Acne

Question 1

What is the order of areas most commonly affected by acne vulgaris?

Answer 1

• Face (99%)
• Back (60%)
• Chest (15%)

Sometimes shoulders and arms

Question 2

What are the conditions associated with increased risk of acne vulgaris?

Answer 2

1. XYY karyotype
2. Endocrine disorders

• PCOS
• Hyperandrogenism
• Hypercortisolism
• Precocious puberty

Question 3

What are the 4 key factors associated with the development of acne vulgaris?

Answer 3

1. ↑sebum production
2. Inflammation
3. Hyperkeratinization of the follicular infundibulum (epithelial area of the hair follicle)
4. Colonization with Cutibacterium acnes (formerly Proprionibacterium acnes)

Question 4

What is the follicular occlusion tetrad?

Answer 4

1. Acne conglobata (severe nodulocystic acne)
2. Hidradenitis suppurativa
3. Dissecting cellulitis of the scalp (scarring alopecia)
4. Pilonidal cysts

Question 5

What are the 3 types of scarring seen in acne

Answer 5

1. Icepick
2. boxcar
3. rolling

Question 6

What is this diagnosis?

What is the recommended treatment?

Answer 6

Acne Excoriée des Jeunes Filles

Antidepressants + psychotherapy

Question 7

Which medications can contribute to hyperandrogenism?

Which OTC product can be associated with hyperandrogenism?

Answer 7

Phenytoin

Lithium

Glucocorticoids

Progestin-only contraceptives

OTC - whey protein supplements

Question 8

Which lab tests would you order if you suspect hyperandrogenism?

Answer 8

Total/free testosterone

DHEAS

Androstenedione

17-OH progesterone

Question 9

List 4 principles of management of acne vulgaris

Answer 9

1. Remove any exacerbating factors
2. Correct the abnormal keratinization (topical retinoids, oral isotretinoin, hormones)
3. ↓bacterial population (antibiotics, benzoyl peroxide, oral isotretinoin [indirectly])
4. ↓sebaceous gland activity (hormones, oral isotretinoin)
5. ↓inflammation (topical retinoid, oral isotretinoin, antibiotics [some])
6. ↓scarring
7. Avoid monotherapy with topical or oral antibiotics
8. ↓antibiotic resistance

Question 10

List 4 recommendations for skin care

Answer 10

1. Do not wash more than 2 X daily
2. Use gentle cleanser
3. Avoid scrubs, astrigents, or other irritating products
4. Oil free/non-comedogenic makeup only
5. Moisturizer placed over irritating topical medications to minimize irritation

Question 11

What is the mechnism of action of topical retinoids

Answer 11

1. Normalize follicular desquamation
2. Some reduce inflammatory response

Question 12

What are the 4 mechanisms of action of oral isotretinoin?

Answer 12

1. ↓sebum production
2. Normalizes follicular desquamation
3. ↓ P acnes indirectly
4. ↓ inflammation