Acne Vulgaris

Acne - Dr Robert Kelly St Vincent’s Hospital

 Extremely common  Often distressing

 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

• Sore , tender, painful • scarring

.12-24yrs- 85%

.25-34yrs - 8%

.35-44yrs - 3%

18yrs: Male > Female > 23yrs: Female > Male

.follicular hyperkeratosis .increased sebum production .propionibacterium acnes .inflammation

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

 other acneiform conditions

.Acne Rosacea .Perioral Dermatitis .Folliculitis .Staphylococcal .Pityrosporum

 Chronic, recurrent  Oral antibiotics  tetracyclines  erythromicin  Topical antibiotics  metronidazole  erythromicin  Azelaic acid

Cause: potent topical steroids idiopathic Treatment: oral tetracyclines, erythromicin 4 to 6 weeks

.Chronic relapsing disease of apocrine gland follicles .Recurrent boils in groin, axillae and sub -mammary areas .Mild to severe

 Antibiotics  Hormonal therapy for females  Roaccutane  Immunosuppressive therapy eg cyclosporin  Biologic therapy – TNF inhibitors  Surgery

.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

 Abrupt onset  Severe cystic acne  May be preceded by mild to moderate acne  Fever, arthralgia’s, myalgia’s  Males 13-16 yrs  Scarring

.diet .water consumption .hygiene .infectious .adolescent problem only .manifestation of a systemic problem

 Amenorrhoea  Acne  Hirsutism  Overweight  Insulin resistance, hyperlipidaemia, infertility

.slow onset of action .prolonged duration of treatment .suppressive vs curative .combination therapy .compliance

.avoid greasy topical applications .avoid excessive scratching and picking .wash face two to three times per day .gentle soap if sensitive skin

.Topical applications .Antibiotics .Hormonal therapy .Isotretinoin

.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

.Minocycline 50mg bd .Doxycycline 50mg bd .Trimethoprim 300mg bd .Bactrim DS one tab bd .Erythromicin 500mg bd

long term toxicity bacterial resistance

.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

 “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

.average duration - 6 months .0.5mg/kg daily dose .98% clear .80% cure .20% recur

.dryness .sun sensitivity .initial exacerbation of acne .tiredness, lethargy, joint aches and pains

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