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ACNE VULGARIS Dr Susan Parker

ACNE VULGARIS Dr Susan Parker. Definition: Acne is a chronic inflammatory disease of the pilosebaceous units. It is characterized by seborrhoea, the formation of comedones, erythematous papules and pustules, less frequently by nodules, deep pustules, or pseudocysts and, in some cases,

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ACNE VULGARIS Dr Susan Parker

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  1. ACNE VULGARISDr Susan Parker Definition: Acne is a chronic inflammatory disease of the pilosebaceous units. It is characterized by seborrhoea, the formation of comedones, erythematous papules and pustules, less frequently by nodules, deep pustules, or pseudocysts and, in some cases, is accompanied by scarring. Four major factors are involved in the pathogenesis: (i) increased sebum production (ii) hypercornification of the pilosebaceous duct (iii) an abnormality of the microbial flora especially colonization of the duct with P. acnes (iv) the production of inflammation

  2. Drugs Reported to Cause Acne or Acne-like Eruptions Hormones and steroids Antituberculous drugs Gonadotrophins Isoniazid Androgens Rifampicin Anabolic steroids Oral and topical steroids Miscellaneous Chlorate hydrate Halogens Cyanocobalamin Bromides Disulfiram Iodides Lithium Halothane Psoralens (with UVA) Anti-epileptic drugs Quinine Diphenylhydantion (phenytoin) Sulphur Phenobarbitone Thiouracil Troxidone Thiourea

  3. ASSESSMENT OF ACNE Assess for Presence or Absence Of: Comedones (open or closed) Inflammatory lesions (papules, pustules, nodules) Cysts Scars Post inflammatory hyperpigmentation Psychological distress Assess as mild, moderate or severe with or without scarring

  4. MILD ACNE Comedonal - Topical Retinoid Inflammatory - Topical Retinoid Topical Antibiotic BPO Benzoyl Peroxide MODERATE ACNE Add Systemic Antibiotic Adequate dose for 3 months (Consider Dianette) Always combine antibiotic with topical retinoid or Benzoyl Peroxide TREATMENT

  5. TOPICAL AGENTS (1) Anti- Anti- ComedonalinflammatorySide EffectsCosts (£) Benzoyl PeroxideYes Yes irritation 1.50 – 4.00 bleaching (try Aquagel or Quinoderm) reduce frequency/ strength Azelaic AcidYes Yes 3.75 Antibiotics:- Dalacin T Yes 4.34 – 8.47 ZinerytYes 7.71 (30mls) 22.24 (90mls) Stiemycin Yes 8.00 (50mls) Zindaclin Yes 8.66 (30g)

  6. TOPICAL AGENTS (2) Anti-ComedonalAnti-InflammatorySide EffectsCosts (£) Retinoids: Tretinoin (Retin A) Yes Yes irritation 5.61 (60g) Isotretinoin (Isotrex) Yes Yes irritation 6.18 (30g) Adapalene (Differin) Yes Yes less irritant 11.40 (45g) _____________________________________________________________________________ CombinationsCost (£) Duac (Clindamycin & BPO) 9.95 (25g) Aknemycin (Tretinoin and Erythromycin) 7.05 (25mls) Isotrexin (Isotretinoin & Erythromycin) 7.78 (30g) Benzamycin (Erythromycin & BPO) 15.62 (50g)

  7. SYSTEMIC ANTIBIOTICS Cost of 28 tablets Oxytetracycline 500mg – 1gm bd £ 1.52 250mg Erythromycin 500mg – 1gm bd £ 7.28 (Erymax 250mg £5.95) Lymecycline 408mg od-bd £ 7.16 Demeclocycline 150 – 300mg od-bd £ 6.94 Doxycycline 100mg od – bd £ 8.22 Minocycline 100mg od – bd £10.60

  8. SIDE EFFECTS OF ROACCUTANE Management if disease is: ______________________________________________________ Side effect Mild Moderate Severe ________________________________________________________________________ Chelitis Lubricant mild steroid Potent steroid ointment Facial dermatitis ointment combined with antiseptic Discoid dermatitis and oral antibiotic Xeroderma Nasal dryness and Lubricant Nasal mupirocin + oral soreness antibiotics Blepharoconjunctivitis Lubricant Mild steroid/antibiotic Antibiotic eye ointment combination + oral antibiotics Arthralgia & myalgia Nil Paracetamol Paracetamol Aspirin Aspirin Non-steroidal Non-steroidal Headache Nil Paracetamol, dose Consider BIH reduction Stop therapy Pyogenic granuloma Nil Potent steroid ointment Potent steroid ointment ± cautery and curettage ± cautery and curettage Note: if in doubt reduce the dose of or stop isotretinoin. BIH, benign intracranial hypertension.

  9. Some uncommon side effects of Isotretinoin • Achilles tendonitis • Acne fulminans • Depression • Diarrhoea • High-tone deafness • Mood changes • Night blindness • Sticky palms • Urticaria • Vasculitis

  10. INDICATION FOR REFERRAL • Non-response to adequate doses of antibiotics (Remember to assess compliance) • Severe acne (Cysts or scars) • Most patients with post inflammatory hyperpigmentation • Evidence of virilisation: Hirsutism Irregular menstruation Infertility Late onset acne • Acne excoriée • Psychological distress

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