Dr Paul Farrant, Consultant Dermatologist & Clinical Lead at BSUH - Dr. Paul Farrant

“Don’t make a mountain out of Dermatology”
                                 Mole Hill Topics:
                                 • Psoriasis & Eczema
                                 • Acne & Rosacea
                                 • Urticaria, Itch & Itchy
                                   Rashes
                                 • Melanoma & it’s mimics
                                 • SCC, Bowens, AKs
                                 • BCC & Benign skin
                                   lumps & bumps

Dr Paul Farrant, Consultant
Dermatologist & Clinical Lead at BSUH

Acne & Rosacea

Pustular and Papular conditions
• Acne
• Rosacea
• Peri-oral dermatitis

Acne

Acne Pathology

Acne
Questions:
• Adolescent vs Late onset?
• Menstrual flare?
• Simple vs scarring
• Predominant feature – comedones vs
  inflammatory

Acne
Management
 – Simple: Avoid greasy/oil based moisturisers &
   make up
 – Targeting the comedo - OTC Salicylic acid,
   Benzoyl Peroxide*, Retinoids & Combinations
 – Targeting P Acnes - Topical antibiotics? Light
   devices? Benzoyl Peroxide
 – Targeting the Sebaceous gland - COCP with anti-
   androgenic effect

 * No evidence of difference between 2.5%, 5%
 and 10% but lower strengths less side effects

Combinations
• Benzoyl Peroxide + Adapalene = Epiduo
• Benzoyl Peroxide + clindamycin = Duac

• Combinations more effective that BPO alone

Acne
Management
 – Inflammatory - Add in systemic antibiotics -
   Tetracyclines, Macrolides, Trimethoprim

 – Systemic Retinoids
    –   Severe Acne (clinical & psychological)
    –   late onset
    –   Scarring
    –   Unresponsive

Sunscreen
• Effaclar Duo+ 30

Acne & COCP
• COCP help both inflammatory and non
  inflammatory acne
• No evidence that those containing
  cyproterone are more effective!
• Consider the progesterone component
• Drosperinone pills eg Yasmin,
• Marvelon and Mercilon

Retinoids
•   Consultant led
•   Safe in expert hands
•   Lots of potential side effects
•   All - Dry skin and dry lips +/- nose bleeds
•   Some - muscle aches, fatigue, hair loss
•   Uncommon - mood change, depression
•   Highly teratogenic > Pregnancy Prevention
    Programme

Contraversies in Acne
Diet
• Often suspected
• Few studies
• High glycameic load diets exacerbate acne
• Chocolate not thought to be a factor
• Dairy possible connection

Rosacea

Rosacea
• F>M
• >30s +, often post-menopausal
• Pale skin types, + Sun exposure
• Mostly facial, but frequently involves eyes,
  can involve scalp and body
• Often chronic / intermittent
• Aetiology unknown - ?Demodex mite

Rosacea
•   No comedones
•   Flushing
•   Telangiectasia
•   Papules
•   Pustules

• Rhinophyma - Is this really part of rosacea?

Rhinophyma – before and after
         surgery

Rosacea - Differential
• Acne
• Lupus

• Overlap with seborrhoeic dermatitis
   – Can use mild steroids eg hydrocortisone
   – Avoid ointments

• Tinea
• Folliculitis

Rosacea – Why does it flare?
• Changes in innate immune system, reactions
  to demodex mite, vascular growth
  factors/mast cells
• Common triggers include
  – Spicy food
  – Alcohol (esp red wine)

How can it be managed?

• Gentle cleansers and “light” moisturisers
   – Cetaphil (Galderma), Bioderma / La Roche Posay
• Topical antibiotics
   – Metronidazole
• Azelaic Acid
• Anti-mite products
   – Topical ivermectin
• Flushing/Redness
   – Brimonidene
   – IPL/Laser

How can it be managed?
• Systemic
  – Tetracyclines
     • High dose
     • Low dose modified release

  – Retinoids
     • Isotretinoin

  – Mast cell stabilisers?
     • Montelukast

Peri-oral Dermatitis
• 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
• Combinations of treatments often more
  effective than single agents
• If severe acne with scarring don’t delay
  referrals

Downloadable copy available:
www.drpaulfarrant.co.uk

Questions:
Paul.Farrant1@nhs.net

Next Topic
Urticaria, Itch and Itchy Rashes
         Thurs 4th June
             7:10pm