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Senior - Derm 1 > 6 - Acne > Flashcards

6 - Acne Flashcards

1
Q

What is acne vulgaris?

A

Disease of the pilosebaceous unit

  • onset w puberty
  • both sexes
  • hereditary tendencies
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2
Q

Acne vulgaris pt population?

A

89% - 12-24 y/o (40 mil)
8% - 24]5-34 y/o (3.2 mil)
3% - 35-44 y/o (1.2 mil)

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3
Q

Morphologic variations w acne vulgaris?

A

Noninflammatory

  • open comedones
  • closed comedones

Inflammatory (1+ of)

  • papules
  • pustules
  • nodules/cysts
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4
Q

Where is acne vulgaris usually located?

A

Sebaceous areas

  • face
  • chest
  • back
  • upper arms
  • groin
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5
Q

Pathogeneous of acne vulgaris?

A

Excess sebaceous gland secretion

Pilosebaceous duct obstruction

Bacterial colonization and inflammation

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6
Q

What bacteria causes acne?

A

Proliferation of propionibacterium acne (P. Acnes)

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7
Q

Action of p acnes?

A

Breaks down sebum (chol/trig) to free fatty acids (FFA) which are

  • irritating
  • inflammatory
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8
Q

Management of acne vulgris?

A

Skin care modification

  • mild soap + water frequently
  • mild exfoliant (scrubbing, masks, peels, acid washes)
  • avoid occlusion (makeup etc)
  • keep hands away from face
  • avoid stress, caffeine, sugar
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9
Q

Acne vulgaris therapeutic targets?

A

Comedonegenis
P. Acnes
Sebum production
Inflammation

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10
Q

Meds for comedogenesis?

A 
Retinoids
Benzoyl peroxide
Salicylic acid
Azelaic acid
Alpha hydroxy acid
Isotretinoin
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11
Q

Meds for P acnes

A

Antibiotics
Retinoids
Benzoyl peroxide

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12
Q

Meds for Sebum production

A

Retinoids
Antiandrogens
- low dose OC

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13
Q

Meds targeting inflammation?

A

Oral antibiotics

Retinoids

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14
Q

When treating acne there is no quick fix and you must start with benign tx and go up. How long do you need to try a therapy before moving on?

A

6-8 weeks

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15
Q

Comedonal acne tx (noninflammatory)

A

Start w retinoid (low dose)
- tretinoin 0.025% @ bedtime

4-8 weeks add benzoyl peroxide/topical abx
- benzacilin (combo tx)

Increase strength of retinoid

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16
Q

Mild inflammatory acne txt?

A

Start w retinoid and/or benzoyl peroxide or topical abx
- alternate days x 2-4 wks

Adust dose prn

Add oral abx if pustules remain

  • doxycycline 100 mg qd
  • tetracycline 500 mg bid
  • minocycline 100 mg bid
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17
Q

Abx for mild acne should be tried for a min of?

A

3 months

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18
Q

Moderate to sever inflammatory acne txt?

A

1st topical antibiotic or benzoyl peroxide
- benzaClin or Duac (combo drugs)

If >10 pustules - oral abx
- doxy, TCN, mino (taper 2-4 mo)

Later
- topical retinoid

Intralesional steroid injection
- triamcinolone 2.5-5mg/ml

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19
Q

If normal moderate - severe acne tx fails?

A

Culture pustules/cysts
- start ampicillin

Accutane (isotretinoin)

  • effective but side effects
  • iPLEDGE program

Women

  • OCP
  • spironolactone
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20
Q

Alternate or 2nd line acne txt?

A 
Adapalene (differin)
- 3rd gen topical retinoid
Azelaic acid (azelex
Oral prednisone
Acne surgery
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21
Q

Morphology of NoduloCystic acne?

A 
Sig inflammation
Papules
Pustules
Nodules
Cysts 
Scarring 
Sinus tracts 
Mild facial edema
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22
Q

Subtypes of nodulocystic acne

A

Cystic acne
Pyoderma faciale
- face only
Acne fulminans
- ulcerative, necrotic acne w arthralgias, myalgias and bone pain
Acne conglobata
- H inflammatory, double comedones, cysts, sinus tracts

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23
Q

____ is MC’ly found in Females

____ is MC’ly found in Males

A

Pyoderma faciale
- MC in 13-40 y/o females

Acne fulminans
- MC in adolescent white males

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24
Q

Which type of acne leads to atrophic or keloidal scarring?

