Transcript Acne Vulgaris

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Acne is a common chronic skin condition which has a significantly
negative psychological impact that can be directly improved
with treatment
It is a disease common but not limited to adolescence. It can often
persist into adulthood
It is estimated that acne accounts for 3.5 million GP visits a year
Severe acne has been associated with suicidal ideation
Infection/ blockage of pilosebaceous units
Multifactorial pathogenesis including genetics
Four main processes include altered keratinization, androgen
induced sebum production, follicular colonisation by P acnes
and inflammation
Diagnostic features - comedones, greasy skin, P acnes and
inflammatory papular pustular lesions, nodules and cysts.
Mild acne: Presence of
comedones and a few
papulopustules
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<20 comedones
<15 inflammatory
lesions
Or total lesion count
<30
Moderate acne: Presence of
comedones, inflammatory
papules, and pustules
A greater number of lesions
are present than in milder
inflammatory acne
Nodulocystic acne: Presence of comedones,
inflammatory lesions, and large nodules
Scars: Raised (hypertrophic or keloid) or
atrophic
Acne conglobata: Severe and uncommon
form of acne - interconnecting nodules,
abscesses, sinuses and scars as well as
haemorrhagic and purulent discharge
Can be targeted to severity
Mild acne - topical treatments including topical retinoids (1st line),
benzoyl peroxide, topical antibiotics. Topical azelaic acid can cause
hypopigmentation.
Moderate acne - oral antibiotics at least 2 different antibiotics for
prolonged time >6months for their anti-inflammatory properties,
COCP, AND topical treatment
Severe acne - Isotretinoin- warn about side effects - dryness, pregnancy
tests, mood
New treatments such as radiofrequency, light, and laser devices are all
active areas of research and development. Blue-light photodynamic
therapy is the only US FDA-approved treatment.
Systemic reviews show they may improve inflammatory acne in the short
term but are ineffective when for severe acne
Other treatment options particularly for scarring include resurfacing
techniques, laser therapy and dermal fillers
Warn patients looking for treatments such as dermabrasion / lasers to
wait at least 1 year after completing a course of isotretinoin
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Radiofrequency Devices – Use radio waves to heat the dermis and SC
tissue. High temperatures kill bacteria and shrink sebaceous glands.
Promising results in studies but small sample sizes.
Light treatment- Cause membrane damage to P acnes. Some penetrate
deeper than others. Confliciting efficacy in studies.
Blue light treatment is FDA approved in US. Initial studies have shown
after 8 weeks of treatment the number of inflammatory lesions are
reduced( 30-70%). But not comedonal lesions.
Laser- Photothermolysis of dilated blood vessels in acne lesions. (TGFβ) a wound healing cytokine.
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Eating chocolate and sugary foods have previously been linked with
acne but studies show there is little evidence for these beliefs.
Recent data – mainly from 2013 onwards show preliminary evidence of
a low glycaemic load diet and improvement in acne.
Recent data suggests that dairy products may increase the risk of
acne, particulalry from pregnant cows. Skimmed is worse due to
higher concentration of hormones
Need to be cautious- Some studies show milk has a positive effect on
reducing obesity
The Global Alliance to improve outcome in acne recommends:
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Benzoyl peroxide may reduce the development of resistant P. acnes strains and
further emergence.
Bacterial resistance may be reduced by using topical benzoyl peroxide with topical
antibiotics, topical retinoids or oral antibiotics.
The combination of benzoyl peroxide and a topical antibiotic (eg. clindamycin,
erythromycin) is more effective than either agent alone
Topical antibiotic monotherapy is not recommended
Use benzoyl peroxide in between abx therapies to prevent future resistance
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Common
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Treatment has a big impact on QOL
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Beware of new evidence on diet
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Beware of new treatments- not all on NHS
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Prescribe benzoyl peroxide with oral
antibiotics
Prescribe benzoyl peroxide between
antibiotics
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British association of Dermatologists www.bad.org.uk
Shinjita Das; Rachel V. Reynolds. Recent Advances in Acne Pathogenesis
Implications for Therapy. American Journal of Clinical Dermatology.
2014;15(6):479-488.
Dermnet New Zealand Facts on Acne:
http://www.dermnetnz.org/acne/index.html
National Institute for Health and Care Excellence Clinical Knowledge Summaries
on Acne: http://cks.nice.org.uk/acne-vulgaris#top
Medscape
The Global Alliance to improve outcome in acne
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