Acne Causes and Treatment Overview

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Questions and Answers

What is the primary action of benzoyl peroxide in acne treatment?

Stimulating hair growth

Shrinking existing lesions

Preventing new lesions from forming (correct)

Increasing skin moisture

Which concentration of benzoyl peroxide is recommended to minimize skin irritation?

2.5% (correct)

3.5%

10%

How should patients initially apply benzoyl peroxide to minimize side effects?

Apply liberally every day

Apply continuously without breaks

Use only at night

Apply sparingly & infrequently (correct)

What precaution should be taken regarding sun exposure when using benzoyl peroxide?

Wear protective clothing to shield treated areas Signup and view all the answers

What is a potential side effect of using benzoyl peroxide?

Peeling and dryness of the skin Signup and view all the answers

Why should facial washes containing benzoyl peroxide be avoided during treatment with other topical preparations?

They increase the likelihood of irritation Signup and view all the answers

What should a patient do if they experience severe irritation from benzoyl peroxide?

Discontinue the product if irritation does not improve Signup and view all the answers

What should patients be informed about regarding the use of benzoyl peroxide and clothing?

It can bleach clothing and bedding Signup and view all the answers

What is a common factor in the onset of acne during adolescence?

Overproduction of sebum and keratin Signup and view all the answers

When is acne most likely to begin in individuals?

Around puberty Signup and view all the answers

Which type of comedone is characterized as a blackhead?

Open comedone Signup and view all the answers

What should be considered when evaluating long-lasting acne that has not responded to over-the-counter treatments?

Referral to a dermatologist Signup and view all the answers

Which factor may exacerbate acne in women just before menstruation?

Changes in progesterone levels Signup and view all the answers

In which demographic is acne believed to be extremely rare?

Young children and babies Signup and view all the answers

What is an indication that acne has been long-lasting and may require referral?

Multiple correctly used OTC treatments without success Signup and view all the answers

What is a potential cause of late-onset acne in adults?

Hormonal changes due to menopause Signup and view all the answers

What causes the color change in a comedone from white to dark?

Accumulation of melanin Signup and view all the answers

Which area is least likely to be affected by acne?

Arms Signup and view all the answers

What is a common feature seen in rosacea that can confuse it with acne?

Pustules Signup and view all the answers

What should be considered if acne does not improve after 8 weeks of treatment?

Refer the patient for alternative treatment Signup and view all the answers

Which of the following medications is likely to induce acne?

Lithium Signup and view all the answers

What is the primary goal of acne therapy?

Removing follicular plugs and reducing bacteria Signup and view all the answers

Why might gels with an alcoholic base be problematic for acne treatment?

They can be irritating to the skin Signup and view all the answers

Why should a non-comedogenic moisturizer be used in acne treatment?

To prevent follicular blockage and irritation Signup and view all the answers

What should be avoided when using benzoyl peroxide?

Contact with eyes and mucous membranes Signup and view all the answers

What is the primary benefit of salicylic acid in acne treatment?

Comedolytic effect and mild anti-inflammatory properties Signup and view all the answers

How often should topical nicotinamide gel be applied?

Twice daily Signup and view all the answers

Which topical treatment has demonstrated efficacy in reducing mild-to-moderate acne?

Tea tree oil Signup and view all the answers

What is the recommended frequency of salicylic acid application under normal circumstances?

Once daily or more based on need Signup and view all the answers

Which of the following topical retinoids is contraindicated in pregnancy?

All of the above Signup and view all the answers

What is a common use for topical sulfur in acne treatments?

It is often combined with salicylic acid or benzoyl peroxide Signup and view all the answers

What is a potential side effect of topical nicotinamide gel?

Skin dryness and irritation Signup and view all the answers

Which retinoid is available without a prescription?

Adapalene Signup and view all the answers

What should patients be advised about using doxycycline?

It increases sensitivity to sunlight. Signup and view all the answers

Why should topical tretinoin and benzoyl peroxide not be applied at the same time?

Tretinoin becomes unstable in the presence of benzoyl peroxide. Signup and view all the answers

What is a contraindication for the use of tetracyclines?