A

Acne conglobata

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25
Q

Clinical presentation of NoduloCystic acne

A

Family history
No response to typical tx
Embarrassing

Locations

  • face
  • neck
  • chest
  • back
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26
Q

Nodulocystic acne management?

A

Isotretinoin (accutane)

  • reduces size and activity of sebaceous glands
  • normalizes keratinization
  • very effective
  • sig SE profile
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27
Q

While isotretinoin affects all four sources of acne it is only approved for which types of acne?

A

Nodular acne

Recalcitrant acne

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28
Q

What needs to be done pre isotretinoin?

A

Is pt reliable and able to be followed x 6 months?

Stop TCN x 4 wks before tx
Stop all topical meds

Review labs

Fam hx of colitis

DC all vitamins esp vit a

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29
Q

Labs for isotretinoin?

A 
CBC
UA
LFT
Lipids
HCG - before and monthly
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30
Q

Pt instructions for isotretinoin?

A 
Lubricate eyes, lips
Bactroban nose
Oil free moisturizer/sunscreen
NO blood donations
Moos swing are common
Freq follow ups required
Low fat diet (rise in lipids)
Avoid ETOH (LFTs)
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31
Q

Reproductive age women should only be given ___ of isotretinoin?

A

1 month at a time

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32
Q

Stop isotretinoin if?

A

HA

  • not relieved by tylenol
  • w visual changes

Mood swings w SI/HI

Concern is Papilledema
- pseudotumor cerebri

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33
Q

Tx plan for isotretinoin?

A

20 week course w q 4 week f/u

Dose: 40mg bid
- increase till effective

Cumulative dose of 120-150 mg/kg x 160 days
- higher for chest and back

Must come from derm

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34
Q

Morphology of pomade acne and acne cosmetica?

A

Small non-inflamed papules and comedones in pts who apply products that increase plugging (oils/creams)

Location:

  • forehea
  • temples
  • sides of face
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35
Q

Area that is spared by pomade acne and acne cosmetica?

A

Spares the sebaceous areas

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36
Q

Management of pomade acne and acne cosmetica?

A 
Change habits
Stop all oils/creams x 1 month
Add 
- tretinoin 0.025%
- BP 10% (if tolerated)
- topical antibiotics

Avoid PO antibiotics

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37
Q

Clinical presentation in adult female acne?

A

Women mid 20’s-30’s
Hormonal sensitive
Flares w menses
Occasionally begin w pregnancy

Lesions

  • Tender
  • few (qty)
  • slow healing
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38
Q

Morphology of adult female acne?

A

Very inflamed
Red
Papules
Comedomes

Sometimes:
Small non-scarring cyst

39
Q

Location for adult female acne?

A

Chin
Jawline
Neck (sometimes)

40
Q

Management of adult female acne?

A

Oral contraceptives
Tretinoin (2nd line)
Erythromycin 250mg
- strong anti-inflammatory action (3rd line)

41
Q

Location of steroid acne?

A

MC

  • chest
  • neck
  • back

Sometimes

  • face
  • arms
42
Q

Morphology of steroid acne?

A

Follicular papules and pustles
Uniform size and symmetric distribution
Non-scarring

43
Q

Clinical presentation of steroid acne?

A

Sudden onset
- 2-4 wks after PO corticosteroids

Teens/adults
Often puritic

Heals w/o scarring

44
Q

I got steroid acne, can i still take my steroids?

A

It is not a C/I for continued or future use of PO corticosteroids

45
Q

Management of steroid acne?

A

DC oral corticosteroids
- clears rapidly

Topical tx

  • benzolyl peroixide
  • sulfacetamide/sulfur lotion

Hydroxyzine (atarax)
Diphenhydramine (for itch)

46
Q

MC infectious folliculitis?

A

Staphylococcus folliculitis

47
Q

Morphology of staph folliculitis?

