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FD9 > 78 - Acne Vulgaris > Flashcards

78 - Acne Vulgaris Flashcards

1
Q

The prevalence of acne is adolescents is higher in _____, but in adults is higher in _____

A

Males

Females

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2
Q

Two indigenous populations that have been described that do not develop acne

A

Papua New Guinea

Paraguay

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3
Q

Drug-induced acne may be caused by

A 
Anabolic steroids
Corticosteroids 
Corticotropin
Phenytoin
Lithium
Isoniazid
Vitamin B complexes
Halogenated compounds
Certain chemotherapy medications, particularly with EGFR inhibitors
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4
Q

Hormonal therapy which can exacerbate or induce acne vulgaris

A

Progestin-only contraceptives
Injectables
Intrauterine devices

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5
Q

Y/N: True cysts are rarely found in acne

A

Yes

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6
Q

Although the majority of inflammatory lesions appears to originate from _____ (54%), a significant number of inflammatory (26%) lesions arise from _____

A

Comedones

Normal uninvolved skin

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7
Q

Categories of atrophic scars in acne

A

Ice pick scars
Boxcar scars
Rolling scars

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8
Q

Narrow, deep scars that are widest at the surface of the skin and taper to a point in the dermis

A

Ice pick scars

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9
Q

Wide sharply demarcated scars that do not taper to a point at the base

A

Boxcar scars

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10
Q

Shallow, wide scars that have an undulating appearance

A

Rolling scars

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11
Q

Another type of scar, which typically presents as atrophic soft papules on the upper part of the trunk

A

Perifollicular elastolysis

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12
Q

Key elements in the pathogenesis of acne vulgaris

A
  1. Follicular epidermal hyperproliferation
  2. Sebum production
  3. Propionibacterium acnes
  4. Inflammation and immune response
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13
Q

Dihydrotestosterone (DHT) is converted from dehydroepiandrosterone sulfate (DHEA-S) by

A

17-beta hydroxysteroid dehydrogenase (HSD)

5-alpha reductase

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14
Q

Compared with epidermal keratinocytes, follicular keratinocytes have increased _____, thus enhancing DHT production

A

17-beta hydroxysteroid dehydrogenase (HSD)

5-alpha reductase

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15
Q

(High/Low) levels of linoleic acid induce follicular keratinocyte hyperproliferation and the production of proinflammatory cytokines

A

Low

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16
Q

IL-_____ induces follicular keratinocyte hyperproliferation and microcomedone formation

A

1alpha

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17
Q

On average, people with acne excrete more sebum than those without acne, and secretion rates (have been shown/have not been shown) to correlate with the severity of clinical manifestations

A

Have been shown

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18
Q

Main component of sebum

A

Triglycerides

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19
Q

Broken down into free fatty acids by P. acnes

A

Triglycerides

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20
Q

The dose of estrogen required to decrease sebum production is (greater/less) than the dose required to inhibit ovulation

A

Greater

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21
Q

Released by the hypothalamus and increased in response to stress

A

Corticotropin-releasing hormone

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22
Q

Predominant cell type within 24 hours of comedo rupture

A

Lymphocyte

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23
Q

_____ lymphocytes are found around the pilosebaceous unit, and _____ cells are found perivasularly

A

CD4+

CD8+

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24
Q

One to two days after comedo rupture, the _____ becomes the predominant cell type

A

Neutrophil

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25
Q

Gram-positive, anaerobic, microaerophilic bacterium found in the sebaceous follicle
Dominant bacterial inhabitant of the human sebaceous gland

A

P. acnes

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26
Q

There is a significant increase in P. acnes colonization at

A

Puberty

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27
Q

Y/N: There are no consistent data correlating the raw number of P. acnes organisms present in a sebaceous follicle and the severity of the acne

A

Yes

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28
Q

Recent studies provide evidence that _____ diets may exacerbate acne and _____ ingestion appears to be weakly associated with acne

A

High glycemic loads

Dairy

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29
Q

Excess androgens may be produced by

A

Adrenal gland

Ovary

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30
Q

Laboratory workup to measure excess androgen

A 
Serum DHEAS
Total testosterone
Free testosterone
LH:FSH ratio
Serum 17-hydroxyprogesterone
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31
Q

Considered the most sensitive for PCOS

A

Free testosterone

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32
Q

Additional test to consider to identify an adrenal source of androgens

A

Serum 17-hydroxyprogesterone

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33
Q

Androgen testing should be obtained

A

Just before or during the menstrual period

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34
Q

Patients taking contraceptives that prevent ovulation will need to discontinue their medication for at least _____ before testing

