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Acne Charl > Acne > Flashcards

Acne Flashcards

1
Q

T/F Approximately 85% young people between 12-24 years have acne

A

T and preadolescent acne is affecting children 7-11 years

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2
Q

35% women and 20% men still report having acne in their 30s whilst 26% women and 12% men still report acne in their 40s

A

T

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3
Q

T/F Caucasian girls and females have a tendency to more severe nodulocystic disease than other groups

A

F Caucasian boys and males have a tendency to more severe nodulocystic disease than other groups

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4
Q

What theoretical foods are associated with acne?

A

Theories include: milk (skimmed milk), whey protein used in body building supplements, high glycemic-load, B12 supplementation

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5
Q

What three things are involved in the pathogenisis of acne?

A
  1. Follicular hyperkeratinization 2. hormonal influences 3. inflammation, in part mediated by P.acnes
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6
Q

T/F Dehydroepiandrosterone (DHEA) is a weak androgen converted to the more potent testosterone by 3-HSD and 17b-HSD

A

T

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7
Q

T/F the rise in serum levels of DHEAS in pre-pubescant children –> acne

A

T

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8
Q

T/F the theory is systemically administed Estrogen increases sebum production

A

F decreases

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9
Q

T/F CD8 T cells and levels of IL-2 have been shown to be increased perifollicularly prior to hyperkeritinization

A

F CD4 T cells and levels of IL-1

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10
Q

T/F P.acnes is a Gram-positive, aerobic cocci found deep within the sebaceous follicle

A

F it’s a rod, often found with smaller numbers of P.granulosum

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11
Q

T/F P.acnes produces porphyrins (primarily coproporphrin III) that fluroesces with Wood’s lamp illumination

A

T

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12
Q

T/F Acne fulimans- patients typically have severe acne prior to the onset

A

F tends t be mild-moderate

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13
Q

T/F Erythema nodosum may also arise in association with acne fulminans

A

T

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14
Q

What does SAPHO stand for?

A 
Synovitis
	Acne
	Pustulosis
	Hyperostosis
	Ostitis 
(can also accompany acne fulminans. Other associations include late-onset congenital adrenal hyperplasia and anabolic steroid use, including tesosterone)
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15
Q

T/F you should stop Isotretinoin immediately in someone with acne fulminans

A

True…for about 2 weeks whilst given Prednislone but then you restart at low dose eg 0.1mg/kg/day

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16
Q

What is the follicular occlusion triad?

A

Acne conglobata, Hydrenadenitis supprativa, Pilonoidal sinuses, and disecting cellulitis of the scalp

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17
Q

What is PAPA syndrome?

A

Pyogenic Arthritis, Pyoderma gangrenosum, and Acne conglobata
AD autoinflammatory disorder
PAPASH- add HS

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18
Q

T/F PAPA is caused by mutation in PSTPIP1 which encodes Proline-Serine-Threonine Posphatase Interacting Protein 1 (PSTPIP1)

A

T

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19
Q

What is Morbihan disease?

A

An unusual and disfiguring complication- solid facial edema. Clinically there is a distoriton of the midline face and cheeks due to soft tissue swelling. The wooding induration may be accompanied by erythema

20
Q

30% newborns are born with neonatal cephalic pustulosis

A

F 20% newborns, lesions usually appear about 2 weeks of age and generally resolve within the first 3 months of life

21
Q

T/F Neonatal cephalic pustulosis responds to topical imidazoles

A

T eg 2% Ketoconazole cream

22
Q

T/F Comedo formation is prominent in infantile acne

A

T- scarring may develop in up to half of patients

23
Q

T/F pathogenisis of infantile acne includes elevated levels of LH in males and elevated DHEA in both boys and girls

A

T LH stimulates testicular production, DHEA produced by infantile adrenal gland

24
Q

T/F oral antibiotics are first line treatment of infantile acne

A

F topical retinoids (eg tretinoin, adapalene) and benzyol peroxide are first line

25
Q

Why should tetracyclines be avoided in children <8 years age?

A

Bone and teeth development abnormalities
tetracyclines discolour teeth and may cause enamel dysplasia, which increases the risk of dental caries. They are also deposited in bone, causing deformities and inhibiting bone growth. However, doxycycline may be used for serious infections, eg Qfever, when other agents are unsuitable (small studies suggest that a short course of doxycycline may not stain teeth).

26
Q

Signs of hyperandrogenism

A

Irregular menstural periods
Severe and abrupt acne
Hirutism, coarsaning of the voice, muscular habitus, androgenetic alopecia, clitoromegaly with variable posterior labial inusion, increased libido

27
Q

What is HAIR-AN syndrome?

A

HyperAndrogenism, insulin resistance and Acanthosis Nigricans- increased risk of CV disease and diabetes

28
Q

Raised DHEAS and 17-hydroxyprogesterone ++?

A

Might indicate congenital adreanal hyperplasia

29
Q

Just raised DHEAS ++ ?

A

Might indicate adrenal tumour

30
Q

Raised testosterone 100-200 ng/dl and increased LH/FSH ratio?

