13- Acne

Question 1

What is the primary lesions of acne

Answer 1

Comedo

Question 2

Types of acne scars

Answer 2

1. Ice pick- temples and cheeks
2. Box car
3. Rolling
4. Anetoderma type (atrophic)
5. Hypertrophic

Question 3

Most neonatal acne remit by age ___

Answer 3

1 year old

Question 4

Acne onset from what age is considered as preadolescent acne?

Answer 4

7-12y

Question 5

The combination of these 3 elements in acne formation leads to the release of proinflammatory mediators➡️ formation of inflammatory lesions

Answer 5

Keratin
Sebum
Microorganisms- propionibacterium acnes

Question 6

Screening tests to exclude a virilizing tumor for severe acne resistant to therapy, relapse quickly or sudden onset

Answer 6

Serum dehydroepiandrosterone (DHEAS) 
Serum testosterone 

2 weeks before onset of menses

Question 7

Most common cause of treatment failure in acne

Answer 7

Lack of adherence

Question 8

Treatment for mild comedonal acne

Answer 8

1st line: topical retinoid + physical extraction

2nd line: alternate retinoid, salicylic, azelaic acid

Question 9

Treatment for mild papular/pustular acne

Answer 9

1st line: topical antimicrobial + topical retinoid, benzoyl peroxide wash if mild truncal lesions

Question 10

Treatment for moderate papular/pustular acne

Answer 10

1st line: Oral antibiotics + topical retinoid + benzoyl peroxide
2nd line: alternate antibiotic, topical retinoid, benzoyl peroxide

Women: spironolactone + OCP + topical retinoid +/- topical antibiotic and/or benzoyl peroxide

Isotretinoin- relapse quickly off oral antibiotics, does not clear or scars

Question 11

Treatment for severe acne

Nodular/conglobate

Answer 11

Isotretinoin
Oral antibiotic + topical retinoid + benzoyl peroxide

Women: spironolactone + OCP + topical retinoid +/- topical or oral antibiotic and/or benzoyl peroxide

Question 12

Preferred agents in maintenance therapy of acne

Answer 12

Topical retinoids

Question 13

Oral antibiotic for pregnant women with acne

Answer 13

Amoxicillin 500mg TID

Question 14

Known side effect of clindamycin that limits its use

150mg TID

Answer 14

Pseudomembranous colitis

Question 15

Antiandrogen treatment prescribed in combination with OCP in the treatment of acne

Answer 15

Spironolactone 100mg ODHS

Question 16

Dose of isotretinoin for severe acne

Answer 16

0.5-1mg/kg/day OD or BID

Starting: 20-40mg/day

Question 17

When taking isotretinoin, women should not become pregnant until stopping medication for at least _______

Answer 17

1 month

Question 18

To ensure excellent absorption, isotretinoin should be taken with

Answer 18

High fat meal

Question 19

Follicular occlusion triad

Answer 19

Acne conglobata
Hidradenitis suppurativa
Dissecting cellulitis of the scalp

Question 20

Therapy of choice for acne conglobata

Answer 20

Isotretinoin 0.5-1mg/kg/day

Total dose of 150mg/kg

Question 21

A second course of isotretinoin may be done in acne conglobata if resolution does not occur after a rest period of _______

Answer 21

2 months

Question 22

Rare form of extremely severe cystic acne that occurs in teenage boys

Highly inflammatory nodules and plaques that undergo swift suppurative degeneration

Fever, arthralgia, myopathy

Answer 22

Acne fulminans

Question 23

Treatment of acne fulminans

Answer 23

Prednisone 40-60mg x 4-8 weeks

Isotretinoin 10-20mg after 4 weeks, slowly increasing until 120-150mg/kg

Question 24

SAPHO syndrome meaning

Answer 24

Synovitis
Acne
Pustulosis
Hyperostosis
Osteitis

Question 25

Most potent acneiform inducing agents

Answer 25

Dioxin ( polyhalogenated hydrocarbons)

Question 26

Occurs in px who have had long periods of moderate acne and have been treated with long term antobiotics (tetracycline)

Answer 26

Gram negative folliculitis

Question 27

Treatment of choice for gram negative folliculitis

Answer 27

Isotretinoin

Question 28

Primarily a cicatricial alopecia variant Persistent folliculitis of the back and neck Fibrosis with coalescence of papules into plaques over time May have sinus tracts

Answer 28

Acne keloidalis

Question 29

Recurrent abscess formation within the folded areas of skin that contain terminal hairs and apocrine glands

Answer 29

Hidradenitis suppurativa

Question 30

Primary site of inflammation in hidradenitis suppurativa

Answer 30

Terminal hair

Question 31

Most frequently affected site in hidradenitis suppurativa

Answer 31

Axilla

Question 32

Treatment of hidradenitis suppurativa

Answer 32

Intralesional steroid + topical clinda or oral doxy Benzoyl peroxide wash Weight loss, reduce friction, laser hair removal Wide surgical excision- permanent cure

Question 33

Follicular inflammatory nodules in the scalp that progress to abscess Scarring and alopecia

Answer 33

Dissecting cellulitis of scalp

Question 34

Most favored sites in dissecting cellulitis of the scalp

Answer 34

Vertex | Occiput

Question 35

Treatment of dissecting cellulitis of the scalp

Answer 35

Tetracycline TMP SMX Quinolones

Question 36

Persistent erythema of the convex surfaces of the face (cheeks and nose most common)

Answer 36

Rosacea

Question 37

Rhinophyma occurs in what subtype of rosacea

Answer 37

Glandular

Question 38

Topical and oral therapy for rosacea

Answer 38

Topical: metronidazole, Na sulfacetamide, sulfur cleansers, ivermectin, azaleic acid Glandular- benzoyl, topical clinda Oral: doxycycline 50-100mg OD or BID Isotretinoin- more resistant disease (0.3mg/kg)

Question 39

Dramatically fulminant onset of superficial and deep abscess, cystic lesions, sinus tracts with purulent material

Answer 39

Pyoderma faciale

Question 40

Pyoderma faciale is differentated from acne by

Answer 40

Absence of comedones Rapid onset Absence of acne on chest and back

Question 41

Treatment of pyoderma faciale

Answer 41

Oral steroids x several weeks Then isotretinoin 10-20mg then 0.5-1mg/kg after inflammation under control