A

1 month

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35
Q

Values of DHEAS in the range of 4000 to 8000 ng/mL may be associated with

A

Congenital adrenal hyperplasia

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36
Q

Patients with a serum DHEAS greater than 800 ng/mL could have a/an

A

Adrenal tumor

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37
Q

Serum total testosterone in the range of 150 to 200 ng/dL or an increased LH-to-FSH ratio (>2.0) can be found in cases of

A

PCOS

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38
Q

Greater elevations in serum testosterone (>200 ng/dL) may indicate a/an

A

Ovarian tumor

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39
Q

In women, there is often variation in relation to the menstrual cycle, with a flare just before the onset of menstruation, especially in those older than _____ of age

A

30 years

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40
Q

Binding of these agents to nuclear RAR affects the expression of genes involved in cell proliferation, differentiations, melanogenesis, and inflammation

A

Retinoids

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41
Q

Retinoids have _____ properties

A

Comedolytic

Antiinflammatory

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42
Q

Some newer formulations use a microsphere delayed-delivery technology or are incorporated within a polyolprepolymer to decreased the _____ potential of tretinoin while allowing greater concentration of medication

A

Irritancy

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43
Q

Inactivated by concomitant use of benzoyl peroxide and is photolabile

A

Generic tretinoin

44
Q

Specifically targets the RARgamma receptor

Both photostable and can be used in conjunction with benzoyl peroxide

A

Adapalene

45
Q

The only retinoid recently made available by the US FDA for over-the-counter treatment for acne in those 12 years and older

A

Adapalene 0.1% gel

46
Q

Tazarotene exerts its action through its metabolite, _____, which in turn inhibits the RARgamma receptor

A

Tazarotenic acid

47
Q

Powerful antimicrobial agent, markedly reducing the bacterial population via release of free oxygen radicals
Also has mild comedolytic properties

A

Benzoyl peroxide

48
Q

Can produce significant dryness and irritation

Can bleach clothing and hair

A

Benzoyl peroxide

49
Q

Bacteria are unable to develop resistance to _____, making it the ideal agent for combination with topical or oral antibiotics

A

Benzoyl peroxide

50
Q

Most recently approved topical antibiotic for acne

A

Topical dapsone 5% and 7.5% gel

51
Q

Y/N: Topical dapsone is not safe for use in patients with G6PD deficiency

A

No -safe for use

52
Q

Topical dapsone should not be applied concomitantly with _____, or it may impart an orange color on the skin

A

Benzoyl peroxide

53
Q

Lipid-soluble beta-hydroxy acid which has comedolytic properties by somewhat weaker than those of a retinoid
Causes exfoliation of the stratum corneum through decreased cohesion of the keratinocytes
Less effective then benzoyl peroxide

A

Salicylic acid

54
Q

Dicarboxylic acid which has both antimicrobial and comedolytic properties
Also a competitive inhibitor of tyrosinase

A

Azelaic acid

55
Q

Thought to have antibacterial properties though their inihibition of para-aminobenzoic acid (PABA), an essential substance for P. acnes growth

A

Sulfonamides

56
Q

Inhibits the formation of free fatty acids and has presumptive keratolytic properties
Often combined with sodium sulfacetamide to enhance its cosmetic tolerabilty due to sulfur’s disctinctive odor

A

Sulfur

57
Q

Resorcinol is also indicated for use in acne for its _____ properties

A

Antimicrobial

58
Q

Does not alter sebum production

Decreases the concentration of free fatty acids while the esterified fatty acid content increases

A

Oral tetracyclines

59
Q

Doxycyline and minocycline are the most commonly used tetracycline derivatives for acne. They have the distincy advantage that

A

They can be taken with food with minimal impaired absorption

60
Q

Major disadvantages of doxycycine and minocycline

A

Potential risk of photosensitivity reaction

61
Q

Can cause blue-black pigmentation, especially in acne scars

A

Minocycline

62
Q

Should be taken on an empty stomach, 1 hour before or 1 hours after meals

A

Tetracycline

63
Q

Tetracycline should not be administered to pregnant women, especially after the fourth month of gestation, and are not recommended for use in children younger than

A

9 years of age

64
Q

Because of the prevalence of _____-resistant strains of P. acnes, the use of oral _____ is generally limited to pregnant women or children

A

Erythromycin

65
Q

First-generation cephalosporin
Hydrophilic; penetrates poorly into the pilosebaceous unit
Success is most likely caused by antiinflammatory rather than antimicrobial properties

A

Cephalexin

66
Q

Antibiotic resistance should be suspected in patients unresponsive to appropriate antibiotic therapy after _____ of treatment

A

6 weeks

67
Q

Resistance is highest with _____ and lowest with _____

A

Erythromycin

Lipophilic tetracylines, doxycyline and minocycline

68
Q

The least resistant is noted with

A

Minocycline

69
Q

Recent guidelines recommend limiting the duration of oral antibiotic therapy in acne to _____ to reduce risk of resistance