A

Commonly seen in PCOS

31
Q

Testosterone ++ in female

A

Consider ovarian tumour

32
Q

What is Apert syndrome?

A

Acrocephalosndactyly type 1, AD disorder
Disfigring synostoses of the bones of the hands and feet, vertebral bodies and cranium
Acne

33
Q

T/F In Apert syndrome- increased incidence of severe, early-onset acne that tends to be nodulocystic, and more widespread than in classic acne

A

T

34
Q

What is an autosomal recessive disorder caused by SH3PXD2B mutations characterised by dysmorpic facies, thick skin, acne conglobata, vetebral abnormalities and mitral valve prolapse?

A

Borrone dermato-cardio-skeletal syndrome

35
Q

What’s the difference with drug induced acne rather than acne vulgaris?

A

Abrupt, MONOMORPHOUS erruption of inflammatory papules and pustules

36
Q

Causes of drug induced acne?

A

Anabolic steroids
Progestin
Corticosteroids - topical, oral or inhaled (particularly high dose/ IV)
Antiepileptics- phenytoin, Quetiapine , Carbamazepine, Phenobarbitone, Gabapentin, Topiramate
Antidepressants- Lithium, sertraline (Rispiridone)
AntiTB- Isoniazid, pyrazinamide
Antivirals Ritonavir, Ganciclovir
cardiac- Nilvadipne, Ramipril
Halogens- Sodium fluride, potassium iodine
Misc. Sirolimus, CSA, AZA , Quinine

Vitamin B6+ B12  MEK inhibitors eg trametinib, TNF inhibitors
37
Q

Offending agents in occupational acne, acne cosmetica, pomade acne?

A

Follicular-occluding substances
Lanolin, Petrolatum, certain vegetable oils
Cutting oils, petroleum, chlorinated hydrocarbons, coal tar derivatives
Bleaching agents
Pomade= greasy preparations to defrizz hair

38
Q

T/F tropical acne typically involves the neck

A

F marked inflamed nodulocystic acne involving the trunk and buttocks

39
Q

5 differentials of closed comedones other than acne

A

Steacystoma Multiplex (but multiple)
Milia
Sebaceous hyperplasia , adenomas and carcinoma - MSH2, 6 MLH1 (micro satelite-instability)
(Pseudoacne of the nose crease)
Contact acne (occupational, pomade, cosmedica, mechanica, chloracne)
Follicular MF

Ectopic sebacous glands 
Adnexal tumours- syringomas (around the eyelides and upper cheeks- seen more in Japanese women)  Fibrofolliculomas (face, neck, upper trunk). If BHDB, rare AD condition Fibrofolliculomas, Acrochordons and Trichodiscomas --> increased risk of colon/ kidney cancer, and spontaneous PNTH due to pulmonary cysts
40
Q

5 differentials of open comedones

A 
Acne 
	Favre Racochet syndrome (but triad of solar elastosis, and cysts) 
	Dilated Pore of Winer (but single) 
	(Pseudoacne of the nose crease) 
	Radiation induced comedones
	Molluscum induced comedones 
Familial comedones
41
Q

5 differentials acne vulgaris

A

Rosacea (particularly granulomatous- synonym lupus milaris disseminatus faciei, acne agminata)
Pyoderma faciale (syn with rosacea fulminans)
Perioral dermatitis
Folliculitis (malaesezzia, foliculitis keloidalis)
Scalp- dissecting cellulitis of the scalp
HS
Acne (drug cause, occupational, pomade, cosmetica, mechanica)
Neutrophilic dermatosis
Keratosis pilaris
Lupus miliaris disseminatus faciei
PAPA, PAPASH, SAPHO

42
Q

Conditions which can worsen/ reduce acne

A

Anorexia nervosa
Bulliaemia
Turner syndrome
PCOS

43
Q

Neonatal acne differentials

A

Sebaceous hyperplasia
Milia
Miliara rubra (especially pustular variant)
Candida

44
Q

Solid facial edema secondary to acne vulgaris differentials

A

Solid facial oedema secondary to rosacea
Melkersson-Rosenhal syndrome, sarcoidosis, leprosy
Lymphoma, leukaemia cuis
A.I CT diseases eg dermatomyositis, lupus, Still disease

45
Q

Complications of acne

A 
Scarring
	Psychological distress 
	Acne fulminans (if treated..)
	Osteoma cutis- focal ossifications in subcut and dermal tissue 
	Pyogenic granulomas in acne 
Seborrhea
46
Q

T/F Topical Benzoyl peroxide + Dapsone can temporarily stain skin yellow-orange whereas Benzoyl peroxide alone can just bleach things (skin and clothes including bedding)

A

F Benzoyl peroxide can just bleach things (skin and clothes including bedding) whereas topical Benzoyl peroxide and Dapsone temporarily stain skin yellow-orange

47
Q

Rare side effects of Minocycline

A

Hypersensitivity
Lupus-like syndrome
Cutaneous PAN often associated with PAN

Acne Charl (2 decks)

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