Acne Vulgaris CS-OSPE

Acne Vulgaris (AV) CS-OSPE

Patient Presentation:

• An 18 Y/O teacher presents with skin lesions for 9 months.
• A 19-year-old man developed a facial eruption 6 months ago.

Diagnosis:

• Diagnosis: Acne Vulgaris
• Severity: Severe Acne Vulgaris

Differential Diagnosis:

• Rosacea (Acne Rosacea)
• Seborrheic dermatitis
• Folliculitis (Also recognized as a condition with pustule as a primary lesion, similar to Acne Vulgaris)

Clinical Description / Primary Skin Lesions:

• Pustule
• Papule (less than 5cm)
• Comedone (a hallmark primary lesion in this condition); these can be (close) white or (open) black headed (Open comedon)
• Nodule
• Cyst
• Scar
• Erythema
• Lesions are typically Red - Face

Severity Classification & Explanation:

• Classify the severity of this condition? Severe acne vulgaris
• Explain your classification/Pathological factors:
  • Presence of Comedones, Papules, Pustules, Cysts, and Nodules.
  • Also noted: Erythema, and Scars on the face and scattered.
  • Severity is indicated by the presence of the nodule.

Body Sites Commonly Examined:

• Face
• Upper chest
• Back
• Shoulder

What are the 4 factors that contribute to development of ACNE?

1. Production of excessive sebaceous gland secretion (Follicular Hyperkeratosis).
2. Obstruction to outflow of this sebum at the mouth of the pilosebaceous canal.
3. Inflammation arising as a result of leakage of contents of the pilosebaceous follicle into the surrounding dermis.
4. Excessive colonization or infection of the pilosebaceous ducts with propionibacterium acnes (P.acnes).

Pathogenesis of acne?

• A
  • Epidermis
  • Epithelium
  • Sebaceous lobule
  • Early comedone
    • Infundibulum
    • Hyperkeratosis
    • Corneocyte cohesiveness
    • Androgen stimulation
    • Of sebum secretion
• B
  • Later comedone
    • Accumulation of shed keratin
    • And sebum
    • Formation of whorled lamellar
    • Concretions
• C
  • Inflammatory papule/pustule
    • Propionibacterium acnes
    • Proliferation
    • Sebaceous lobule regression
    • Mild inflammation
• D
  • Nodule/c
    • Marked
    • Scarring

Hyperproliferation at Hair Follicle “Hyperkeratosis” ↑ sebum production Proliferation at propionibacterium ↑ Inflammatory response

What are the Stages of acne?

1. Normal follicle.
2. Open comedone (blackhead).
3. Closed comedone (whitehead).
4. Papule.
5. Pustule.

What is the possible cause of acne? Mostly Genetic Aspect. ⬆️ Androgen production

How to manage this patient? / Most appropriate treatment:

• Full history
• Examination
• Education
• Sunscreens (Sun block)
• Avoidance of aggravating factors.
• Mild: Topical keratolytic (Topical Tretinoin)
• Moderate: Oral antibiotic (doxycycline)
• Topical Antibiotic: clindamycin
• Laser and light therapy
• Severe: Oral Isotretinoin (indicated for Nodulocystic Acne, or when not responding to topical treatments)
• Emollient

Isotretinoin Specifics:

Mechanism: works on all pathogenesis of acne

Indication:

• Severe acne + failure of topical treatment.

Pre-prescription tests for Oral Isotretinoin:

• Lipid profile
• LFT (Liver Function Test)
• RFT (Renal Function Test)

Side Effects / Complications:

• Dryness (Xerosis is the most common)
• Mood changes (Depression)
• Increased intracranial pressure (pseudo cerebri)
• Teratogenicity
• Epistaxis
• Photosensitivity
• Contraindicated to give with doxycycline

Specific Notes on Lesions:

• Lesion pointed by the arrow (example from image): Open comedon
• Diseases with pustule as primary lesion:
  • Acne vulgaris
  • Folliculitis

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Folliculitis

What is the Diagnosis?

• Folliculitis

Mention two diseases with pustule as primary lesion?

• Acne vulgaris
• Folliculitis