Acne

Acne is a really common problem to see in general practice. However we cover all you need to know in about 7 minutes!

 

Lecture by

Video Duration: 6 minutes

  • Acne
    Created by Helen Bartlett
    General
    Epidemiology

    A chronic inflammatory condition of the skin that primarily affects the pilosebaceous units

    • Very common - especially in 16-18 year olds
    • Slightly less common in Asian and Black ethnicity
    Pathology

    Disease primarily affects the pilosebaceous units of the head and neck.

    • Primary lesion is increased formation of keratin within the hair follicle itself.
    • Excess keratin blocks the pore and forms a micro-comedome
    • Bacterial lipases from P. acnes convert lipids into fatty acids, which in combination with the excess keratin drive an inflammatory reaction
    • Inflammatory reaction leads to further plugging of the pore - and further inflammatory changes
    • The enlarging pore is called a closed comedone or whitehead
    • This structure can rupture, releasing pro-inflammatory exudate and causing inflammation of surrounding tissue, leading to papules, nodules and pustules.
    Top three causes

    None

    Clinical Features
    Symptoms
    • Adverse social and psychological effects
    • Pain associated with inflammation
    Signs
    • Open and closed uninflamed comedones
    • Inflamed papules and pustules
    • In severe acne - nodules and pseducysts
    • Post-inflammatory erythematous or pigmented macules and scars
    Investigations
    Cultures

    None

    Bloods

    Rarely done unless acne is suspected to be the result of an underlying condition such as polycystic ovary disease

    Imaging

    None

    Scopic/Biopsy

    None

    Functional

    None

    Treatment
    Conservative

    Patient education surrounding skin care - e.g. avoiding excess use of oily cosmetics

    Explore the psychological impacts of the disease

    Medical
    • Topical preparations
      • Benzyl peroxide (must wash hands after application)
      • Topical retinoids
    • Topical antibiotic creams - minimum of 6 months
      • Topical erythromycin or topical clindamycin
    • Oral antibiotics - in moderate to severe acne unresponsive to topical therapy
      • Oxytetracycline, doxycycline and minocycline
      • Reassess patient after 3 months of treatment
    • Oral isotretinoin - only for severe cases
      • Consultant dermatologist only due to side affect profile
        • Tetatogenicity, abnormal lipid profile, hepatitis
    Surgical

    None