Acne

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30 Questions

What is the main characteristic that distinguishes open comedones from closed comedones?

Presence of dilated follicular opening

Which of the following is NOT a type of lesion associated with inflammatory acne?

Closed comedones

At what age range does acne vulgaris typically affect the majority of boys?

13-14 years

What is the main characteristic of infantile acne?

Localized acne lesions on the face in early life

Which variant of acne is more common in boys and tropical climates?

Acne conglobata/fulminans

What percentage of women over 40 are affected by adult acne?

5%

Which type of acne may last up to 5 years and potentially cause scarring in infants?

Infantile acne

What is the most significant psychological impact associated with acne?

Suicidal ideation

Which of the following factors plays a role in the pathogenesis of acne by influencing sebum production and composition?

Androgenic hormones

What is the main function of Propionibacterium acnes in acne development?

Producing lipases to break down triglycerides

Which factor is NOT listed as a contributor to acne development?

Antioxidants in diet

What is the main role of androgenic hormones in acne development?

Stimulating sebaceous glands

Which of the following is a dietary factor that is controversial in its association with acne?

Green leafy vegetables

In acne pathogenesis, what role does follicular hyperkeratinisation play?

Causes accumulation of hyperkeratotic plugs

What distinguishes Acne fulminans from nodulocystic acne?

Presence of systemic symptoms like malaise, fever, and joint pains

What type of acne is characterized by facial excoriations in teenage girls without primary lesions?

Acne excoriée

Which topical treatment for acne is known for its bacteriostatic effects on P. acnes and mild comedolytic properties?

Benzoyl peroxide

What mechanism of action does salicylic acid have in treating acne?

Promotes desquamation of follicular epithelium

What is the main characteristic of Acne keloidalis?

Scarring acne particularly on the neck in men

Which type of acne is associated with neurotic excoriation in teenage girls?

Acne excoriée

What is the mechanism of action of topical retinoids in acne treatment?

Causes anti-inflammatory effects

Which antibiotics are commonly prescribed for acne treatment along with other agents like zinc or benzoyl peroxide?

Erythromycin and clindamycin

Which type of therapy can be considered for individuals who do not respond well to conventional acne treatments?

Phototherapy with ultraviolet or visible light

What type of therapy includes the use of oral antibiotics and hormonal treatments for acne?

Systemic therapy

Which age group is recommended to be cautious when using tetracyclines for acne treatment due to the risk of dental hypoplasia and teeth staining?

12 years and above

Which hormonal treatments for acne work by increasing sex hormone-binding globulin and reducing free testosterone levels?

Estrogen-progestin birth control pills

What should be avoided when treating acne in pregnant or breastfeeding individuals?

Oral antibiotics

Which alternative therapy may be beneficial for acne treatment and some individuals unable to use standard treatments?

Phototherapy with visible light

What are the key components of systemic therapy for acne?

Oral antibiotics and hormonal treatments

Which type of oral antibiotics are generally avoided in pregnancy/breastfeeding and children for acne treatment?

'Tetracyclines'

Study Notes

Acne

  • Acne is a multifactorial disorder of the pilosebaceous unit, affecting all age groups, with peak incidence during adolescence.
  • Psychological impact of acne includes social isolation, anxiety, depression, and even suicidal ideation.

Underlying Factors

  • Genetic factors: number, size, and activity of sebaceous glands; tendency of severe acne runs in families.
  • Dietary factors: controversial, but may include skim milk, whey protein, high glycemic diets, and dietary supplements like vitamin B12.
  • Androgenic hormones: increase size of sebaceous glands and sebum amount.
  • Iatrogenic factors: corticosteroids, androgens, combined OCP, antiepileptics, EGFR inhibitor.
  • Other factors: fluid retention (premenstrual), stress (inflammation), seasons, and cosmetics (comedogenic).

Pilosebaceous Unit Pathogenesis

  • Follicular hyperkeratinization: corneocytes normally extruded in acne accumulate, forming a hyperkeratotic plug.
  • Hormonal influences: testosterone and dihydrotestosterone most potent in sebum production and composition.

Inflammation in Acne

  • Propionibacterium acnes: uses sebum as a substrate and produces lipases, breaking down triglycerides in sebum to form free fatty acids.

Clinical Features

  • Localisation: sites of well-developed sebaceous glands, non-inflammatory vs inflammatory.
  • Non-inflammatory acne: open vs closed comedones (white heads, black heads).
  • Inflammatory acne: papules, pustules, nodules, pseudocystes (filled with pus and serosanguinous fluid), and sinus tracts.

Variants of Acne

  • Acne vulgaris: common type of acne, occurs during puberty, affects comedogenic areas of the face, back, and chest.
  • Infantile acne: localized acne lesions on the face in the first few months of life, may require topical or systemic therapy.
  • Acne conglobata/fulminans: severe form of acne, more common in boys, in tropical climates, with extensive nodulocystic acne and abscess formation.
  • Occupational acne, drug-induced acne, cosmetic-induced acne, acne keloidalis, and acne excoriée are other variants of acne.

Treatment of Acne

  • General measures: full explanation, active therapy, and avoiding precipitating factors.
  • Topical treatments: benzoyl peroxide, salicylic acid, topical retinoids, and topical antibiotics.
  • Systemic treatments: oral antibiotics, hormonal treatments, oral retinoids, and hormone therapies.
  • Phototherapy: alternative therapy using ultraviolet or visible light, helpful in those unresponsive to or unable to tolerate conventional treatments.

Learn about different types of acne such as acne fulminans, occupational acne, drug-induced acne, and more. Understand the characteristics and locations where each type of acne is commonly found.

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