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Year 2 - Dermatology > Acne > Flashcards

Acne Flashcards

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Dermatology Board Prep flashcards
1
Q

Baby acne usually presents where

A

cheeks

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2
Q

Pathophysiology of acne vulgaris

-4 main pathogenic factors that contribute

A

initial step in the development of acne is the formation of the microcomedo

Sebaceous gland hyperplasia and excess sebum production

Abnormal follicular differentiation

Colonisation of cutibacterium (Propionibacterium) acnes

Inflammation and immune response

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3
Q

In normal follicles, keratinocytes are shed as single cells into the lumen and then excreted.

In acne, what is wrong with the keratinocytes

A

retained in the lumen and accumulate due to their increased cohesiveness

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4
Q

What bacteria colonises in acne + is it gram +ve/-ve + where are they found + what do they stimulate

A

cutibacterium (Propionibacterium) acnes

-gram-positive, non-motile rods are found deep in follicles and stimulate the production of pro-inflammatory mediators

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5
Q

Inflammation and immune response is one of the factors contributing to the later stages of acne formation - what exactly happens at this stage

A

Inflammatory cells and mediators efflux into the disrupted follicle, leading to the development of papules, pustules, nodules, and cysts

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6
Q

What stimulates sebaceous glands to enlarge and produce more sebum; esp in puberty

A

androgens

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7
Q

Clinical features of acne vulgaris

  • non-inflammatory lesions (mild acne)
  • inflammatory lesions (moderate/severe acne)
A

Non-inflammatory lesions

  • open comedones (blackheads)
  • closed comedones (whiteheads)

Inflammatory lesions

  • papules,
  • pustules,
  • nodules,
  • cysts

Skin tenderness
Hyperpigmentation (redness)
Scarring

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8
Q

What are blackheads due to

A

Melanin deposition and lipid oxidation within the debris of the comedone

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9
Q

Mild acne is

  • … comedones
  • > … inflammatory lesions

Severe acne is

  • > … pseudocysts
  • > … comedones
  • > … inflammatory lesions
A

20
15

20
15

5
100
50

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10
Q

Variants of acne

A

Acne fulminans - most severe form of cystic acne

Drug induced acne

Acne exocoriee

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11
Q

Acne fulminans is characterised by what + what systemic presentations (4)

A

characterised by the abrupt onset of nodular and suppurative acne

with systemic manifestations (fever, arthralgias, myalgias, hepatosplenomegaly)

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12
Q

Drug induced acne can be seen as a side effect of what medications

A

anabolic steroids, corticosteroids, phenytoin, lithium

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13
Q

Acne exocoriee (a variant of acne vulgaris) is characterised by what

A

papules and comedones that are self inflicted due to repetitive picking of skin leaving crusted lesions that may scar

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14
Q

Differences between drug induced acne and acne vulgaris

  • duration of onset/age of onset
  • difference between lesion types
A

sudden onset, and an unusual age of onset, with a monomorphous eruption of inflammatory papules or papulopustules.

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15
Q

Pilosebaceous unit consists of

A

hair follicle, arrector pili muscles, and sebaceous gland

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16
Q

Types of medication used to treat acne

  • 4 topical
  • 3 oral
A

Topical retinoids

Topical benzoyl peroxide

Topicalantibiotics
(Clindamycin/Erythromycin)

Topical azelaic acid

Oral antibiotics (tetracycline)

In women, thecombined oral contraceptive pill

Isotretinoin tablets – only for SEVERE ACNE

17
Q

What acne medication should not be used in pregnant women

A

Retinoids - topical or oral as they’re teratogenic

18
Q

Why is azelaic acid used for acne

A

antimicrobial and anticomedonal properties

reducing post-inflammatory hyperpigmentation.

19
Q

Why is benzoyl peroxide used for acne

A

comedones and inflamed lesions respond well

20
Q

How does isotretinoin work + indications for its use in acne

A

reduces sebum secretion.

used for the systemic treatment of nodulo-cystic, severe acne, scarring which has not responded to an adequate course of a systemic antibacterial

21
Q

What is rosacea + what does it lack that acne has

A

chronic disorder of the skin characterised by EPISODES (then remission) of erythema, flushing and other cutaneous findings on CENTRAL FACE; without presence of comedones

22
Q

Signs of rosacea (6)

A

Erythema
flushing,
Papules
Pustules
telangiectases - one of the HALLMARK SIGNS
Ocular disturbance - foreign body sensation in eye, tearing, blurry vision

23
Q

Rosacea primarily affects what areas

A

Central face

  • cheeks
  • chin
  • nose
  • central forehead
24
Q

Pathophysiology of rosacea is unknown but what factors/triggers are associated with the onset (4)

A

Climatic exposures - sensitive to sunlight

Vasculature - exaggerated vasodilation to certain stimuli like increased temp, hot drinks/showers (abnormal reactivity of vessels)

Chemical and ingested agents, e.g. medications, spicy foods –> inducing inflammation

Increased number of demodex folliculorum

25
Q

Increased number of what mite is associated with rosacea

A

demodex folliculorum

26
Q

In more advanced untreated rosacea, what can develop on the nose

A

roughened skin –> rhinophyma (large, red, bumpy bulbous nose)

27
Q

What triggers induce telangiectasia in rosacea

A

Sunlight
Hot drinks/showers
Stress

28
Q

Cutaneous signs of inflammatory rosacea

A

persistent central facial erythema,

telangiectases

transient deep red papules and pustules to occasional deep cystic nodules

Soft or solid facial oedema

29
Q

Cutaneous signs of phymatous rosacea

A

Overgrowth of sebaceous glands –> thickened skin, irregular lumpy surface and enlargement; most often rhinophyma

30
Q

Clinical features of ocular rosacea

A 
watery eye
dryness, 
foreign body sensation, 
blurred vision, 
burning or stinging
31
Q 
Rosacea treatment (5)
\+ specific treatment for rhinophyma + specific treatment for ocular rosacea
A

AVOID TRIGGER

TOPICAL METRANIDAZOLE
ORAL TETRACYCLINES

Adjuncts

  • Topical azelaic acid
  • Topical benzoyl peroxide

Surgery for rhinophyma

Artificial tears + warm water rinsing

Year 2 - Dermatology (10 decks)

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