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Habif 7: Acne, Rosacea, And Related Disorders > Acne > Flashcards

Acne Flashcards

1
Q

Acne gender predisposition

A

Most severe form more common in men but more persistent acne in females

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2
Q

Post adolescent acne

A

Can be correlated with smoking
Low grade, mostly comedonal
Possibly hyperandrogen related as classically flares before menses
Distributed on lower face/mandible

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3
Q

Acne inflammatory lesions

A

Papules
Pustules
Nodules

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4
Q

Acne noninflammatory lesions

A

Closed and open comedones

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5
Q

Inflammatory Acne grading

A

Mild: just papules and or pustules (up to 20 pustules)
Moderate: can have nodules
Severe: many nodules
Other factors: scaring, persistent drainage, sinus tracts

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6
Q

Acne treatment: mild non inflammatory acne

A

Start with retinoid-> should work in 1-2 mo-> can add BPO/topical antibiotic combo and increase tretinoin strength
-initially can alternate the tretinion and BPO/antibiotic wash at night and increase to tretinoin at night and BPO in am as tolerated

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7
Q

Acne treatment: mild inflammatory

A

Start with retinoids +/- topical antibiotic/BPO
Can add oral antibiotic (3mo trial)
If female and still need more tx: can add spironolactone

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8
Q

Acne tx moderate inflammatory

A

Start with topical antibiotics (drying agent) with BPO (can add oral antibiotic as well)
If not controlled in 2 months, can add retinoid
If still flaring, can consider acutane or spironolactone

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9
Q

Acne tx severe inflammatory

A

If minimal scaring: try conventional topical and oral before acutane
If significant scaring:
Can go straight to acutane

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10
Q

Notes on doxycycline

A

Photo toxicity
Dyspepsia (can take with food)
Don’t use in kids under 12

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11
Q

Notes on minocycline

A 
Dizziness/vertigo
Blue grey skin staining
Hepatotoxicity
Lupus-like syndrome
Not to use in kids under 12
Can cause pseudotumor cerebri
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12
Q

Bactrim notes

A

Good alternative for severe inflammatory acne if acutane contraindicated
Can cause SJS
Okay for use in kids over 2mo

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13
Q

Erythromycin notes

A

Useful in pediatric population

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14
Q

Which acne treatments act by normalizing the pattern of follicular keratinization

A

Tretinion

Acutane

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15
Q

Which acne treatments act by inhibiting sebaceous gland function

A

OCPs
Low dose oral steroids
Acutane
Spironolactone

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16
Q

Which acne treatments act by anti inflammatory effect

A

Intralesional steroids
NSAIDs
Oral steroids (high dose)
Antibiotics by preventing neutrophil chemotaxis

17
Q

Which acne treatments act by antibacterial effect

A

BPO
Topical and oral antibiotics
Accutane

18
Q

What type of bacteria is p. Acnes

A

Anaerobic diptheroid

19
Q

How to differentiate between a closed comedone and small pustule

A

Closed comedowns can typically be accentuated with skin stretching

20
Q

Types of nodulocystic acne

A

Pyoderma faciale
Localized/Diffuse cystic acne
Acne conglobata
Acne fulminans

21
Q

Pyoderma faciale

A

Confined to face of adult women
Rapid onset
Spontaneous purulent drainage from cysts

22
Q

Acne fulminans

A

Ulcerative form
Acute onset with systemic symptoms: arthralgias and severe muscle pain
MC seen in adolescent white males
Can see fever and weight loss

23
Q

Acne conglobata

A

Chronic condition
Involved areas with double comedones, communicating cysts, and draining sinus tracts
Sometimes associated with hidradenitis suppurativa and dissecting cellulitis of the scalp

24
Q

Special actions of specific retinoids azalaic acid and adapalene

A

Azalaic acid: strong antibacterial potency

Adapalene: anti inflammatory activity

25
Q

Tretinoin time course/what to expect

A

1-4 weeks: redness/irritation which should resolve in a month
3-6 weeks: May see new papules or pustules due to comedone irritation
After 6 weeks: should see improvement by 9-12 weeks

26
Q

Four main topical retinoids

A

Tretinoin
Tarazotene
Adapalene
Azelaic acid

27
Q

Gram negative acne

A

Can be seen when new pustules/cysts develop after long term antibiotic use

28
Q

Ampicillin in acne

A

Can be used for gram negative acne

Can be used in pregnancy/breastfeeding

29
Q

When to consider hormone labs in acne

A

Women with rapid onset acne, hirsutism, androgenic alopecia or other virilization signs or if concerned for Cushings:
Labs to check: total and freetestosterone, prolactin, LH, FSH, lipid profile, glucose tolerance, and DHEAS

30
Q

Hormonal acne treatments and indication

A

OCPs: failed antibx, free testosterone elevated

Spironolactone: failed antibx

Dexamethasone/Prednisone: DHEAS elevated or no response to the previous two

31
Q

Isotretinoin dosing

A

Cumulative dose of 120-150mg/kg which determines remission rate
Goal of 1mg/kg/day unless patients are older (especially men)
Start with lower dosages and titrate up
Usually treat for 4 to 5 months

32
Q

Isotretinoin efficacy

A

39% relapse rate
23% require antibiotics
17% require additional isotretinoin

33
Q

Very “greasy” acne treatment

A

A good add on therapy is sulfacetamide/sulfur lotion to dry skin out

34
Q

Who relapses on Isotretinoin

A

Younger patients (14-19)
More severe acne
Truncal acne

35
Q

Side-effects of Isotretinoin

A 
Teratogenicity
Increased triglycerides
Asymptomatic bone spurs 
Cheilitis
Acute conjunctivitis 
Muscle pains
Exuberant granulation tissue at severe acne sites
36
Q

Steroid acne

A

Sudden onset of uniformly sized, symmetrically distributed papules and pustules on the neck, chest, and back
No scarring

37
Q

Infantile vs neonatal acne

A

Neonatal: caused by maternal androgens and common
Infantile: rare with male predominance, inflammatory pattern. Typically takes 18 months to clear

38
Q

Acne mechanica

A

Acneiform eruption at sites of mechanical pressure (chin straps, etc)

Habif 7: Acne, Rosacea, And Related Disorders (1 decks)

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