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Dermatology > Acne > Flashcards

Acne Flashcards

1
Q

What are the type sof Acne?

A

Acne Vulgaris

Acne Rosacea

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2
Q

Who is most effected by Vulgaris and rosacea?

A

Acne Vulgaris peaks at 15-18yrs although many women have a delayed onset. M=F but M is more severe

Acne Rosacea peaks at 30-40yrs. F>M but M is more severe. Almost always fair skinned caucasians

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3
Q

Explain the pathogenesis of Acne Vulgaris?

A

A disease of the Pilo-sebaceous unit:

1) Keratin plugs: Increased Keratinocytes, melanin and keratin blocks up the follicle- form a plug= commodore
2) Sebum becomes more viscous and so harder to clear. More released in response to androgens
3) Bacterial overgrowth= In the case of closed comedones bacteria of the epidermis of the skin build up. These attract immune cells, they attack the bacterial cells. Combination of immune cells and bacterial cells= pus=white heads

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4
Q

What bacteria is most responsible for inflammation in acne vulgaris?

A

Propionobacterium acnes

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5
Q

Explain the formation of whiteheads, blackheads and papules/pustules/cysts/scars etc

A

White heads - Closed Comedones, aka the skin has closed over the comedone. No erythema

Black head - Open comedone, aka the plug is so big the skin cant close and its visible. (Black because of melanin not dirt)

Papules/pustules/cysts/nodules - due to bacterial inflammation

Scars form after inflammation, especially if the spots are picked or popped

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6
Q

What anti-biotics are used for Acne Vulgaris?

A

Topically

  • Erythromycin
  • Tetracyclines
  • Clindamycin

Non-topical:

  • Erythromycin
  • Tetracyclines
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7
Q

Pros and cons of isotretinoin?

A
  • Best treatment available for stubborn/severe acne
  • Permanently cures 60-70% of Acne Vulgaris Patients
  • Easy to take (swallowed 1/day with a main meal)

Highly teratogenic (+1 month after stopping)
Expensive
Causes severe dry skin

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8
Q

Describe the pathogenesis of Acne Rosacea?

A

Chronic inflammation of the PSU (Pilo-sebaceous unit) and cutaneous vasculature.
Not associated with seborrhoea
Unlike Vulgaris, rosacea lacks comodones

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9
Q

What are the subtypes of Rosacea?

A
  • Erythemato-telangectasic Rosacea
  • Papulo-pustular Rosacea
  • Phymatous rosacea (Big red swollen nose, mainly men)
  • Ocular rosacea

Generally they overlap & they’re mostly treated the same

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10
Q

characters of ocular rosacea

A

-Pain/ dryness/ tiredness/ oedema/ tearing/ chalazia/ corneal damage

N.B chalazia= benign lump inside the upper or lower eyelid

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11
Q

How is does rosacea look?

A

Ace of clubs distribution
Rarely appears off face

Many patients get pronounced flushing on alcohol, hot drinks, emotion and spicy foods

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12
Q

Quick list of rosacea treatments

A

Avoid vasodilators

Topical:

  • Anti-biotics: metronidazole
  • Azeleic Acid
  • Ivermectin
  • Brimonidine

Non-topical:

  • Anti-biotics: tetracycline
  • Isotretinoin
  • Light based therapies

Surgery for rhinophymas

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13
Q

How is isotretinoin different for rosacea?

A

Its used in smaller doses as rosacea patients already suffer from dry skin

It doesn’t cure it so needs to be kept on long-term

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14
Q

what subtypes of rosacea have special treatments?

A

Erythemato-telangectasic Rosacea is best treated with light therapies

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15
Q

How does azeleic acid work?

A

It kills acne bacteria and inhibits keratin production

Used for Acne Rosacea

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16
Q

How does brimonidine work?

A

Causes vasconstriction thus reducing the redness of rosacea.

Its used when someone has a night out or important event they want to minimise their rosacea for, not an everyday treatment

17
Q

Different subtypes of acne vulgarisms

A 
Mild 
-Non-inflammatory 
-<20 comedones
<15 inflammatory lesions
-No scarring

Moderate

  • Inflammatory
  • <100 comedones
  • comedones can be papulular or pustular
  • <50 inflammatory lesions
Severe
-Scarring 
->100 comedones 
>50 inflammatory lesions
-Nodularcystic lesions
18
Q

Aetiology for acne vulgaris

A
  • Genetic: leads to hyperkeratosis
  • Hormones: androgens : leads to hyperkeratosis
  • Polycystic ovarian syndrome: XS androgens
  • Stress: cortisol: release of sebum
  • Products which block pores
  • Wearing a headband
  • XS washing of face
19
Q

Treatment depending on acne

A

Mild acne: topical treatment e.g. benzoyl peroxide/ salicylic acid
Moderate: Antibiotics e.g. doxycycline/ tetracycline and spironolactone
Severe: Isotretinoin= vitamin A derivative which Impacts on sebum secretion

Or OCP and anti-anxiety meds

20
Q

What to use to treat acne scars

A
  • Tretinoin creams ( topical retinoid): helps unstick comedones
  • Microabrasions
  • Injectable fillers
  • Laser treatments can prevent proliferation of epidermal tissue
21
Q

What Is acne fulminans manifestations

A
  • Nodular and suppurative acne
  • Fever
  • Arythalgia
  • Myalgia
  • Hepatosplenomegaly
22
Q

Which drugs are associated with drug induced acne

A
  • corticosteroids
  • anabolic steroids
  • phenytoin
  • lithium
23
Q

What is acne excroie

A

Term used to refer to papules and comedones which have been neurotically excortiated leaving crusts/scars

24
Q

Phymatous rosacea

A
  • Enlargement of sebaceous glands
  • Pores become more evident
  • Skin becomes smoother and more swollen
  • Lumpy surface
25
Q

inflammatory rosacea

A
  • papules/ postules/ occasionally cystic nodules
  • Deep red colour compared to ACNE
  • solid or soft facial oedema
26
Q

Blushing rosacea

A

Blushing/ Flushing of the skin

Telangiectasias begins to form

27
Q

Presentation of rosacea

A
  • affects the convex area of the face e.g. cheeks, nose, forehead
  • Erythema and burning sensation triggered by stimuli
  • Vascular changes such as episodic flushing with NO SWEATING
  • Papules/ pustules with NO COMEDONES
  • thickening of the skin due to oedema, fibrosis and glandular hyperplasia

Dermatology (14 decks)

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