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Year, pagecount:2022, 23 page(s)
Language:English
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Uploaded:June 09, 2022
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Brighton and Sussex University
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Acne & Rosacea Dr Paul Farrant Consultant Dermatologist Brighton and Sussex University NHS Hospitals Trust Pustular and Papular condiBons • Acne • Rosacea • Peri-‐oral dermaBBs Acne Acne Pathology Acne QuesBons: • Adolescent vs Late onset? • Menstrual flare? • Simple vs scarring • Predominant feature – comedones vs inflammatory Acne Management – Simple: Avoid greasy/oil based moisturisers & make up – TargeBng the comedo -‐ OTC Salicylic acid, Benzoyl Peroxide*, ReBnoids & CombinaBons – TargeBng P Acnes -‐ Topical anBbioBcs? Light devices? Benzoyl Peroxide – TargeBng the
Sebaceous gland -‐ COCP with anB-‐ androgenic effect * No evidence of difference between 2.5%, 5% and 10% but lower strengths less side effects CombinaBons • Benzoyl Peroxide + Adapalene = Epiduo • Benzoyl Peroxide + clindamycin = Duac • CombinaBons more effecBve that BPO alone Acne Management – Inflammatory -‐ Add in systemic anBbioBcs -‐ Tetracyclines, Macrolides, Trimethoprim – Systemic ReBnoids – – – – Severe Acne (clinical & psychological) late onset Scarring Unresponsive Acne & COCP • COCP help both inflammatory and non inflammatory acne • No evidence that those
containing cyproterone are more effecBve! • Consider the progesterone component • Yasmin, Marvelon and Mercilon ReBnoids • • • • • • • Consultant led Safe in expert hands Lots of potenBal side effects All -‐ Dry skin and dry lips +/-‐ nose bleeds Some -‐ muscle aches, faBgue, hair loss Uncommon -‐ mood change, depression Highly teratogenic > Pregnancy PrevenBon Programme Contraversies in Acne Diet • Oden suspected • Few studies • High glycameic load diets exacerbate acne • Chocolate not thought to be a factor • Dairy possible connecBon Demodex mites • TentaBve associaBon,
not the same as proving causal link Rosacea F>M >30s +, oden post-‐menopausal Pale skin types, + Sun exposure Mostly facial, but frequently involves eyes, can involve scalp and body • Oden chronic / intermigent • AeBology unknown -‐ ?Demodex mite • • • • Rosacea • • • • Flushing -‐ triggers spicy food, alcohol No comedones Papules, Pustules, Telangiectasia Rhinophyma -‐ Is this really part of rosacea? Rhinophyma – before and ader surgery Rosacea -‐ DifferenBal • Acne • Lupus • Overlap with seborrhoeic dermaBBs – Can use mild steroids eg hydrocorBsone – Avoid
ointments • Tinea • FolliculiBs Mirvaso – New topical treatment Brimonidine • Alpha2 Blocker • Once daily Adverse reacBons include: • Pruritus • Burning • Flushing • Erythema Rosacea • Management – Topicals -‐ Metronidazole, Azelaic Acid – Systemics -‐ Tetracyclines, ReBnoids – Fixed Telangiectasia -‐ laser – Rhinophymas -‐ CO2 laser/Shave Rosacea My top Bps: • Wash with Cetaphil cleanser • Cetaphil moisturiser if skin dry • Finacea gel • Add in tetracycline anBbioBc – Low dose modified release doxycycline Peri-‐oral DermaBBs • Small monomorphic papules around mouth with
sparing of vermillion border • F>M • Assoc. steroid cream use • Ocular variant • Stop steroids + course tetracyclines 4/52 Acne & Rosacea • Common skin problems • GPs should be familiar with first line management • CombinaBons of treatments oden more effecBve than single agents • If severe acne with scarring don’t delay referrals
Sebaceous gland -‐ COCP with anB-‐ androgenic effect * No evidence of difference between 2.5%, 5% and 10% but lower strengths less side effects CombinaBons • Benzoyl Peroxide + Adapalene = Epiduo • Benzoyl Peroxide + clindamycin = Duac • CombinaBons more effecBve that BPO alone Acne Management – Inflammatory -‐ Add in systemic anBbioBcs -‐ Tetracyclines, Macrolides, Trimethoprim – Systemic ReBnoids – – – – Severe Acne (clinical & psychological) late onset Scarring Unresponsive Acne & COCP • COCP help both inflammatory and non inflammatory acne • No evidence that those
containing cyproterone are more effecBve! • Consider the progesterone component • Yasmin, Marvelon and Mercilon ReBnoids • • • • • • • Consultant led Safe in expert hands Lots of potenBal side effects All -‐ Dry skin and dry lips +/-‐ nose bleeds Some -‐ muscle aches, faBgue, hair loss Uncommon -‐ mood change, depression Highly teratogenic > Pregnancy PrevenBon Programme Contraversies in Acne Diet • Oden suspected • Few studies • High glycameic load diets exacerbate acne • Chocolate not thought to be a factor • Dairy possible connecBon Demodex mites • TentaBve associaBon,
not the same as proving causal link Rosacea F>M >30s +, oden post-‐menopausal Pale skin types, + Sun exposure Mostly facial, but frequently involves eyes, can involve scalp and body • Oden chronic / intermigent • AeBology unknown -‐ ?Demodex mite • • • • Rosacea • • • • Flushing -‐ triggers spicy food, alcohol No comedones Papules, Pustules, Telangiectasia Rhinophyma -‐ Is this really part of rosacea? Rhinophyma – before and ader surgery Rosacea -‐ DifferenBal • Acne • Lupus • Overlap with seborrhoeic dermaBBs – Can use mild steroids eg hydrocorBsone – Avoid
ointments • Tinea • FolliculiBs Mirvaso – New topical treatment Brimonidine • Alpha2 Blocker • Once daily Adverse reacBons include: • Pruritus • Burning • Flushing • Erythema Rosacea • Management – Topicals -‐ Metronidazole, Azelaic Acid – Systemics -‐ Tetracyclines, ReBnoids – Fixed Telangiectasia -‐ laser – Rhinophymas -‐ CO2 laser/Shave Rosacea My top Bps: • Wash with Cetaphil cleanser • Cetaphil moisturiser if skin dry • Finacea gel • Add in tetracycline anBbioBc – Low dose modified release doxycycline Peri-‐oral DermaBBs • Small monomorphic papules around mouth with
sparing of vermillion border • F>M • Assoc. steroid cream use • Ocular variant • Stop steroids + course tetracyclines 4/52 Acne & Rosacea • Common skin problems • GPs should be familiar with first line management • CombinaBons of treatments oden more effecBve than single agents • If severe acne with scarring don’t delay referrals
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