1. Acne
What is acne?
Symptoms
Causes
WWHAM
Medical treatment
Counselling

2. What is acne? Common skin complaint
Affects the skin sebaceous follicles (hair follicle and sebaceous glands)
appears at puberty and around 80% of people will have some degree of acne between the ages of 11 and 30.
Most common on the face, arms, back, and chest.

3. What are the symptoms? Non-inflammatory acne Whiteheads Blackheads
Papules
Pustules
Nodules
Blackhead
Whitehead
Papule c c
Social symptoms
Loss of self confidence
Anxiety and depression
May withdraw from
society
Pustules
Nodules

4. What are the causes? Major cause
During puberty, increase in testosterone production
Excess oil production (sebum)
Blockage of pores
Non-inflammatory spots
Infection by bacteria Propionibacterium
Inflammatory spots

5. During puberty, increase in testosterone production
What are the causes?
Major cause
During puberty, increase in testosterone production
Other causes
Genetics
Stress
Hormonal changes during menstrual cycles
Certain drugs – hydrocortisone, phenytoin,
anabolic steroids used by body builders

6. WWHAM Who ? What symptoms? Very young or very old patients
-> refer to a doctor
What symptoms?
By examining the patient
mild acne
-> OTC treatment
severe acne, severe psychological symptoms
-> refer to a doctor

7. WWHAM Actions taken? Medication? Previous treatments and their effects
Correct treatment - takes 2 months to see benefit.
Failure of treatment - refer to GP / use a 2nd line treatment.
Incorrect treatment e.g. infrequent application,
unsuitable strength– advise on correct use.
Medication?
Hydrocortisone cream for eczema
Steroids and the combined contraceptive pill

8. Drug treatment 1st line treatment
Retinoids for non-inflammatory lesion
vitamin A derivative
encourages the outer layer of skin to flake off
side effect: redness and peeling of skin
to minimize the effect, apply every 2 -3 days increasing to
once nightly when tolerated
contraindicated pregnancy – advise on use of effective
contraception. Avoid use in women who want to get
pregnant or are pregnant.

9. Drug treatment 1st line treatment
Benzoyl peroxide for inflammatory lesion
keratolytic and antibacterial action
Benzoyl peroxide 5% , 2.5%, 10%
Formulations: alcoholic gel for oily skin, aqueous cream for
sensitive or dry skin
Initial side effect: redness and peeling of skin
Start using once a day until tolerance is developed, then increase
the frequency to twice a day and the strength to 5%.

10. Drug treatment 2nd line treatment Nicotinamide Azelaic acid
alternative to benzoyl peroxide if it is not acceptable
anti-inflammatory action
topical cream
Azelaic acid
alternative to benzoyl peroxide for people with sensitive skin
inhibit growth of bacteria
Cleansing agent (GSL)
contains anti-bacterial ingredients (chlorhexidine, cetrimide)
remove excess sebum and skin cells and reduce bacteria on skin
placebo effect!

11. Counselling Diet Regular washing Make-up Sunlight
Not caused by eating chocolate or greasy food
Regular washing
Use soap water to remove excess sebum oil
Make-up
use water-based foundation rather than oil-based foundation
remove at the end of the day
Sunlight
Has drying and degreasing effect
However, use of sunbed is not recommended
as risk of melanoma outweigh the benefit.
ACNE IS NOT THEIR FAULT!

12. Role Play
Please Enjoy!

13. Summary Acne Minor ailment Main cause Hormonal changes during puberty
Non-inflammatory acne
Whiteheads, blackheads
Inflammatory acne
Papules, pustules, nodules
Symptoms
1st line treatment
Retinoids
Benzoyl peroxide
Nicotinamide
Azelaic acid
2nd line treatment
Benzoyl peroxide