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OS 212 DERMATOLOGY > Acne > Flashcards

Acne Flashcards

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Dermatology Board Prep flashcards
1
Q

Epidemiology of Acne

A

90% of adolescents
Usually (+) Fmhx

Typically presents at ages 8-12 years old

For women -> first outbreak at 20-35 years old

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2
Q

2 types of morphology of Acne

A

Non-inflammatory papules

Inflammatory papules

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3
Q

Non inflammatory papules

A

Comedones:

Open - blackheads
Closed - whiteheads

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4
Q

Inflammatory papules

A

Erythematous papules

Erythematous nodules and cysts (PIC)

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5
Q

History of acne

A

When does it start?

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6
Q

4 Basic event that occur during acne formation

A

Increased sebum production

Follicular epithelial hyperproliferation

Colonization of P. acnes

Production of inflammation

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7
Q

Main stimuli for Pathogenesis for Acne

A

Androgenic Stimuli

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8
Q

Increased Sebum Production

A

Sebaceous gland hyperactivity

5a-reductase -> testosterone to 5a testosterone -> receptors in SG -> increase SS -> hyperseborrhea or oily skin

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9
Q

Composition of sebum

A

Free fatty acid

Lower concentration of linoleic acid

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10
Q

How does sebum induces follicular hyperkeratosis

A

Through IL-1 secreted by the sebocytes

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11
Q

Increased production of dead skin

A

Hyperkeratiniation

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12
Q

Follicular Epithelial Hyperproliferation

A

more dead skin cells from stratum corneum are being formed in the follicle, while the sebum plugs the follicle ->microcomedone formation

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13
Q

Sebum + dead skin

A

Microcomedone

-precursor of other acne lesions

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14
Q

Earliest microscopid manifestation (histologic inflammation)

A

Microcomedone

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15
Q

Follicular Epithelial Hyperproliferation is triggered by..

A

Androgen hormones

Alterations in follicular linoleic acid and IL-1

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16
Q

Gram negative, anaerobic diphtheroid. Constituent of normal cutaneous flora, Produces LIPASE that digest the free fatty acid in sebum

A

P. acnes

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17
Q

Three pathways in the production of Inflammation

A

Inciting of inflammatory by P. acnes

Rupture of follicular epithelium

Exces sebum production (linoleic acid deficiency)

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18
Q

Inciting of inflammation by P. acnes

A

innate immunity

TLR-2 (homologous to IL-1)

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19
Q

part of the innate immune system that recognizes stimuli (endotoxin, bacteria, neuropeptidases) including P. acnes stimulating the immune response

A

TOLL receptors

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20
Q

Rupture of Follicular epithelium

A

Expansion of the follicular unit -> plug -> build up -> RUPTURE -> foreign body response -> more perifollicular inflammation

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21
Q

Causes infundibular rupture

A

EGF/TGF

-levels of EGF receptor decreases with age

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22
Q

Not clinically inflamed but histologic inflammation exists

A

Comedonal acne

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23
Q

Treatment to normalize follicular hyperkeratinization

A

Comedolytic/keratolytic agents

Topic retinoids
BPO
SA
AHA

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24
Q

Treatment to decrease sebum production

A

Sebostatic agents

Oral isotretenoin
OC pills
Anti-androgens

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25
Q

treatment to reduce P. acnes Proliferation

A

Use antibiotics

BPO
Topical/oral antibiotics (Clindamycin, lindocyclin)

Bacteriostatics preferably used because P. acnes is part of normal flora so it should not be completely eradicated

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26
Q

Treatment for the Inflammation

A

Intralesional steroids or oral (use with caution; acne ironically is a side effect)

Topical isotretinoin
Topical erythromycin, clindamycin, tetracycline

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27
Q

MOA for retinoids

A

Keratolytic and has activity against TLr (both keratolytic and anti-inflammatory)