A

Lone or grouped small pustules

Mild-moderate surrounding erythema

48
Q

Location of folliculitis

A

Face

  • around nares
  • lower face

Chest (anywhere w hair)

49
Q

Staph folliculitis associated sx?

A

Tenderness
Low grade fever
Injury (from shaving or similar)

50
Q

Causes of staph folliculitis?

A

infection around follicles by S. Epidermidis or S. Aureus

Complication of occlusive topical steroid therapy

51
Q

If staph folliculitis is persistent or recurrent?

A

Poss nasal carrier

  • seeded skin by contact
  • health care workers
52
Q

Management of staph folliculitis?

A

Isolated

  • erythromycin
  • diclox

Recurrent/persistent

  • cephalexin
  • rifampin
  • bactroban to nares
  • wash w hibiclens
  • change towel and pillowcase daily
53
Q

Perioral dermatitis is MC in?

54
Q

Clinical presentation of perioral dermatitis?

A

young women
- fair, delicate skin
Mildly pruritic
Recurrent

55
Q

Etiology of perioral dermatitis?

A

UKN
- proposed - skin intolerance reaction to chronic dry skin

Associted w

  • habitual use of moisturizing creams
  • Previous topical steroid use
  • topical irritants (tretinoin, BP, Etoh based)
56
Q

Morphology of perioral dermatitis?

A

Small papules and pustules (resembles acne)

Typically confined to:

  • chin
  • nasolabial folds

Pustules on cheeks adjacent to nasolabial folds (highly characteristics)

Occasionally red and scaly

Clear zone around vermilion border

57
Q

Management of perioral dermatitis

A

Doxycycline 100mg PO
- 2-4 wks (sometimes longer)

Topical metronidazole (not as effective as doxy)

1% HC cream

DC facial moisturizers and cosmetics

58
Q

Acne rosacea etiology?

A

Unknown

- demodex folliculorum

59
Q

Acne rosacea morphology

A

Erythema (transient/nontransient)

Telangiectasia
Papules/pustules
Rhinophyma
Swelling of cheeks and forehead

60
Q

What is rhinophyma?

A

Enlarged nose

61
Q

Clinical presentation of acne rosacea?

A 
Fair skinned
More sebaceous activity
- mid face (malar area)
- eyelid involvment
- chin (severe)

Easily flushed - vasodilation

  • ETHO increases erythema
  • hot spicy foods
  • hot drinks/caffiene
  • hot climate/exercise
  • emotions
  • sun

Mid 30’s-40’s persistent o old age

62
Q

Management of mild to moderate acne rosacea?

A

Meds

  • metronidazole 1% topical BID (active against mite)
  • doxycycline bid
  • erythromycin
  • minocycline ($$)

Sunscreen

Avoid triggers

63
Q

Management of persistent/severe acne rosacea?

A

Accutane
Rhinophyma
- specialty surgery

64
Q

What is hidradentitis suppurativa?

A

Chronic suppurtative scarring dz of skin and subQ tissue

65
Q

Etiology of hidradentitis suppurativa

A

Family tendency for scarring acne

Hyperkeratosis over apocrine gland w secondary bacterial infection

66
Q

Clinical presentation of hidradenitis suppurativa

A 
20’s-40’s (always after puberty)
F>M
Obesity
Chronic
Painful
Debilitating
67
Q

Locations for hidradenitis suppurativa

A

Axilla
Groin (anogenital region)
- suprapubic and anal
Under breasts

68
Q

Morphology of hidradenitis suppuraiva?

A 
Mild-sever 
- erythema
- cysts
- abscesses
(Progressive and self perpetuating)

Double-comedone
- blackhead w 2+ communicating surface openings

Sinus tracts develop as disease developes

Scarring
- healing permanently alters dermis
(Cordlike band of scar tissue)

69
Q

Management of hidradenitis suppurativa?

A

no smoking

Mild dz
- long term abx (mainstay)
—(TCN, doxy, e-mycin, minocycline)
- hot compress
- I/D large cysts/abscesses

Extensive dz

  • surgical excision and grafts
  • isotretinoin 1mg/kg/day x 20 wks
70
Q

Etiology of pseudofolliculitis barbae (PFB)

A

Foreign body reaction causes inflammation

Chronic distortion of follicle

71
Q

Clinical presentation of PFB?