Breastfeeding. Signup and view all the answers

Which of the following antibiotics is recommended as a second-line treatment for acne?

Erythromycin Signup and view all the answers

What can happen if oxytetracycline or tetracycline is taken with dairy products?

Decreased effectiveness of the antibiotic. Signup and view all the answers

Which formulation of tretinoin is resistant to the presence of benzoyl peroxide?

Tretinoin gel microsphere Signup and view all the answers

Which of the following is a common misconception about acne treatment?

Diet has a direct link to acne. Signup and view all the answers

Study Notes

Acne

Acne predominantly occurs during teenage years, often starting at puberty, but might begin a year before or continue into the late teens or twenties.
Hormonal changes during puberty, especially the production of androgens, contribute to acne's onset.
Increased keratin and sebum production during adolescence are also significant factors, with excessive keratin blocking follicles and forming comedones.
Very rare in young children and babies, acne in these cases should be referred, as a hormone-producing tumor may be the cause.
In adults developing acne at later ages, factors beyond puberty should be considered, such as medication, occupational exposure, and hyperandrogenism in women.
Oils and greases at work can trigger acne.
Acne may worsen just before or during menstruation, influenced by progesterone fluctuation.

Severity

Over-the-counter (OTC) treatment is suitable for mild acne.
Comedones can be 'open' (blackhead) or 'closed' (whitehead), with sebum trapped in closed comedones.
Initially white, the keratin plug at the follicle entrance in a comedone darkens due to melanin accumulation (blackhead).
Sebum production continues leading to swelling and comedone rupture, releasing its contents beneath the skin.
Released sebum triggers inflammation, causing small red papules in less severe cases.
In more severe acne, painful red pustules develop, necessitating referral to a general practitioner (GP) for alternative treatment like topical or systemic antibiotics.

Treatment

Establish the identity and usage of any prior treatment, as improper use can affect success.
Current therapy should be considered, as acne can be drug-induced.
Lithium, phenytoin, progestogens, levonorgestrel, and norethisterone (in oral contraceptives) can cause acne.
Refer patients with acne suspected due to drug therapy to their doctor.
Patients with mild to moderate acne not responding to treatment within eight weeks should be referred.

Management

OTC treatment can be recommended for mild to moderate acne.
Treatment aims to remove follicular plugs, facilitating sebum flow and reducing skin bacteria.
Treatment should reduce comedone formation.
Most useful formulations include lotions, creams, and gels.
Alcoholic base gels dry quickly but may irritate, while aqueous base gels dry slower with less irritation.
A non-comedogenic moisturizer can help alleviate dryness caused by treatment.

Benzoyl Peroxide

Benzoyl peroxide is the first-line OTC treatment for inflammatory and non-inflammatory acne.
Available in various vehicles (cleansers, gels, lotions, creams, pads, masks, washes) and concentrations (2.5-10%), usually applied once daily.
It exhibits keratolytic action (skin peeling) and antibacterial properties, reducing skin flora.
Anti-inflammatory action occurs at all strengths.
Concentrations above 2.5% may not improve benefits and may increase skin irritation.
Regular application can improve acne of all severities for most people.

Benzoyl Peroxide Usage Advice

Initial skin reddening and soreness are common, and patients should be warned.
Gels suit oily skin, creams suit dry skin.
Wash the skin mildly with soap/cleanser, rinse with water, and let it dry fully before applying benzoyl peroxide to reduce sebum.
Benzoyl peroxide prevents new lesions rather than shrinking existing ones, so apply it to the entire affected area, not just individual comedones.
Avoid using facial washes containing benzoyl peroxide if already using a topical benzoyl peroxide product.
Benzoyl peroxide increases sunburn risk. Use sunscreen or protective clothing (T-shirts) for the chest and back.
During the initial days, expect redness, slight soreness, stinging, dryness, and peeling.

Reducing Irritation

Start with the lowest strength.
Apply sparingly and infrequently during the first week.
Wash off benzoyl peroxide after 15 minutes initially, gradually extending exposure in 15-minute increments until tolerated for two hours or more.
If irritation persists, discontinue the product.