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28
Q

fIRST GENERATION rETINOIDS

A

Retinol, tretinoin, isotretinoin

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29
Q

Reduces concentration of MMPs in sebum

A

Isotretinoin

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30
Q

Second generation Retinoids

A

etretinate, acitretin

manoaromaticcompounds

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31
Q

third generation retinoids

A

less local irritation as compared with tretinoin

Polyaromatic compounds such as adapalene and tazarotene

32
Q

Commonly prescribed Retinoids

A

Tretinoin
Adapalene - least potent
Tazarotene

33
Q

Can act both as comedolytic and anti-inflammatory

A

Salicylic acid

-Lipophilic characteristics facilitte peeling of the exterior layer of the dermis and open follicles that are plugged

34
Q

Can interfere with arachidonic acid cascade of the inflammatory process-> reduces inflammation

A

Salicylic Acid

35
Q

Most effective acne medication

A

Oral isotretinoin

-hits on all 4 processes of acne devt. but with many side effects

36
Q

Potential Side effects of oral Isotretinoin

A

Xerosis, Chelitis

Teratogenicity, Hypertriglyceridemia, hepatotoxicity, depression

37
Q

Bacteriostatic agents

A

ERYTHROMYCIN
CLINDAMYCIN

chloramphenicol
sulfonamides
trimethoprim
Tetracyclines

38
Q

Bactericidal agents

A

Benzoyl Peroxides

Aminoglycosides
Beta lactams
Vancomycin
Quinolones
Rifampicin
Metronidazole
39
Q

Lipophilic
Applied topically
Only bactericidal medication - others are bacteriostatic

Breaks down into benzoic acid and oxygen upon contact with skin

Both bactericidal and anti-inflammatory

A

Benzoyl peroxide

40
Q

Intereferes with the synthesis of bacterial capsule, rendering it susceptible to phagocytosis

A

Clindamycin

41
Q

Reversible binding to ribosomal subunits will inhibit protein synthesis

A

Erythromycin

42
Q

First Generation Cycline Antibiotic

A

tetracycline, oxytetracycline

  • impaired by food and milk, very cheap
  • 500 mg BID
43
Q

second generation cycline antibiotics

A

Doxycycine 100mg - 200mg OD

Minocycline 100 mg-200mg OD

Lymecycline 300mg - 600mg OD

44
Q

Anti-inflammatory Agents

A

BPO - Reduces P. acnes

Clindamycin - acts on pro inflammatory cytokines

Erythromycin - inhibitory effect on neutrophil chemotactic factor activity of P. acnes
- Inhibitory effect on production of ROS

Retinoids - Activity against TLR; isotretinoin can reduce conc. of MMPs in sebum

Corticosteroids

Oral antibiotics

45
Q

Increasing sex hormone binding globulin and decrease circulating free testosterone

A

Oral Contraceptives

46
Q

Androgen receptor blocking properties

Decreasing sebum production in acne

A

Spironolactone

47
Q

Treatment consideration of TOPICAL RETINOIDS

A

Use of sunscreen and protective clothing to reduce photosensitivity induced by retinoids

BPO and retinoids are not applied at the same time because BPO oxidizes and colored fabrics

48
Q

Treatment consideration of BPO

A

May bleach hair and colored fabrics

49
Q

treament consideration of BPO and topical retinoids

A

May irritate skin - start on alternate day dosing

Use of moisturizer to reduce irritancy

50
Q

Rationale of combination therapy

A

Improved efficacy
Minimized complications
Enhanced tolerability

51
Q

Most common cause of treatment failure (ACNE)

A

Lack of adherence

52
Q

Topical agents take ____months to see effects

A

2-3 months

53
Q

Therapy should be continued for at least _____ weeks before treatment response can be accurate

A

8 weeks

54
Q

Grades of Acne

A

Grade 1: Comedones (Open or closed), ocassionaly pustules or papules, no scarring

Grade 2: Papules, comedones, few pustules; mild scarring

Grade 3: Predominant pustules, nodules, abscesses, moderate scarring

Grade 4: Mainly cysts, abscesses, scars; severe scarring.
(Add oral treatment for grades 2, 3, 4)

