37- Acne vulgaris

Question 1

what inflammatory infiltrates are seen in acne lesions?

Answer 1

Pustules- neutrophils

Nodules/cytes- influx of T helper lymphocytes, foreign body type giant cells and neutrophils

Question 2

What porphyrins do propionibacterium acnes produce?

Answer 2

• coproporphyrin III (fluroesces with Wood’s lamp).

Question 3

What is the mechanism by which infants get acne?

Answer 3

• infant boys have elevated LH and testosterone –> results in testicular overproduction.

Infant boys and girls have an increased level of dehydroepiandrosterone due to the immaturity of the early adrenal gland.

After the age of 1 year hormone levels decrease.

Question 4

What are the clinical features of acne fulminans?

Answer 4

• abrupt onset of nodules and suppurative acne.
• lesions may coalesce into painful oozing, heamorhagic crusts.
• Affects young males usually 13-16 years of age
• may have osteolytic bone lesions.
• systemic manifestations include fevers, arthralgias, myalgias, hepatosplonomegaly and severe prostration.

patients may have erythema nodosum

Question 5

what is the treatment of acne fulminans?

Answer 5

• intralesional corticosteroids
• oral corticosteroids
• oral abs
• oral istotretinoin

isotretinoin can paradoxically induce acne fulminans in some patients.

Question 6

what are the features of acne conglobata?

Answer 6

• this is severe eruptive nodulocystic acne without systemic manifestations.

can be partof the follucular occlusion tetrad.

Question 7

What is PAPA syndrome

Answer 7

pyogenic arthritis, pyoderma gangrenosum and acne.

Question 8

what genetic defect is found in PAPA syndrome?

Answer 8

PSTPIP1 gene defect (CD2 antigen-binding protein 10

Question 9

What is Morbihan’s disease?

Answer 9

Solid facial edema presenting as distortion of the midline face and cheeks due to soft tissue swelling.

“Woody”, non scaling induration.

Question 10

What is acne mechanica?

Answer 10

This is acne secondary to repeated rubbing and frictional obstruction of the pilosebaceous unit.

E.g helmets,, chin straps, collars, “Fiddler’s neck”.

Question 11

What drugs can cause acne or acneiform lesions?

Answer 11

• anabolic steroids
• corticosteroids
• corticostropin
• phenytoin
• lithium
• isoniazid
• iodides
• eGFR inhibitors

less commonly - azathioprine, CsA, vitamins B1, B6,B12, PUVA, disulfiram.

Question 12

What is chloracne and how does it present?

Answer 12

Chloracne is acne which is cause by exposure to chlorinated, aromatichydrocarbons.

The malar, retroauricular and mandibular regions are commonly affected.

The axilla and scrotum are also affrected.

Lesions can heal with significant scarring and there can be recurrent outbreaks.

treatment is aimed at vigorously removing the chemical. Topical or oral retinoids can be used.

Question 13

How does neonatal acne (benign cephalic pustulosis) present?

Answer 13

• Lesions appear at 2 weeks of age and resolve within the 3 months of life.
  Small, inflammed papules arise on the cheeks and nasal bridge.

thought to be due to Malassezia.

Question 14

How is benign cepahlic pustulosis treated?

Answer 14

• topical 2% ketoconazole and benzoyl peroxide.

Question 15

How does infantile acne present?

Answer 15

• appears at 3- 6 months of age.
• prominent comedones
• potentially pitted scarring
• deep cystic lesions and suppurative nodules.

Treated with topical tretinoin and benzoyl peroxide.

Question 16

What is HAIR-AN syndrome

Answer 16

hyperandrogenism that occurs with Insulin resistance with acanthosis nigricans.

Question 17

What do acneiform eruptions in eGFR inhibitor look like?

Answer 17

Lesions are eruptive, monomorphoous follicular pustules and papules involving the face, scalp and upper trunk.

Question 18

How does radiation acne present?

Answer 18

• presents as comedo-like papules occuring at a site of previous exposure to therapeutic ionizing radiation. Lesions appear as the acute phase of radiation dermatitis begins to resolve.

Question 19

What are the features of Apert syndrome?

Answer 19

- disfiguring synostoses of the bones of the hands and feet and cranium. 
-
seborrhea
- nai dystrophy
- cutaneous and ocular hypopigmentation

Lesions are more diffuse involving the entire extensor aspect of the arms, buttocks and thighs.

highly resistat to topical therapies,

Question 20

What are the histological findings of acne?

Answer 20

Early lesions - narrolwed follicular opening, imacted shed keatinocytes, prominent granular layer.

Closed comedones - follucular distention. Eosinophililc and keratinoaceous debris.

Open comedones- expanded follicular ostia and folliculardistensions.

Sebaceous glands are atrophic or absent.