Acne and rosacea

Question 1

What is a macule?

Answer 1

A flat well-defined hyper/hypo pigmented mark
Eg. freckle, petechiae

Question 2

What is the difference between a patch and macule?

Answer 2

Patch is larger

Question 3

What is a papule?

Answer 3

<1cm, elevated and well-defined
(Elevated due to increased thickness in the skin
Eg. cherry haemangioma, verruca, molloscum contagiosum

Question 4

What is a plaque?

Answer 4

A larger papule
Eg. psoriasis, acne scarring, nummular dermatitis

Question 5

What is a nodule?

Answer 5

Larger volume than papule
Often >2cm
Eg. lipoma, lymphoma cutis, neurofibroma

Question 6

What is a vesicle?

Answer 6

Elevated, well-defined, primarily filled with clear fluid
<1cm
Eg. HSV, varicella

Question 7

What is a bulla?

Answer 7

A large vesicle (>1cm), filled with clear fluid
Eg. friction blister, bullous pemphigoid

Question 8

What is a pustule?

Answer 8

Elevated, well-defined, filled with purulent fluid
Eg. folliculitis, acne vulgaris, pustular psoriasis

Question 9

What is a fissure is derm?

Answer 9

Break in the skin usually due to intense dryness. Often painful
Eg. dermatitis, sebopsoriasis

Question 10

What is erosion in derm?

Answer 10

Partial loss of the epidermis

Question 11

What is excoriation?

Answer 11

Caused by picking at the skin, causing damage to the epithelium
Eg. bites, atopic dermatitis

Question 12

What is lichenification?

Answer 12

Thickening (acanthosis) of the skin
Eg. atopic dermatitis, lichen simplex chronicus

Question 13

What is the pathophysiology of acne vulgaris?

Answer 13

Inflammation of the pilosebaceous units
1. excess sebum production
2. Clogged hair follicles
3. Bacteria (p.acnes)
4. Inflammation

Question 14

What factors contribute to acne vulgaris?

Answer 14

Drugs
- lithium, Isoniazid, glucocorticoids, oral contraceptives, iodides, androgens

Other:
- Emotional stress, occlusion, and pressure on the skin

Question 15

What are the clinical manifestations of acne vulgaris?

Answer 15

• Comedomes (open: whitehead, closed: blackhead)
• Papules and papulopustular
• Nodules or cysts

Question 16

What are the treatment options for acne vulgaris?

Answer 16

Mild acne:
- Benzoyl peroxide (anti-bacterial)
- Topical retinoid (prevents clogging)
- Topical antibiotics Eg. clindamycin

Moderate:
- Oral antibiotics + topical therapy

Severe acne:
- Vitamin A derivate

Question 17

What is rosacea?

Answer 17

A long-term inflammatory skin condition that causes reddened skin and a rash, usually on the nose and cheeks

Question 18

What is the pathophysiology of rosacea?

Answer 18

• Neurovascular dysregulation
• Activation of immune system
• Demodex mite infestation

Question 19

What is the clinical manifestation of rosacea?

Answer 19

• Fixed centrofacial erythema in a characteristic pattern that may periodically
  intensify
• No comedomes

Question 20

What are the diagnostic criteria for rosacea?

Answer 20

• Flushing
• Papules and pustules
• Telangiectasia (dilation of capillaries)
• Ocular manifestations (light sensitivity, blepharitis, conjunctivitis)

Question 21

What is the management of rosacea?

Answer 21

• Stay clear of triggers
• Sunscreen
• cosmetic camouflage
• Avoid irritating skin with cleansers

Treatment:
Erythema: brimonidine tartrate
Papules and pustules: topical antibiotics
Ocular: artificial tears
Flushing: propanolol

• Laser treatment and surgery may be an option

Question 22

What is perioral dermatitis?

Answer 22

A rash that can resemble acne or rosacea
- Avoid topical glucocorticosteroids
- Avoid occlusive creams

Treat with oral or systemic antibiotics

Question 23

What is actinic keratosis?

Answer 23

Rough scaly patches on the skin caused by UV damage
- Can turn into squamous cell skin cancer

Treatment: topical gels and creams. Cryotherapy and surgery to scrape away the patches

Question 24

What is seborrhoeic dermatitis?

Answer 24

Scaly patches of inflamed skin usually on oily parts of the body

Cause: overgrowth of malassezia yeast triggering inflammation

Treatment: antifungal creams

Question 25

What is atopic dermatitis?

Answer 25

AKA eczema

Question 26

What is erysipelas?

Answer 26

Skin infection under the dermis layer, started by a cut on the skin usually

Cause: Group A strep

Question 27

What are the features of a lupus facial rash?

Answer 27

A butterfly-shaped rash (malar rash)

It usually spares the sides of the nose

Question 28

What is dermatomyositis?

Answer 28

An uncommon inflammatory disease marked by muscle weakness and rash

Cause: unknown
Treatment: corticosteroids

Question 29

What is keratosis pilaris?

Answer 29

Skin becomes rough and bumpy

Cause: build up of keratin