A

Tightly curled hair, cut short

50-70% of blacks
3-5% of whites

72
Q

Morphology of PFB?

A

Inflammation
Papules and pustules
Post-inflammatory hyperpigmentation
Scarring and keloids

73
Q

Management of PFB?

Techniques

A

Modify shaving technique

  • hydrate and soften beard
  • brush hair w toothbrush
  • wash w benzoyl peroxide
  • glycolic acid or aveeno shaving cream x 5 min
  • shave w grain
  • bump fighter razor q
74
Q

Management of PFB

Meds

A

Rx

  • Topical abx after shaving
  • Retin-a 0.025%
  • Po abx if pustules develop

Additional

  • Medicated after shave lotion
  • temp profile x 3 mo
  • laser hair removal
75
Q

What is acne keloidalis nuchae (AKN)?

A

Chronic scarring folliculitis of ukn etiology
Men only

Black»white

76
Q

Morphology of AKN?

A

Process same as PFB
Coexists w PFB

Nape more prone
Occasionally over scalp

77
Q

Management of acne keloidalis nuchae?

A

No short/shaved haircuts
Pustular or exudative
- culture
- txt up to 3-6 mo

78
Q

3 step plan for control AKN

A

Topical clina bid (cleocin)
Fluocinonide (lidex)
Tretinoin 0.05%

  • DC steroid after 3-6 mo everything else x 12 mo
79
Q

Add on therapy for AKN?

A

Oral steroids
Intralesional steroid inj
Laser therapy
Excisional surgery

80
Q

Epidermal inclusion cyst (EIC)

A

Derived from upper part of follicle

  • occluded and dysfunctional
  • implanted under epidermis due to trauma

Follicle becomes filled w sebum and swells rapidly

81
Q

Morphology for EIC?

A
  • Round protruding smooth-surfaced mass
  • soft
  • mobile
  • few mm to several cm
  • visible but dysfunctional pore
82
Q

Clinical presentation of EIC?

A
  • Present after puberty
  • MC in oily skin ppl
  • acne-prone fam tendency for cysts
  • typically asymptomatic
  • non-inflamed lesion may spontaneously resorb and resolve
  • can spontaneously rupture
83
Q

Management of EIC?

A

No tx if asymptomatic/cosmetically acceptable

Remove non-inflamed lesions

Inflamed cyst

  • intralesional inj kenalog
  • then remove

Ruptured inflamed cyst
- excise after I/D

84
Q

Clinical presentation of milia?

A

Small epidermal cyst w/o openings

Response to sun damage/other

Any age

85
Q

Morphology of milia?

A

Tiny, white pea shaped cyst
Asymptomatic
Solitary/multiple

86
Q

Location of milia?

A

MC face
Esp around eyelids
Can occur anywhere

87
Q

Management for Milia?

A

Solitary

  • incise over lesion
  • extraction

Multiple
- tretinoin 0.025% - 0.5% cream

88
Q

Miliaria is?

89
Q

Morphology of miliaria?

A 
Multiple 
Diffusely scattered 
1mm papules/vesicles
Skin colored 
- miliaria crystallina 
Red 
- miliaria rubra
90
Q

Location of miliaria?

A

Anywhere but esp:

  • forehead
  • cheeks
  • trunk
91
Q

Clinical presentation of miliaria

A 
“Prickly heat” “heat rash”
Sweat retention
Hot/humid weather
Profound sweating
Young babies
Stinging or pruritic
92
Q

Morphology of pilar cyst (wen)?

A

Multiple, firm, smooth, Movable 1-3cm sub q cysts

Asymptomatic

30% solitary

Tough lining

Keratinizes differently from EIC

Produces a compact homogenous material that can calcify

93
Q

Location of pilar cysts?

A

90% are in scalp

94
Q

(Spoken by a horse)

“Its derby weekend and guess who has a blemish”

A

“Things nayyyver go my way”

Senior - Derm 1 (7 decks)

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