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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