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Dermatology > Acne > Flashcards

Acne Flashcards

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Dermatology Board Prep flashcards
1
Q

What 3 physiological processes involved in acne?

A
  1. INCREASE in sebum excretion rate (SER)
  2. HYPERCORNIFICATON of the follicular lining leading to obstruction of the pilosebaceous ducts
  3. COLONISATION with bacterium propionibacterium acnes within the pilosebaceous ducts and subsequent inflammation
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2
Q

What hormones promote sebum production and secretion?

A

Androgens (e.g. dihydrotestosterone)

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3
Q

What is seborrhoea?

A

Greasy skin due to increased sebum secretion

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4
Q

Are androgen levels higher in pts with acne?

A

not usually, it is thought to be receptor hypersensitivity rather than excess hormone in the blood

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5
Q

What occurs in the hypercornification stage of acne?

A

Occurs at the same time as seborrhoea -

the keratinocyte cells lining these ducts show abnormal differentiation

so that there is hyperkeratosis,

and abnormal shedding.

This leads to retention of the cell lining

and resultant occlusion of the ducts,

forming a microcomedo in affected ducts

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6
Q

What is a microcomedo?

A

a blocked pore which is the

PRIMARY lesion of acne

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7
Q

In what type of duct does ance occur in?

A

pilosebaceous duct

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8
Q

What bacteria causes inflammation in acne?

A

propionibacterium acnes

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9
Q

How does propionibacterium acnes cause inflammation?

A

Chemotactic and pro-inflammatory mediators diffuse into the surrounding dermis`

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10
Q

What are the two categories of lesions found in acne?

A

Non-inflammatory lesions

Inflammatory lesions

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11
Q

What are the non-inflammatory lesions found in acne?

A

Open comedones (blackheads)

Closed comedomes (whiteheads)

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12
Q

Which category of comedomes are more likely to become inflamed and why?

A

Closed comedones as they are more likely to rupture

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13
Q

What are the inflammatory lesions found in acne?

A

erythematous papules

pustules

nodules

cysts (rarely)

abscesses (rarely)

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14
Q

Which form of acne do abscesses almost uniquely form in? (starts in adulthood)

A

acne conglobate (starts in adulthood)

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15
Q

What must all acne conditions begin with?

A

microcomedo

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16
Q

Name some commoner types of acne?

A

Acne vulgaris (most common)

Acne cosmetica

Acne medicamentosa (esp. steroids)

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17
Q

What is the advice regarding closed comedones?

A

Do not pop as will further inflame lesion

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18
Q

Which medications can worse acne?

A

high progesterone-containing OCP

potent topical or oral steroids

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19
Q

What are the DDx’s for acne? (how can the be differentiated)

A

rosacea

peri-oral dermatitis

folliculitis

(but there are no comedones in any of these conditions)

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20
Q

What should you investigate in children with acne?

A

full endocrine evaluation

to exclude an

androgen-secreting tumour of the

adrenals or

ovaries

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21
Q

What are the treatments in acne vulgaris?

A

Antibacterials - topical

Antiobiotics - oral or topical

Retinoids - oral or topical

Hormone therapy

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22
Q

For how long should acne treatments last (except for what)?

A

6 weeks (except systemic retinoids e.g. isotretinoin)

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23
Q

What are the two types of topical antibacterial use in acne? (which is more commonly used)

A

benzoyl peroxide (widely used)

azelaic acid cream (rarely used)

24
Q

How often should antibacterials be applied in acne? (however what is the problem with this)

A

twice a day (often not possible as causes irritation)

25
Q

How do topical antibacterials in acne reduce inflammation?

A

They have some comedolytic activity, but its main effects is

reducing the number of p.acnes bacteria

and inflammation

26
Q

What are the benefits of antibacterials?

A

No problems with resistance

27
Q

What are the negatives of antibacterials?

A

Cause local irritation

BPO can bleach clothes

28
Q

How do topical retinoids work?