Sensitization

Occasionally, sensitization to benzoyl peroxide occurs after prolonged use.
Skin becomes red, inflamed, and sore, requiring treatment discontinuation.

Bleaching

Benzoyl peroxide can bleach clothing and bedding.
Use white bed linens and wear old clothes to minimize damage.
Avoid contact with eyes, mouth, and mucous membranes.

Other Keratolytics

Include potassium hydroxyquinoline sulfate and salicylic acid, used as second-line treatments.
Salicylic acid has a comedolytic effect and mild anti-inflammatory properties.
Usually applied once daily, increasing to two or three times per day if needed.
Frequency can be reduced to once daily or every other day in case of dryness or peeling.
Available in various nonprescription forms (gels, lotions, solutions, cleansers, pads, masks).
Can be combined with benzoyl peroxide, their mechanisms complementing each other.
Topical sulfur has been used for acne, but its efficacy is unclear. Often combined with salicylic acid or benzoyl peroxide in OTC products.

Nicotinamide

Topical nicotinamide gel has mild anti-inflammatory action and is applied twice daily.
Limited evidence of effectiveness.
Side effects may include skin dryness and/or irritation.
Full effects might take several weeks.

Tea Tree Oil

Derived from the Melaleuca alternifolia plant, tea tree oil is known for its antimicrobial, anti-inflammatory, and antioxidant properties.
Effective in reducing mild to moderate acne, offering a natural alternative to conventional treatments like benzoyl peroxide.
May take longer to show results, but reduced side effects make it appealing for sensitive skin.

Antiseptic Agents

Skin washes and soaps containing antiseptic agents like chlorhexidine are available.
Useful in acne by degreasing the skin and reducing skin flora.
Limited evidence of effectiveness.

Topical Retinoids

Adapalene, tretinoin, and isotretinoin are topical retinoids commonly prescribed by doctors.
Can cause skin irritation, especially in people with eczema, and are contraindicated in pregnancy.
Teratogenic, meaning they can harm the developing baby.
Adapalene 0.1% gel is the only OTC topical retinoid.
Topical tretinoin should not be applied simultaneously with benzoyl peroxide.
If both are prescribed, apply benzoyl peroxide in the morning and tretinoin in the evening.
Tretinoin's stability decreases when exposed to benzoyl peroxide due to oxidation, exacerbated by light exposure.
Newer tretinoin formulations (tretinoin gel microsphere, micronized tretinoin gel, tretinoin 0.05% lotion in polymeric emulsion) are stable with benzoyl peroxide.
Adapalene is also more stable with benzoyl peroxide than tretinoin.

Antibiotics

Oral antibiotic therapy (prescription-only medicine [POM]) typically involves tetracyclines.
Doxycycline and lymecycline are often used, with a convenient once-daily dose that can be taken with food.
Doxycycline increases sun sensitivity, requiring sunscreen use.
Minocycline should no longer be prescribed for acne due to severe adverse reactions and skin pigmentation.
When taking oxytetracycline or tetracycline, avoid dairy, antacids, or iron preparations within an hour before or after taking the antibiotic.
Chelation by metal ions in dairy products or antacids may hinder antibiotic effectiveness.
Tetracyclines are contraindicated in pregnancy, breastfeeding, and children under 12 years.
Erythromycin is also used for acne but is considered second-line treatment.
Bacterial resistance to erythromycin is high, making it less effective.
Topical antibiotics (like clindamycin 1%) are used for mild to moderate acne, but should be combined with benzoyl peroxide to prevent resistance.

Practical Points

A) Diet: No evidence links diet to acne, despite emerging data suggesting high glycemic index (GI) diets (including sweets or chocolate) might worsen acne.
B) Sunlight: There's a common belief in the beneficial effects of sunlight on acne.

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Description

This quiz delves into the causes and treatments of acne, particularly during teenage years. It highlights the hormonal factors influencing its development and the severity of the condition. Understand different types and appropriate over-the-counter treatments for managing acne effectively.