3.1 Acne and Related Conditions

Question 1

Four key pathogenic features of acne

Answer 1

1. Abnormal follicular keratinization
2. P acnes cleaves lipids into pro-inflammatory FFAs
3. Inflammation
4. Androgens increase sebum production by sebaceous glands

Question 2

Difference btwn acne fulminans and acne conglobata?

Answer 2

Both are sudden onset nodular acne, but fulminans has systemic sx (myalgias, arhralgias, fevere, ESR, WBCs) vs conglobata does not

Question 3

Follicular occlusion triad?

Answer 3

Dissecting cellulitis of scalp, pilonidal cyst, and HS

Question 4

Difference btwn neonatal acne and infantile acne?

Answer 4

Age. Neonatal is 2 weeks - 3 months, infantile is 3 mo - 2 years

Question 5

What is drug-induced acne (acneiform eruption = abrupt onset monomorphic papules and pustules but no comedones) caused by?

Answer 5

Steroids, phenytoin, lithium, isoniazid, iodides, epidermal growth factor receptor inhibitors (cetuximab, erlotinib, geftinib), anabolic steroids

Question 6

What is PAPA syndrome? Which mutation? What age do you see it?

Answer 6

Pyogenic Arthritis (sterile), Pyoderma gangrenosum, Acne
AD, CD2 binding protein 1 mutation (which is part of inflammatory pathway)
Presents near or at puberty

Question 7

What is HAIR-AN syndrome?

Answer 7

HyperAndrogenism, Insulin Resistance, Acanthosis Nigricans

Question 8

What is SAPHO syndrome? What is tx?

Answer 8

Synovitis, Acne (conglobata), Pustulosis (palmoplantar), Hyperostosis, Osteitis (common: sternoclavicular joint and long bones)
Tx: bisphosphonates vs MTX, anti-TNFa

Question 9

What is gram negative folliculitis? Tx?

Answer 9

Presents with perinasal centrofacial pustules as exacerbation of acne after long-term abx use, treat with isotretinoin if severe or recurrent

Question 10

Treatment of acne keloidalis nuchae?

Answer 10

Tretinoin, topical/systemic abx, ILK

Question 11

Tx of pseudofolliculitis barbae?

Answer 11

Topical/systemic abx, topical steroids, topical benza/clin, prevention with clippers, chemical depilatoris, and glycolic acid lotion

Question 12

Tx of perioral dermatitis?

Answer 12

Oral tetracycline, topical metronidazole or azelaic acid

Question 13

Cause of acne inversa (hidradenitis suppurativa)? Tx?

Answer 13

Occlusion of follicular infundibula with subsequent rupture of the follicle and surrounding inflammation.
Tx: weight reduction, hibiclens, absorbent powder, topical aluminum chloride, ILK, acitretin, surgical excision
Not good: systemic sterodis, isotretinoin, I and D

Question 14

Fox-Fordyce disease tx if intensely pruritic?

Answer 14

Topical and ILK, topical tretinoin, topical clinda

Question 15

Four types of rosacea?

Answer 15

1. erythematotelangiectatic
2. papulopustular
3. phymatous
4. ocular

Question 16

Three rosacea variants?

Answer 16

1. lupus miliaris disseminatus faciei - yellow-brownt o red small monomorphic smooth papules on malar cheeks and periorificially, tx: long term mino or isotretinoin
2. pyoderma faciale (rosacea fulminans): acute onset of papules/pustules/nodules/abscesses in centrofacial region with background of dull cyanotic erythema, can have systemic sx of acne fulminans (tx: topical steroids followed by isotretinoin)
3. Morbihan’s disease (solid facial edema): woody, nonscaling edema involving midline face and cheeks (tx: isotretinoin)