A

They are comedolytic, which means

they remove the surface keratin

  • essentially unblocking the pores

and allowing drainage of

microcomedonal contents

29
Q

What are first line therapy for comedonal acne?

A

Topical retinoids

30
Q

What are the risks of topical retinoids?

A

Still teratogenic even in the topical form and should not be used in breast-feeding or pregnancy

31
Q

Which antibiotics are used topically?

A

Erythromycin and

clindamycin

32
Q

What is a particular problem with topical antibiotics and how is the avoided?

A

Resistance, thus it is

combined with BPO and

limited to 6 months

33
Q

For what type of acne is BPO particularly useful?

A

Papulopustular acne

34
Q

What are the indications for systemic treatment over topical treatment for acne?

A

Moderate to severe acne

Failure of topical treatment

Scarring (or marked post-inflammatory hyperpigmentation)

Consider if chest or back involvement

35
Q

How should a pt transition from topical to oral treatment for acne?

A

A pt should use topical treatment for acne aswell as systemic

at least 1 topical treatment should be used

36
Q

What are the 1st and 2nd line systemic antibiotic treatments for acne?

A

1) Lymecycline (most common)
1) Doxycycline
1) Tetracycline

2) macrolides -> Erythromycin

37
Q

In whom are cyclines contraindicated? (Why)

A

pregnancy (tetragenic)

breastfeeding (tetragenic)

children (stains teeth)

38
Q

What are the benefits and problems with erythromycin?

A

Benefit - safe in pregnancy

Issue - GI side effects
Issue - staph resistance

39
Q

For how long should systemic antibiotics be used?

A

at least 6 weeks

if there is no clinical effect, use

an alternative antibiotic

40
Q

If you are using topical and systemic antibiotics should you use the same or different antibiotics?

A

Use the same antibiotics, so bacteria only become resistant to one type of antibiotics

41
Q

What require monitoring when a pt is on isotretinoin?

A

FBC

LFTs

Fasting lipids

Pregnancy test

42
Q

What are the side effects of systemic retinoids?

A

photosensitivity

teterogenic (contraindicated in breast-feeding and pregnancy)

Depression

Hyperlipidaemia

Deranged liver function

43
Q

What % of pts who take systemic retinoids will relapse?

A

About 25%

44
Q

Who must prescribe systemic retinoids and why?

A

A dermatologist due to serious side effects

45
Q

What hormone therapy is used in acne?

A

cyproterone acetate

known as “Dianette” in the UK

46
Q

What are the problems with cyproterone acetate ?

A

variable tolerance

increased risk of venous thromboembolism

47
Q

Minor acne has what characteristics?

A

+ papules and pustules

48
Q

Moderate acne has what characteristics?

A

+/++ papules and pustules

-/a few small nodules/cysts

+ inflammation

49
Q

Severe acne has what characteristics?

A

+++ papules and pustules

mainly small nodules/cysts

++ inflammation

+ scaring

50
Q

Very severe acne has what characteristics?

A

+++ papules and pustules

+++ nodules/cysts

+++ inflammation

+ scaring

51
Q

What is the indication that acne will scar?

A

Greater inflammation = more scarring

52
Q

What are possible treatments for acne scarring?

A

Dermabrasion

Microdermabrasion

Excision

Laser resurfacing

Intralesional steroid for keloid scars

53
Q

At what stage of acne should scars be treated?

A

Once acne is no longer active

54
Q

What are the possible sequelae in acne vulgaris?

A

Resolution (i.e. no scaring) or

scaring

55
Q

What are the types of scars that occur in acne vulgaris?

A

Ice pick scar

Atrophic scar

Keloid/hypertrophic scar

56
Q

If you have to retreat acne should you change antibiotic?

A

No assuming it was effective last time, use the same antibiotic

57
Q

How long should systemic retinoids (isotretinoin) be used for?

A

4-6mnths

Dermatology (11 decks)

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