“Don’t make a mountain out of Dermatology” Mole Hill Topics: • Psoriasis & Eczema • Acne & Rosacea • Urticaria, Itch & Itchy Rashes • Melanoma & it’s mimics • SCC, Bowens, AKs • BCC & Benign skin lumps & bumps

Dr Paul Farrant, Consultant Dermatologist & Clinical Lead at BSUH Acne & Rosacea Pustular and Papular conditions

• Acne • Rosacea • Peri-oral dermatitis Acne Acne Pathology Acne

Questions: • Adolescent vs Late onset? • Menstrual flare? • Simple vs scarring • Predominant feature – comedones vs inflammatory

Acne Management – Simple: Avoid greasy/oil based moisturisers & make up – Targeting the comedo - OTC Salicylic acid, Benzoyl Peroxide*, Retinoids & Combinations – Targeting P Acnes - Topical antibiotics? Light devices? Benzoyl Peroxide – Targeting the Sebaceous gland - COCP with anti- androgenic effect

* No evidence of difference between 2.5%, 5% and 10% but lower strengths less side effects Combinations

• Benzoyl Peroxide + Adapalene = Epiduo • Benzoyl Peroxide + clindamycin = Duac

• Combinations more effective that BPO alone Acne Management – Inflammatory - Add in systemic antibiotics - Tetracyclines, Macrolides, Trimethoprim

– Systemic Retinoids – Severe Acne (clinical & psychological) – late onset – Scarring – Unresponsive

Sunscreen • Effaclar Duo+ 30 Acne & COCP

• COCP help both inflammatory and non inflammatory acne • No evidence that those containing cyproterone are more effective! • Consider the progesterone component • Drosperinone pills eg Yasmin, • Marvelon and Mercilon

Retinoids • Consultant led • Safe in expert hands • Lots of potential side effects • All - Dry skin and dry lips +/- nose bleeds • Some - muscle aches, fatigue, hair loss • Uncommon - mood change, depression • Highly teratogenic > Pregnancy Prevention Programme Contraversies in Acne

Diet • Often suspected • Few studies • High glycameic load diets exacerbate acne • Chocolate not thought to be a factor • Dairy possible connection Rosacea Rosacea

• F>M • >30s +, often post-menopausal • Pale skin types, + Sun exposure • Mostly facial, but frequently involves eyes, can involve scalp and body • Often chronic / intermittent • Aetiology unknown - ?Demodex mite Rosacea

• No comedones • Flushing • Telangiectasia • Papules • Pustules

• Rhinophyma - Is this really part of rosacea?

Rhinophyma – before and after surgery Rosacea - Differential

• Acne • Lupus

• Overlap with seborrhoeic dermatitis – Can use mild steroids eg hydrocortisone – Avoid ointments

• Tinea • Folliculitis Rosacea – Why does it flare?

• Changes in innate immune system, reactions to demodex mite, vascular growth factors/mast cells • Common triggers include – Spicy food – Alcohol (esp red wine) How can it be managed?

• Gentle cleansers and “light” moisturisers – Cetaphil (Galderma), Bioderma / La Roche Posay • Topical antibiotics – Metronidazole • Azelaic Acid • Anti-mite products – Topical ivermectin • Flushing/Redness – Brimonidene – IPL/Laser How can it be managed?

• Systemic – Tetracyclines • High dose • Low dose modified release

– Retinoids • Isotretinoin

– Mast cell stabilisers? • Montelukast Peri-oral Dermatitis

• Small monomorphic papules around mouth with sparing of vermillion border • F>M • Assoc. steroid cream use • Ocular variant • Stop steroids + course tetracyclines 4/52 Acne & Rosacea

• Common skin problems • GPs should be familiar with first line management • Combinations of treatments often more effective than single agents • If severe acne with scarring don’t delay referrals Downloadable copy available: www.drpaulfarrant.co.uk

Questions: [email protected] Next Topic

Urticaria, Itch and Itchy Rashes Thurs 4th June 7:10pm