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Acne Justin Walker October 2009. Classification  Mild to moderate Plugged pores Plugged pores Sebum collection Sebum collection  Moderate to severe.

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Presentation on theme: "Acne Justin Walker October 2009. Classification  Mild to moderate Plugged pores Plugged pores Sebum collection Sebum collection  Moderate to severe."— Presentation transcript:

1 Acne Justin Walker October 2009

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3 Classification  Mild to moderate Plugged pores Plugged pores Sebum collection Sebum collection  Moderate to severe Propionibacterium acnes Propionibacterium acnes Inflammation, pustules Inflammation, pustules Cysts, nodules, scarring Cysts, nodules, scarring  Other causes PCOS PCOS Halogenated hydrocarbons Halogenated hydrocarbons

4 Differentials

5 Differentials  Rosacea Older age group Older age group Absence of comedones, nodules and scarring Absence of comedones, nodules and scarring

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7 Differentials

8 Differentials  Folliculitis Infected hair follicle, responds to abx. Infected hair follicle, responds to abx. NB demodex folliculitis caused by mites, pityrosporum folliculitis caused by yeasts. NB demodex folliculitis caused by mites, pityrosporum folliculitis caused by yeasts.

9 Differentials

10 Differentials  Perioral dermatitis Distribution! Distribution! Associated with fluorinated steroids. Associated with fluorinated steroids.

11 What makes it worse?  Progesterone only pill  Hormone changes with periods  Make up  Picking and squeezing  Humid environment/sweating  Tight clothing  Drugs – phenytoin, steroid creams  Anabolic steroids

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13 Myths  Poor hygiene  Diet  Stress  Water intake  Sunshine  Cannot be cured

14 Topical Treatments  Benzoyl peroxide Available over the counter Available over the counter Good for comedones & infected lesions Good for comedones & infected lesions % available, start low and increase as tolerated % available, start low and increase as tolerated Wash skin beforehand, wash off after several hours Wash skin beforehand, wash off after several hours Start od, bd if tolerated. Start od, bd if tolerated.

15 Topical Treatments  Topical Retinoids Adapalene, tretinoins and isotretinoin Adapalene, tretinoins and isotretinoin Unblock pores, reduce inflammation Unblock pores, reduce inflammation S/E: skin redness and peeling, sun sensitivity – apply at night and wash off in morning. S/E: skin redness and peeling, sun sensitivity – apply at night and wash off in morning. Use lower strength if not tolerated. Use lower strength if not tolerated. Avoid in pregnancy – discuss contraception! Avoid in pregnancy – discuss contraception!

16 Topical Treatments  Topical antibiotics Erythromycin and clindomycin Erythromycin and clindomycin Good for inflammation but don’t unblock pores Good for inflammation but don’t unblock pores Local guidelines recommend topical for those who cannot tolerate oral. Local guidelines recommend topical for those who cannot tolerate oral. Can use with short courses benzoyl peroxide/ azelaic acid Can use with short courses benzoyl peroxide/ azelaic acid Topical abx need to be used for 6 months. Topical abx need to be used for 6 months.

17 Topical Treatments  Azelaic acid Unblocks pores, some reduction of inflamed acne Unblocks pores, some reduction of inflamed acne Less effective than topical antibiotics or benzoyl peroxide Less effective than topical antibiotics or benzoyl peroxide

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19 Oral Treatments  Antibiotics Reduce inflammation, Reduce inflammation, Not good at unblocking pores – may need concommitant topical bp/aa Not good at unblocking pores – may need concommitant topical bp/aa Local guidelines: doxycycline, lymecycline, erythromycin Local guidelines: doxycycline, lymecycline, erythromycin Use for 3 months and review Use for 3 months and review Tetracyclines: not for under 12s, not in pregnancy – discuss contraception. Women on cocp need additional precautioins for first 3 weeks. Tetracyclines: not for under 12s, not in pregnancy – discuss contraception. Women on cocp need additional precautioins for first 3 weeks.

20 Oral Treatments  Isotretinoin Suppresses sebum production Suppresses sebum production Specialist initiation Specialist initiation Teratogenic Teratogenic S/E dry skin/mucous membranes, nosebleeds, joint pains S/E dry skin/mucous membranes, nosebleeds, joint pains Minimum course 16 weeks. Minimum course 16 weeks.

21 Oral Treatments  Co-cyprinidol Cyproterone acetate with ethinylestradiol aka Dianette Cyproterone acetate with ethinylestradiol aka Dianette Contains anti-androgen Contains anti-androgen Same effectiveness as oral broad spectrum Same effectiveness as oral broad spectrum Useful if a woman also requires oral contraception, although not licensed as a contraceptive. Useful if a woman also requires oral contraception, although not licensed as a contraceptive. Increased risk of venous thromboembolism Increased risk of venous thromboembolism Use only in women with severe acne and hirsutism Use only in women with severe acne and hirsutism

22 When to Refer?  Immediate referral Acne fulminans Acne fulminans  Urgent referral Severe/Nodulocystic acne and may benefit from oral isotretinoin Severe/Nodulocystic acne and may benefit from oral isotretinoin Severe psychological/social problems Severe psychological/social problems  Routine referral At risk of or are developing scarring despite therapy At risk of or are developing scarring despite therapy Moderate acne failing to respond (2 x 3 month courses abx) Moderate acne failing to respond (2 x 3 month courses abx) Possible underlying endocrinological cause eg PCOS Possible underlying endocrinological cause eg PCOS

23 Acne fulminans

24 Thank you!


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