Acne

Dr Josephine Yeatman154 Grimshaw Street Greensborough 3088

Austin HealthMercy Hospital for Women

Acne lesions

Inflammatory• Papules• Pustules• Nodules• Cysts• Draining Sinuses

Non Inflammatory• Open comedones• Closed

comedones

Predisposing Factors Age

• Young preteen comedones only

• Later teen papules and pustules as well

• Peak age 16-18

• Adults Change in distribution classically jawline

• 15% of adult women and 5% of men have acne

Diet

• Western diet• the Kitavan Islanders of Papua New

Guinea and the Ache hunter-gatherers of Paraguay do not get acne

• Suggest acne diet (low GI diet)• Have usually tried zinc by the time

they see me

Genetics

Often positive family history and also gives and idea about prognosis, especially with parents with ongoing acne

Hormones

• PCOS• Ask about premenstrual flare,

hirsutes, menstrual irregularities• Also a good time to ask about

reproductive plans in adults to determine optimum timing of treatment eg in 35 year old wanting isotretinoin

Treatment

Antibiotics

Systemic• doxycycline, minocycline, erythromycin,

trimethoprim, cotrimoxizole• Effective and rapid but only work on

inflammatory component and only while used so acne will usually recur after cessation

• Warn to use condoms for first month if on the pill

Antibiotics

Topical• erythromycin• clindamycin• Can be very effective but generally

only play role in mild acne also can be expensive

Anti-androgens

• Diane 35ED and clones, Yasmin, Yaz, Valette, spironolactone, cyproterone acetate

• Very effective especially in hormonal acne• Slow minimum two months for onset of action• 2x risk of thrombosis vs regular pill• Standard pill will have some anti-acne effect

due to elevation of SHBG• Progesterone only contraception eg Implanon

can exacerbate acne

Retinoids

• Work on both inflammatory and non-inflammatory components

• Contra-indicated in pregnancy

Retinoids

Topical• Initially irritating but tolerance

usually develops• Take at about three months to show

effect• Can flare inflammatory acne initially

if used alone so usually combine with antibiotic at start

Retinoids

Topical preparations• adapalene• retinoic acid - Retin A gel 0.01%

30ml and cream 0.05% 20g, ReTrieve 0.05% 50g, Steiva A 25g 0.025% 0.05% 0.1%

• isotretinoin - Isotrex

RetinoidsSystemic

Isotretinoin• Well established role in severe

cystic acne, scarring acne and refractory acne

• Avoid in summer, poorly compliant especially females, depression, pilots, armed force aspirants, VCE

Benzoyl peroxide (BP)

• Useful adjunct especially for inflammatory disease and helps reduce antibiotic resistance

• Popular product Proactiv expensive, usually tried by the time they see me

• Other cheaper OTC preps• New combination preparations• clindamycin/BP,adapalene/BP• More effective but expensive

Physical Treatment

• Comedone extraction• Laser and light therapies• Controversial for active acne• Main use is for scarring

Acne in pregnancy

• Benzoyl peroxide and erythromycin safe

• Tetracyclines contra-indicated in second and third trimester and until children 8 years of age (some say 12)

Other types of acne and related conditions

• Infantile acne• Acne excoriee• Acne keloidalis nuchae• Hidradenitis suppurativa• Senile comedones and Favre-

Racouchot syndrome

Infantile acne

Acne excoriee

Acne keloidalis nuchae

Hidradenitis suppurativa

Hidradenitis suppurativa

Senile comedones

Favre-Racouchot syndrome

Other related diseasesPerioral dermatitis

• Erythematous and pustular perioral rash

• Fluctuates in severity and is irritable rather than itchy

• Related to use of occlusive moisturisers and exacerbated by topical steroid use

• Treat with oral tetracyclines

Perioral dermatitis

Perioral (periorifial) dermatitis

Rosacea

• Erythema, flushing, telangiectasia, papules, pustules, swelling (rhinophyma)

• No comedones but sometimes co-exists with acne ie redness, flushing and comedones

• Treat with antibiotics, topical metronidazole for maintenance, vascular laser for redness and telangiectasia