Acne

Question 1

Site of predilection of acne

Answer 1

face, chest, back, upper arms

Question 2

open comedones

Answer 2

blackheads

Question 3

closed comedones

Answer 3

whiteheads

Question 4

basic events which occur in acne formation

Answer 4

inc sebum production
follicular epithelial hyperproliferation
colonization of P. acne
production of inflammation

Question 5

initiating stimulus of acne formation which begins at puberty

Answer 5

androgen stimulation

Question 6

inc activity of this enzyme in sebaceous glands inc sebaceous secretion

Answer 6

5a-reductase

Question 7

components of sebum

Answer 7

free fatty acid 
linoliec acid ( which induces follicular hyperkeratinization)

Question 8

sebum induces hyperkeratosis through

Answer 8

IL-1

Question 9

sebum plus dead skin (plug) ; precursor of other lesions

Answer 9

microcomedome

Question 10

triggers of follicular epithelial hyperproliferation

Answer 10

androgen hormones

alterations in follicular linoleic acid and IL1

Question 11

gram negative, anaerobic diptheroid which causes acne, part of normal cutaneous flora, produces lipase enzymes that digest the free fatty acid in sebum

Answer 11

Propionibacterium acne

Question 12

three pathways of inducing inflammation in acne

Answer 12

inciting inflammation by P. acne
rupture of follicular epithelium
excess sebum proliferation

Question 13

Part of the innate immune system that recognizes stimuli stimulating immune response

Answer 13

TOLL receptors

Question 14

normalize follicular hyperkeratinization

Answer 14

comedolytic/keratolytic agents

benzoyl peroxide, salicylic acid, alpha hydroxylic acid

Question 15

dec sebum production

Answer 15

sebostatic agents 
(oral isotretenoin, OC pills, anti-androgens)

Question 16

reduce P. acnes proliferation

Answer 16

antibiotics

Question 17

anti-inflammatory

Answer 17

steroids

Question 18

main side effect of steroid use esp topical

Answer 18

acne formation

Question 19

Retinoids MOA

Answer 19

keratolytic and activity against TOLL receptors

Question 20

First Gen Retinoids

Answer 20

Retinol, tretinoin, isotretenoin

Question 21

Second Gen Retinoids

Answer 21

etretinate, acitretin

Question 22

Third Gen Retinoids

Answer 22

Adapalene and tazarotene

Question 23

Salicylic acid MOA

Answer 23

comedolytic and anti-inflammatory

Question 24

Only oral formulation effective as sebostatics

Answer 24

oral isotretinoin

Question 25

most effective acne medication

Answer 25

oral isotretinoin ( effective in 85% users)

Question 26

side effects of isotretinoin

Answer 26

xerosis, cheilitis, teratogenicity, hypertriglyceridemia, hepatotoxicity, depression

Question 27

Only bactericidal medication ; bactericidal and anti-inflammatory

Answer 27

Benzoyl peroxide (BPO)

Question 28

interferes with synthesis of bactericidal capsule

Answer 28

clindamycin

Question 29

reversible binding to ribosomal subunits will inhibit protein synthesis

Answer 29

erythromycin

Question 30

Inc. sex hormone binding globulin and dec your circulating free testosterone

Answer 30

Oral contraceptives

Question 31

androgen receptor blocking properties; dec sebum production in acne

Answer 31

spironolactone

Question 32

most common cause of treatment failure

Answer 32

lack of adherence

Question 33

topical agents wait for _________ months

Answer 33

2-3 months

Question 34

Grades of Acne | Comedones, occ pustules, no scarring

Answer 34

Grade 1

Question 35

Grades of Acne | Papules, comedones, few pustules, mild scarring

Answer 35

Grade 2

Question 36

Grades of Acne | Predominant pustules, nodules, abscess with moderate scarring

Answer 36

Grade 3

Question 37

Grades of Acne | Mainly cysts, absceses, scars, severe scarring

Answer 37

Grade 4

Question 38

2 weeks of age; spontaneously resolves w/in 3 mos | not true acne: comedone formation is absent

Answer 38

Neonatal acne

Question 39

3-6 months old resolves at 1-2 years of age true acne: comedones present transient elevation of DHEA (immature adrenal glands)

Answer 39

Infantile acne

Question 40

Treatment for infantile acne

Answer 40

topical retinoids, BPO

Question 41

Treatment for neonatal acne

Answer 41

no combination treatment

Question 42

Between 1-7 years old, very rare | possible sequelae of excess androgens ( consider adrenal tumors, congenital adrenal hyperplasia)

Answer 42

Mid-childhood acne

Question 43

DHEAS 4000-8000

Answer 43

congenital adrenal hyperplasia

Question 44

DHEAS > 8000 ng/ml

Answer 44

adrenal tumor

Question 45

serum testosterone | > 150 ng/ml

Answer 45

ovarian source of excess androgen

Question 46

inc. LH/FSH ratio

Answer 46

> 2.0 polycystic ovary disease

Question 47

common in teenage males, draining lesion discharge

Answer 47

acne conglobata

Question 48

severe form of acne fever, leukocytosis, bone pain in clavicle and sternum, polyarthralgia, anemia sudden explosive appearance isotretinoin will aggravate the inflammation

Answer 48

acne fulminans

Question 49

common in young women | extensive neurotic excoriations leaving crusted erosions that scar

Answer 49

acne excoriae

Question 50

sports induced acne

Answer 50

acne mechanica

Question 51

acneiform folliculitis may occur 2 weeks after steroids are started monomorphous (uniform) papules and/or pustules

Answer 51

steroid folliculitis

Question 52

testosterone, progesterone, steroids lithium, phenytoin, isoniazid vitamins b2, b6 and B12

Answer 52

drug induced acne