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👩🏼‍⚕️ ANDREWS' DISEASES OF THE SKIN 13TH EDITION > 13- Acne > Flashcards

13- Acne Flashcards

1
Q

What is the primary lesions of acne

A

Comedo

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2
Q

Types of acne scars

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

Most neonatal acne remit by age ___

A

1 year old

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4
Q

Acne onset from what age is considered as preadolescent acne?

A

7-12y

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5
Q

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

A

Keratin
Sebum
Microorganisms- propionibacterium acnes

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6
Q

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

A 
Serum dehydroepiandrosterone (DHEAS) 
Serum testosterone

2 weeks before onset of menses

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7
Q

Most common cause of treatment failure in acne

A

Lack of adherence

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8
Q

Treatment for mild comedonal acne

A

1st line: topical retinoid + physical extraction

2nd line: alternate retinoid, salicylic, azelaic acid

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9
Q

Treatment for mild papular/pustular acne

A

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

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10
Q

Treatment for moderate papular/pustular acne

A

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

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11
Q

Treatment for severe acne

Nodular/conglobate

A

Isotretinoin
Oral antibiotic + topical retinoid + benzoyl peroxide

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

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12
Q

Preferred agents in maintenance therapy of acne

A

Topical retinoids

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13
Q

Oral antibiotic for pregnant women with acne

A

Amoxicillin 500mg TID

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14
Q

Known side effect of clindamycin that limits its use

150mg TID

A

Pseudomembranous colitis

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15
Q

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

A

Spironolactone 100mg ODHS

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16
Q

Dose of isotretinoin for severe acne

A

0.5-1mg/kg/day OD or BID

Starting: 20-40mg/day

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17
Q

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

A

1 month

18
Q

To ensure excellent absorption, isotretinoin should be taken with

A

High fat meal

19
Q

Follicular occlusion triad

A

Acne conglobata
Hidradenitis suppurativa
Dissecting cellulitis of the scalp

20
Q

Therapy of choice for acne conglobata

A

Isotretinoin 0.5-1mg/kg/day

Total dose of 150mg/kg

21
Q

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

A

2 months

22
Q

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

A

Acne fulminans

23
Q

Treatment of acne fulminans

A

Prednisone 40-60mg x 4-8 weeks

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

24
Q

SAPHO syndrome meaning

A 
Synovitis
Acne
Pustulosis
Hyperostosis
Osteitis
25
Q

Most potent acneiform inducing agents

A

Dioxin ( polyhalogenated hydrocarbons)

26
Q

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

A

Gram negative folliculitis

27
Q

Treatment of choice for gram negative folliculitis

A

Isotretinoin

28
Q

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

A

Acne keloidalis

29
Q

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

A

Hidradenitis suppurativa

30
Q

Primary site of inflammation in hidradenitis suppurativa

A

Terminal hair

31
Q

Most frequently affected site in hidradenitis suppurativa

A

Axilla

32
Q

Treatment of hidradenitis suppurativa

A

Intralesional steroid + topical clinda or oral doxy

Benzoyl peroxide wash

Weight loss, reduce friction, laser hair removal
Wide surgical excision- permanent cure

33
Q

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

A

Dissecting cellulitis of scalp

34
Q

Most favored sites in dissecting cellulitis of the scalp

A

Vertex

Occiput

35
Q

Treatment of dissecting cellulitis of the scalp

A

Tetracycline
TMP SMX
Quinolones

36
Q

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

A

Rosacea

37
Q

Rhinophyma occurs in what subtype of rosacea

A

Glandular

38
Q

Topical and oral therapy for rosacea

A

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)

39
Q

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

A

Pyoderma faciale

40
Q

Pyoderma faciale is differentated from acne by

A

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

41
Q

Treatment of pyoderma faciale

A

Oral steroids x several weeks

Then isotretinoin 10-20mg then 0.5-1mg/kg after inflammation under control

👩🏼‍⚕️ ANDREWS' DISEASES OF THE SKIN 13TH EDITION (32 decks)

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