Acne

Question 1

What is chronic inflammation of pilosebaceous unit?

Answer 1

acne vulgaris

Question 2

What causes sebaceous glands to increase sebum production?

Answer 2

androgens

Question 3

What acts on sebum to break down to fatty acids?

Answer 3

propionibacterium acnes

Question 4

What does fatty acid create?

Answer 4

inflammatory response in pilosebaceous unit

Question 5

What is p. acne?

Answer 5

preferential anaerobic
aerotolerant
diptheroid
gram +
rod shaped

Question 6

What does plugging cause?

Answer 6

open and closed comedone

Question 7

What does acne becomes when it ruptures into dermis?

Answer 7

papule, pustule, nodule

Question 8

What is the patho of acne?

Answer 8

accumulate apithelial cells and keratin –> accumulation of shed keratin and sebum –> p. acnes proliferation (mild inflammation) –> marked inflammation

Question 9

What are the key players in acne?

Answer 9

androgen excess
emotional stress
medications
mechanical - leaning face on hands

Question 10

What are the different types of acne lesions?

Answer 10

papule, pustule, nodule/cyst

Question 11

What are the type of acne scars?

Answer 11

pitted, hypertrophic, keloid

Question 12

What is an open vs closed comedome?

Answer 12

open comedone = no skin layer
closed comedone = sealed by skin

no inflammatory response

Question 13

What is a papule?

Answer 13

raised lesion, more inflammatory

Question 14

What are pustules?

Answer 14

raised, purulent fluid, erythema

Question 15

What is cysts and nodules in acne?

Answer 15

nodule - firm
cysts - fluid filled

lots of surrounding inflammation

Question 16

What do pitted scars look like?

Answer 16

diffuse lesions with erythematous base, pitting present, concave shape

Question 17

What are hypertrophic scars?

Answer 17

raised, firm, fibrosis

Question 18

What are acne keloidalis nuchae?

Answer 18

more in AA, dark skin, excess over growth

Question 19

Where are locations for acne?

Answer 19

face, neck, upper arms, trunk

Question 20

What is the most common location for acne?

Answer 20

face

Question 21

How to tell severity?

Answer 21

type of lesion, surface area, inflammatory response

Question 22

What is the treatment for mild acne superficial, topical abx?

Answer 22

1. Erythromycin 2% solution, gel,ointment
   2. Clindamycin 1% solution, gel, lotion
   3. Sodium Sulfacetamide 10% gel, cream, lotion

Question 23

What are some topical retinoids for mild acne?

Answer 23

1. Tretinoin (Retin A) solution,cream,gel
   2. Tazarotene (Tazorac) cream, gel
   3. Adapalene (Differin) cream, gel
   4. Azalaic Acid (Finacea) gel

Question 24

What are some OTC treatment for mild acne?

Answer 24

BPO

Question 25

What make up needs to have?

Answer 25

noncomudogenic - doesn’t clog your pores

Question 26

What is the treatment for moderate to severe acne?

Answer 26

Add PO antibiotic:  
Tetracycline 
Minocycline 
Doxycycline
Erythromycin
Oral Contraceptives 
Anti-androgen effect

Question 27

What are the dosing for ABX PO?

Answer 27

Tetracycline 250-500mg BID
Minocycline 50-100mg BID
Doxycycline 100mg BID
Erythromycin 250-500mg BID

Question 28

What is used for recalcitrant acne?

Answer 28

isotretinoin (Accutane)
1mg/kg/day PO divided BID
15-20 wks

Question 29

What are the side effects of isotretinoin?

Answer 29

teratogenic - preg test 2x, be on OCP
increase triglycerides - LFT at baseline then 1-2 wks until stable
Depression/suicide - screen monthly

Question 30

What are some other acne treatments?

Answer 30

intralesion triamcinalone, acne surgery, cryotherapy, chemical peels, dermabrasion, laser