55
Q

Onset of Neonatal Acne

A

birth to 6 weeks

56
Q

Onset of Infantile acne

A

6 weeks to 1 year

57
Q

Onset of Mid-childhood acne

A

1 year to 7 years

58
Q

Onset of Pre adolescent acne

A

7 to 12 years or menarche in girls

59
Q

Onset of Adolescent acne

A

12 to 19 years or after menarche in girls

60
Q

Neonatal acne

A

2 weeks of age

Spontaneously resolves within 3 months

Not true acne: comedone formation is absent

Transiently elevated sebum excretion rate

Baby has high risk of having severe acne later on

61
Q

Infantile acne

A

3-6 months

Resolves at 1-2 years of age

True acne: Comedones are present

transient elevation of DHEA

TREATMENT: topical retinoids, BPO (lower concentrations are given)

62
Q

Mid Childhood acne

A

between 1 to 7 years old

very rare

Possible sequelae of excess androgens

63
Q

Treatment of Acne variants

A

1-7 year olds : rule out underlying systemic abnormality

Preadolescent acne: similar to older age except!!!

<8 : avoid oral tetracycline - damage to enamel and bones

Retinoids: ADAPALENE, BPO 2.5% for >9 years old

Tretinoin 0.05%: FDA approved for >10 years old

64
Q

Post adolescent women (Androgens in acne)

A

Serum hormone levels usually normal

Acne lesions often perioral and along the jaw line

65
Q

Hormonal Acne

A

DHEAS :
4000-8000 ng/ml : congenital adrenal hyperplasia
>8000 ng/ml: adrenal tumor

SERUM TOTAL TESTOSTERONE
>150 ng/ml : Ovarian source of excess (150-200 :PCOS)

INCREASED LH/FSH ratio
>2.0: polycystic ovary disease

66
Q

Teenage male
Draining lesion discharge
Subcutaneous dissection with formation of multichannel sinus tracts.

can outgrow this condition (but scarring acne)

A

Acne Conglobota

-treatment: isotretoin, antibiotic or intralesional steroids

67
Q

Most severe form, associated with systemic sypmtoms

Sudden, explosive appearance

Appears in the back and chest (Face and neck are usually spared)

A

Acne Fulminans

TreatmentL systemic steroids

68
Q

Young women

Extensive neurotic excoriations leaving crusted erosions that scar.

A

Acne Excoriee

69
Q

Sports induced acne

Combination of heat, pressure, occlusion of the skin areas and repetitive fictional rubbing (fiddler’s acne)

A

Acne Mechanica

70
Q

Chloracne

A

Chorinated hydrocarbons

Comedone, cysts, and pigmentary changes

71
Q

Can occur as early as 2 week after steroids are started,

Monomorphous papules and/or pustules.

Note Hx: constant application of topical steroids or intake of oral steroids, you will have more acne

Also a differential for acne vulgaris, steroid-induced acne

A

Steroid Folliculitis

72
Q

Drug-induced Acne

A

Testosterone, Progesterone, Steroids

Lithium, Phenytoin, Isoniazid

Vitamins B2, B6, and B12

Halogens: Bromides , iodides

73
Q

Pre existing acne on long term oral antibiotics especially tetracyclines .

Enterobacter, Klebsiella, Escherichia, Proteus

A

Tx: oral antibiotics with gram (-) coverage, oral isotretinoin, oral cephalosporin

74
Q

may look like acne but comedones are absent
Not related to hormones
Flushing
Telangiectasia
Triggers: Alcohol, sunlight, hot beverages, picy food, emotional stress

A

Rosacea

75
Q

Papules, pustules, with scaling around mouth, nose and eyes

Absence of comedones

HPI: History of prior or current use of topical steroids

A

Periorificial Dermatitis (Perioral Dermatitis)

OS 212 DERMATOLOGY (9 decks)

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