13- Acne Flashcards
What is the primary lesions of acne
Comedo
Types of acne scars
- Ice pick- temples and cheeks
- Box car
- Rolling
- Anetoderma type (atrophic)
- Hypertrophic
Most neonatal acne remit by age ___
1 year old
Acne onset from what age is considered as preadolescent acne?
7-12y
The combination of these 3 elements in acne formation leads to the release of proinflammatory mediators➡️ formation of inflammatory lesions
Keratin
Sebum
Microorganisms- propionibacterium acnes
Screening tests to exclude a virilizing tumor for severe acne resistant to therapy, relapse quickly or sudden onset
Serum dehydroepiandrosterone (DHEAS) Serum testosterone
2 weeks before onset of menses
Most common cause of treatment failure in acne
Lack of adherence
Treatment for mild comedonal acne
1st line: topical retinoid + physical extraction
2nd line: alternate retinoid, salicylic, azelaic acid
Treatment for mild papular/pustular acne
1st line: topical antimicrobial + topical retinoid, benzoyl peroxide wash if mild truncal lesions
Treatment for moderate papular/pustular acne
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
Treatment for severe acne
Nodular/conglobate
Isotretinoin
Oral antibiotic + topical retinoid + benzoyl peroxide
Women: spironolactone + OCP + topical retinoid +/- topical or oral antibiotic and/or benzoyl peroxide
Preferred agents in maintenance therapy of acne
Topical retinoids
Oral antibiotic for pregnant women with acne
Amoxicillin 500mg TID
Known side effect of clindamycin that limits its use
150mg TID
Pseudomembranous colitis
Antiandrogen treatment prescribed in combination with OCP in the treatment of acne
Spironolactone 100mg ODHS
Dose of isotretinoin for severe acne
0.5-1mg/kg/day OD or BID
Starting: 20-40mg/day
When taking isotretinoin, women should not become pregnant until stopping medication for at least _______
1 month
To ensure excellent absorption, isotretinoin should be taken with
High fat meal
Follicular occlusion triad
Acne conglobata
Hidradenitis suppurativa
Dissecting cellulitis of the scalp
Therapy of choice for acne conglobata
Isotretinoin 0.5-1mg/kg/day
Total dose of 150mg/kg
A second course of isotretinoin may be done in acne conglobata if resolution does not occur after a rest period of _______
2 months
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
Acne fulminans
Treatment of acne fulminans
Prednisone 40-60mg x 4-8 weeks
Isotretinoin 10-20mg after 4 weeks, slowly increasing until 120-150mg/kg
SAPHO syndrome meaning
Synovitis Acne Pustulosis Hyperostosis Osteitis
Most potent acneiform inducing agents
Dioxin ( polyhalogenated hydrocarbons)
Occurs in px who have had long periods of moderate acne and have been treated with long term antobiotics (tetracycline)
Gram negative folliculitis
Treatment of choice for gram negative folliculitis
Isotretinoin
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
Acne keloidalis
Recurrent abscess formation within the folded areas of skin that contain terminal hairs and apocrine glands
Hidradenitis suppurativa
Primary site of inflammation in hidradenitis suppurativa
Terminal hair
Most frequently affected site in hidradenitis suppurativa
Axilla
Treatment of hidradenitis suppurativa
Intralesional steroid + topical clinda or oral doxy
Benzoyl peroxide wash
Weight loss, reduce friction, laser hair removal
Wide surgical excision- permanent cure
Follicular inflammatory nodules in the scalp that progress to abscess
Scarring and alopecia
Dissecting cellulitis of scalp
Most favored sites in dissecting cellulitis of the scalp
Vertex
Occiput
Treatment of dissecting cellulitis of the scalp
Tetracycline
TMP SMX
Quinolones
Persistent erythema of the convex surfaces of the face (cheeks and nose most common)
Rosacea
Rhinophyma occurs in what subtype of rosacea
Glandular
Topical and oral therapy for rosacea
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)
Dramatically fulminant onset of superficial and deep abscess, cystic lesions, sinus tracts with purulent material
Pyoderma faciale
Pyoderma faciale is differentated from acne by
Absence of comedones
Rapid onset
Absence of acne on chest and back
Treatment of pyoderma faciale
Oral steroids x several weeks
Then isotretinoin 10-20mg then 0.5-1mg/kg after inflammation under control
