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Dermatology > Acne > Flashcards

Acne Flashcards

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Dermatology Board Prep flashcards
1
Q

Pathophysiology of acne

A

Chronic inflammatory disease of pilosebaceous unit

Androgens > increased sebum production > plugging w/ desquamated keratinocytes > bacterial proliferation (P. acnes) > inflammation

Significant genetic component

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2
Q

Epidemiology of acne vulgaris

A

Common in 18-24s

More severe in males

More persistent in females

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3
Q

Presentation of acne - non-inflammatory lesions

A

Comedones: small raised lesions from impaction and distenson of follicles by sebum/keratinocytes

Closed: Whiteheads

Open: Blackheads, from oxidised sebum

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4
Q

Presentation of acne - inflammatory lesions

A

Papules: Raised, red lesions

Pustules: Squeezable yellow/white spots

Nodules: Enlarged spots from severe inflammation

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5
Q

Presentation of acne - secondary lesions

A

Scars - from old spots, esp after excoriations

Pigmented macuels - from old spots, dark skin

Erythematous macules - from old spots, fair skin

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6
Q

Secondary causes of acne - endocrine

A

Ovarian: Tumours, PCOS

Adrenal: 21-a hydroxylase deficiency, tumours

Pituitary: Cushing’s, acromegaly, prolactinoma

Obesity

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7
Q

Secondary causes of acne - drugs

A

Phenytoin

Inhibitors of EGFR (cancer)

Moisturisers

Phenobarbitone

Lithium

Estrogen (OCP)

Steroids - incl. anabolic

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8
Q

Conservative management of acne

A

No evidence for diet

Smoking likely unhelpful

UV light ?helpful

Avoid abrasive/irritant skin treatment, scratching

Face washing helps

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9
Q

Medical management of mild acne

A

Comedones only - topical retinoids e.g. retin-A, adapalene

Papulopustular - combination Rx: abx (clindamycin, tetracycline), benzoyl peroxide, retinoid

3-4mo for effect

Retinoid + benzoyl irritant - gradual buildup of contact time

Apply to all spot-prone areas not just spots

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10
Q

Management of moderate acne

A

Topical retinoid/benzoyl +/- abx

Oral abx - tetracycline/emecycline/erythromycin - four-month course

Consider OCP in females - anti-adrogen cyproterone acetate

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11
Q

Baseline bloods for Roaccutane (isotretinoin)

A

Lipids, LFTs, pregnancy test (monthly)

Femalesmust be on OCP + advise 2nd contraception as well

Must not be on tetracycline - risk of BIH

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12
Q

Side-effects of Roaccutane

A

Anxiety/mood disturbance

Dry skin, eyes, etc..

Teratogenic

Lipid/LFT disturbance

Initial flare-up of acne

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13
Q

Acne variants contraindicated topical retinoid

A

Acne conglobata

Acne fulminans

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14
Q

Features of acne conglobata

A

Severe nodulo-cystic acne

Assoc w/ pilonidal sinus, scalp cellulitis, hidradenitis suppurative

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15
Q

Features of acne fulminans

A

Abrupt onset

Systemic unwellness - swinging fevers

Inflammatory, ulcerated, severe acne

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16
Q

Investigation of acne fulminans

A

Refer to derm, consider admission

B: FBC (leukocytosis, anaemia), ESR

O: Skin swabs - exclude 2ry infection w/ staph

X: Bone scans - radionuclide uptake in areas of pain

17
Q

Management of acne fulminans

A

Oral prednisolone 0.5-1mg/kg per day for 4-8w

After steroid - isotretinoin course

NSAIDs for myalgia/arthralgia

Antiseptic wash

Potent Topical steroid BDS for granulating ulcers

18
Q

Indications for immediate/urgent derm referral

A

Severe variant of acne (e.g. fulminans)

Severe nodulocystic disease that could benefit from oral isotretinoin

Social/psychological problems

19
Q

Indications for routine derm referral for acne

A

Scarring despite management

Failed two courses of oral abx (3 months each)

Suspected underlying cause (e.g. PCOD)

20
Q

Presentation of acne rosacea

A

Inflammation of blood vessels of skin - persistent, patchy redness but NOT SCALY (c.f. seb derm)

Affects face not trunk, usually symmetrical

Erythematous, telangiectasia, papules/pustules NO COMEDONES

3rd-4th decades, Hx of easy blushing/flushing

Rhinophyma - enlarged nose; eye involvement common

21
Q

Conservatice management of rosacea

A

Avoid photoexacerbation

Avoid irritants (e.g. soap)

22
Q

Topical management of rosacea

A

Metronidazole

Brimonidine (vasoconstriction) - temp reduction in redness, but risk of contact sensitisation

Cosmetic camouflage

NB: retionoid gel contraindicated

23
Q

Medical management of rosacea

A

Oral abx (e.g. tetracycline) - treat papulopustular disease but not redness

Oral isotretinoin may help papulopustular

Dermatology (10 decks)

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