Acne and Folliculitis Flashcards
Acne Pathogenesis
- 4 steps overview + 1
- Follicular plugging
- Excess sebum
- Presence/activity of P. acnes
- Inflammation
- Genetics
Follicular plugging
Microcomedone turns into comedone when corneocytes accumulate in the hair follicle, leading to hyperkareatosis
Excess sebum
Caused by androgens: DHT and DHEAS
Presence of p. acnes
Bacteria typically found deep in sebaceous follicle, proliferations inside pustule, causing more inflammation
Inflammation
Hyperkeratotic hair follicle expands and ruptures, leading to a pustule and inflammation
Clinical features of acne
- Comedones-open (blackhead) and closed (whitehead)
- Papules/Pustules: inflammatory
- Nodules/Cysts: can be scarring
4 Treatment options for acne
- Topicals
- Oral abx
- Oral retinoids
- Hormonal Therapy
Topicals medications for acne
- Antibiotics
- Retinoids
Topical antibiotics
- Action against p. acnes
- Anti-inflammatory
- Not comedolytic (won’t get rid of comedones)
- Erythromycin, clindamycin, sulfur, benzoyl peroxide, dapsone
- Bacterial resistance with erythromycin, benzoyl lessens resistance and gives comedolytic properties
Topical retinoids
- Comedolytic
- Anti-inflammatory
- Can cause sensitivity
- Tretinoin, adapalene, tazarotene
- Used alone or in combo with topical antibiotic
oral antibiotics
- Reduces p. acnes colonization of skin and follicles and decrease inflammation
- Doxycycline, minocycline
- Second line options: trimethoprim/sulfamethoxazole, sometimes azithromycin
- Can cause GI upset, photosensitivity (doxy), vertigo, hyperpigmentation, SJS/TENS, ER options help
Oral retinoids
- name
- MoA
- Isotretinoin (accutane)
- Normalizes epidermal differentiation, suppressing sebum production, decreasing inflammation
- Does not help with infection or inflammation
Oral retinoids
- Monitoring
Have to enroll in iPledge for contraceptive counseling
- baseline LFTs, lipids, CBC, hCG
- monitor blood-work monthly
Oral retinoids
- MC side effects
- Dryness: decreased oil gland activity
- Dry skin, lips, eyes, joints
- HA
- GI
- Blurry vision (usu dry eyes)
- Arthralgia (dry joints)
Oral retinoids
- when used with ____ family of drugs, risk for _____
- tetracyclines
- pseudomotor cerebri
What two things do people worry about when using oral retinoids that are not supported by evidence
- link to depression, anxiety, mood changes, suicidal ideation/suicide
- link to ulcerative colitis
Hormonal therapy
- Two main drugs used
- spironolactone (MC)
- oral contraceptives
Spironolactone in acne
- binds to androgen receptors and reduced androgen production, suppresses sebum production
- usu used in adult females
- monitor bp and k+
Oral contraceptive use for acne
- used as adjunct therpay
- reduce androgens by decreases SHBG which reduces testosterone
- Yaz commonly used
- not usually Rxed by terms, usually send to gyn.
Folliculitis
- overview
- inflammation and infection of hair follicle
- MC staph, sometimes pseudomonas (hot tub)
- damaged follicle caused by irritation (clothing rubbing on skin, trauma, shaving, sweat blockage, oil, makeup)
Pseudofolliculitis barbae
(razor bumps)
- Growth of stiff hairs into the skin may cause chronic low-grade irritation or inflammation that may mimic infectious folliculitis
Folliculitis clinical features
- found all over body
- chronically found in areas of shaving, waxing, hair plucking, friction
- Superficial pustule surrounding a hair follicle with itching and burning
Folliculitis treatment
- avoid shaving area, change razor often, warm compress, anti-bacterial soap, non-occlusive moisturizer
- avoid friction and rubbing
- avoid lycra workout clothes and tight, rough fabric like jeans
- benzoyl peroxide 5% wash (MC)
- Clindamycin 1% lotion, gel, foam
- Cephalexin, dicloxacillin, doxy, minocycline
How to treat hot tub folliculitis
clears on its own without treatment
Pityrosporum folliculitis
- etiology
- Warm weather, occlusion and excessive sebum production
- Can be confused with back acne. The pustules and papules will ALL be the same size unlike acne which will have a bunch of
Pityrosporum folliculitis
- treatment
Topical antifungals or systemic fluconazole different sized lesions
