly - not to be reproduced without permission of the author Oral Antibiotics .Minocycline 50mg bd .Doxycycline 50mg bd .Trimethoprim 300mg bd .Bactrim DS one tab bd .Erythromicin 500mg bd Copyright Dr Robert Kelly - not to be reproduced without permission of the author Oral Antibiotics - Issues long term toxicity bacterial resistance Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne - hormonal therapy .Oral contraceptive .Cyproterone acetate .Androcur (cyproterone acetate) .50mg days 5 - 14 with the pill .Aldactone .100 to 200 mg/day Copyright Dr Robert Kelly - not to be reproduced without permission of the author Isotretinoin (Roaccutane) Extremely effective Relatively safe Side effects common, predictable, not serious Frequently curative Copyright Dr Robert Kelly - not to be reproduced without permission of the author Isotretinoin - Myths “Strong”, dangerous Depression common Affects the liver Permanent side effects Copyright Dr Robert Kelly - not to be reproduced without permission of the author Isotretinoin - indications severe scarring resistant psychological factors Copyright Dr Robert Kelly - not to be reproduced without permission of the author Isotretinoin (Roaccutane) .average duration - 6 months .0.5mg/kg daily dose .98% clear .80% cure .20% recur Copyright Dr Robert Kelly - not to be reproduced without permission of the author Isotretinoin - side effects .dryness .sun sensitivity .initial exacerbation of acne .tiredness, lethargy, joint aches and pains Copyright Dr Robert Kelly - not to be reproduced without permission of the author Isotretinoin - side effects elevation of LFT’s, lipids birth defects depression Copyright Dr Robert Kelly - not to be reproduced without permission of the author Acne .Common .impacts on quality of life .treatable Copyright Dr Robert Kelly - not to be reproduced without permission of the author.

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