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Acne

Acne . Dr Stephen Chadwick GPsWI. Acne. Very common Most teenagers will have some acne Tends to resolve by late teens or early twenties, but can persist Late onset 10% will have acne in thirties 6% in forties. Features . Comedones (open and closed) Grease Red papules and pustules

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Acne

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  1. Acne Dr Stephen Chadwick GPsWI

  2. Acne • Very common • Most teenagers will have some acne • Tends to resolve by late teens or early twenties, but can persist • Late onset • 10% will have acne in thirties • 6% in forties

  3. Features • Comedones (open and closed) • Grease • Red papules and pustules • Nodules and cysts • Scarring • Pain and tenderness • Low self esteem and confidence

  4. Cause • Disorder of pilosebaceous follicle • Excess of oil • Dead skin not shed properly and blocks the pores with blackheads • Microcomedones and comedones • Pockets of oil form ideal breeding ground for Propionibacterium acnes • Inflammation leads to red papules and pustules.

  5. Assessment • Previous treatments • Compliance and side effects • How bad does the patient feel it is ?/10 • Objective assessment of severity • Mild/moderate/severe and face/chest/back • Comedones, papules and pustules • Nodules and cysts • Scarring

  6. Treatment • Do not pick or squeeze • Ask about inappropriate emollient use • Oil-free make-up, non-comedogenic • Use mild soap or gentle cleanser • Expect topical treatments to dry or irritate, and manage this • At least 2 months to assess any treatment

  7. Comedonal

  8. Comedonal • Topical retinoid • E.g. Tretinoin 0.025% gel applied nocte, or Adapalene 0.1% gel/cream • Or Azelaic Acid • E.g. Skinoren 20% cream

  9. Mild papulo-pustular • Topical Retinoid and Topical Antimicrobial • E.g.tretinoin gel nocte and antimicrobial marne (?BPO, or Duac), or possibly Epiduo gel (adapalene + BPO) • Or Azelaic Acid + Topical Antimicrobial • E.g. Zineryt lotion

  10. Moderate Papulo-pustular • Oral antibiotic + Topical Retinoid +/- BPO • E.g. Lymecycline od, or Erythromycin 500mg bd, + Tretinoin gel nocte +/- BPO marne • Or Alt. oral antibiotic + alt. retinoid/azelaic acid +/- BPO • E.g. Trimethoprim 300mg bd + adapalene +/- BPO • Or Females, ? Add Dianette

  11. Nodulo-cystic • Oral antibiotic + topical retinoid +/- BPO • ? High Dose, eg Lymecycline bd or Trimethoprim 300mg bd • Or Oral Isotretinoin • Or Females, Dianette + topical retinoid +/- oral antibiotic

  12. Severe, includes any scarring

  13. Severe, includes any scarring • Oral Isotretinoin • Or High Dose Oral Antibiotic + Topical Retinoid + BPO • Or Females, Dianette + topical retinoid +/- oral antibiotic

  14. Maintenance Treatment • Use Oral Antibiotics for 6-12 months minimum, continue topical retinoid (azelaic acid) long term • For moderate-severe cases, ?topical retinoid +/- BPO long term

  15. How to reduce referrals? • Manage expectations, compliance and side effects • Use PILs e.g. www.bad.org.uk • Use more Topical Retinoids and combine them with Topical or Oral Antibiotics +/- BPO

  16. When to refer • Refer early if scarring, or severe cases • Mild-moderate cases not responding to standard treatments regimes • Females for ?Ro-accutane, discuss contraception prior to referral

  17. Questions?

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