A

3 to 6 months

70
Q

Two progestins have demonstrated antiandrogenic properties

A
  1. Cyproterone acetate

2. Drospirenone

71
Q

Usually restricted to severely involved patients, often overlapping with isotretinoin to limit any potential flaring at the start of treatment

A

Glucocorticoids

72
Q

Glucocorticoids in low dosages are also indicated in

A

Female patients who have an elevation in serum DHEAS associated with an 11- or 21-hydroxylase deficiency
Other individuals with demonstrated androgen excess

73
Q

Act on the pituitary gland to disrupt its cyclic release of gonadotropins

A

GnRH agonists, such as leuprolide

74
Q

GnRH agonists are used in the treatment of

A

Ovarian hyperandrogenism

75
Q

Aldosterone agonist and functions in acne as both an androgen-receptor blocker and inhibitor of 5-alpha reductase

A

Spironolactone

76
Q

Side effects of spironolactone

A 
Diuresis
Potential hyperkalemia
Irregular menstrual periods
Breast tenderness
Headache
Fatigue
77
Q

Combining spironolactone treatment with _____ can alleviate the symptoms of irregular menstrual bleeding

A

Oral contraceptive

78
Q

Long-term studies in rats receiving high doses of spironolactone demonstrated an increased incidence of _____, resulting in a black box warning by the FDA

A

Adenomas on endocrine organs and the liver

79
Q

Progestational antiandrogen that blocks the androgen receptor

A

Cyproterone acetate

80
Q

Androgen receptor blocker

A

Flutamide

81
Q

Liver function tests should be monitored while using flutamide because cases of _____ have been reported

A

Fata hepatitis

82
Q

Isotretinoin is also effective in the treatment of

A

Gram-negative folliculitis
Pyoderma faciale
Acne fulminans

83
Q

The risk of _____ may be increased with concomitant used of tetracyclines and isotretinoin

A

Pseudotumor cerebri

84
Q

Most common musculosketal complain with the use of isotretinoin

A

Myalgia

85
Q

Baseline laboratory monitoring for patients taking isotretinoin

A

CBC
Liver function tests
Lipid panel

86
Q

The greatest attention should be paid to following serum _____ levels

A

Triglyceride

87
Q

Baseline values for serum triglycerides should be obtained and repeated at _____ of therapy

A

4 and 8 weeks

88
Q

If serum triglycerides increase above _____, the levels should be monitored frequently. Levels above _____ are a reason for interrupting therapy or treating the patient with a lipid-lowering drug

A

500 mg/dL

700 to 800 mg/dL

89
Q

Y/N: Isotretinoin is not mutagenic; its effect is on organogenesis

A

Yes

90
Q

Y/N: Because isotretinoin is not mutagenic, there is no risk to a fetus conceived by a man who is taking isotretinoin

A

Yes

91
Q

Patients with severe acne often need pretreatment for 1 to 2 weeks with _____, which may be continued for the first 2 weeks of therapy

A

Prednisone (40-60 mg/day)

92
Q

It is standard practice to allow at least _____ between courses of isotretinoin

A

2 to 3 months

93
Q

Preferable type of comedo extractor

Has a broad flat plate and no narrow sharp edges

A

Unna

94
Q

The removal of _____ comedones is desirable for cosmetic purposes. In contrast, _____ comedones should be removed to prevent their rupture

A

Open

Closed

95
Q

Subcision is most effective for _____ acne scars

A

Rolling

96
Q

Major endogenous porphyrin of P. acnes

Can absorb light at the near-UV and blue spectrum of 415 nm

A

Coproporphyrin III

97
Q

_____ light is currently approved for the treatment of moderate inflammatory acne

A

Blue

98
Q

Penetrates deeper into the dermis and has greater antiinflammatory properties but causes less photoactivation of the porphyrins

A

Red light

99
Q

The most consistent improvement in acne after light treatment has been demonstrated with

A

Photodynamic therapy

100
Q

Photodynamic therapy involves the topical application of aminolevulinic acid (ALA) 1 hour before exposure to a low-power light source. The topical ALA is taken up by the pilosebaceous unit and metabolized to

A

Protoporphyrin IX

101
Q

Applies negative pressure (ie, suction) to the skin and then delivers a broadband-pulsed light (400-1200 nm)

A

Photopneumatic device

102
Q

Retinoid: “may use during pregnancy”

A

Adapalene

103
Q

Retinoid: “consider avoiding use during pregnancy”

A

Tretinoin

104
Q

Retinoid: “use alternative during pregnancy”

A

Tazarotene

105
Q

Pregnancy Category B mediations

A 
Azelaic acid
Clindamycin
Erythromyin
Metronidazole
Oral amoxicillin
Oral azithromycin
Oral cephalexin
Oral erythromycin

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