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MBBS 4 Dermatology > Acne and Rosacea > Flashcards

Acne and Rosacea Flashcards

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Dermatology Board Prep flashcards
1
Q

What is acne?

A

Multi factorial skin disease which usually begins during puberty

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2
Q

Epidemiology of acne?

A
  • Very common, around 80% experiences some form of acne during puberty
  • Usually stops after puberty, but not rarely persists
  • Man and women equally affected but severe acne more common in men
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3
Q

Pathogenesis of acne?

A
  1. Pilosebaceous duct hyperkeratosis
  2. Increased sebum secretion
  3. Colonization of the duct with Propionibacterium acnes
  4. Release of inflammatory mediators
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4
Q

What are comedones?

A

pores of hair follicles that have gotten blocked with bacteria, oil and dead skin cells to form a bump on your skin

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5
Q

Describe an early comedone?

A
  1. infundibulum
    - hyperkaratosis
    - corneocyte cohesiveness
  2. androgen stimulation of sebum secretion
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6
Q

Describe a later comedone?

A
  1. accumulation of shed keratin and sebum
  2. formation of whorled lamellar concretions
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7
Q

What is a whitehead?

A

a skin lesion consisting of a hair follicle that is occluded with sebum and keratin, appearing white at the surface
- closed comedo with no disruption of the epidermis

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8
Q

What is a blackhead?

A

skin lesion consisting of a hair follicle that is occluded with sebum and keratin darkened by oxidation
- open comedo with disruption of the epidermis

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9
Q

Describe an inflammatory papule/pustule?

A
  • Propionibacterium acnes proliferation
  • sebaceous lobule regression
  • mild inflammation
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10
Q

What is a nodule/cyst?

A
  • marked inflammation
  • scarring
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11
Q

What are the types of acne?

A
  1. Acne vulgaris
  2. Acne conglobata
  3. Acne excoriée
  4. Cosmetic / pommade
  5. Acne keloidalis
  6. Drug-induced
  7. Infantile
  8. Chloracne
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12
Q

What is acne vulgaris?

A
  • Most common one
  • Usually onset in puberty and usually remission after
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13
Q

Features of acne vulgaris?

A
  1. Papules
  2. pustules
  3. nodules
  4. comedones
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14
Q

What is acne conglobata?

A

is a highly inflammatory disease presenting with comedones, nodules, abscesses and draining sinus tracts
- is a severe form of acne
- begins at the ages between 18 and 30

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15
Q

What is acne excoriee?

A

aka pickers acne
- is a mild acne accompanied by extensive excoriations caused by the person picking at the pimples

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16
Q

What is pommade acne?

A

aka hairline acne
- type of acne caused by the use of hair styling products such as hair pomades, oils and gels that contain pore-clogging ingredients linked to comedone formation

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17
Q

What is peri-oral dermatitis?

A
  • chronic facial dermatitis affecting the perioral region
  • affecting primarily children and women 20-45 years
  • Presumably caused by regular application of (glucocorticoid) creams and/or cosmetics
18
Q

Clinical features of perioral dermatitis?

A
  1. Erythema with grouped papules and pustules
  2. Dry skin with painful burning and a sensation of tightness
  3. No residual scarring after resolution
19
Q

What is acne keloidales?

A

Keloid around the hair follicle due to acne or folliculitis

20
Q

Epidemiology of acne keloidales?

A
  1. dark-skinned people
  2. men
21
Q

Distribution of acne keloidalis?

A
  1. Chest
  2. back
  3. Neck: acne keloidalis nuchae (also hair that grows in the skin)
22
Q

What is acne keloidales nuchae?

A
  • A chronic inflammatory skin condition affecting the nuchal and occipital region of the scalp
  • Typically affects postpubertal individuals: usually men
23
Q

Etiology of acne keloidales nuchae?

A
  1. Unclear; male preponderance suggests an association with increased androgen levels.
  2. Lesions are caused by an abnormal immune response to trauma.
24
Q

Clinical features of acne keloidales nuchae?

A

The following features are circumscribed to the region surrounding the posterior hairline.
1. Keloid-like papules, plaques, and/or pustules
2. Cicatricial alopecia
3. Can cause itching, pain, and bleeding

25
Q

What is pseudofollicultis barbae?

A

razor bumps - ingrown hairs
- An inflammatory skin condition characterized by firm, hyperpigmented, tender, pruritic papules and pustules on hair-growing areas on the lower face
- Often caused by an inflammatory skin reaction in response to short hair that becomes entrapped within the skin i.e ingrown hairs (e.g., after shaving)
- More common in Black males.

26
Q

Treatment for Pseudofollicultis barbae?

A
  1. Grow the beard
  2. Long shave
  3. Shave in direction of hairs
  4. Topical retinoids, steroids
  5. Antiinflammatory antibiotics
  6. Laserepilation
27
Q

Drug induced causes of acne?

A
  1. Hormones (androgens)
  2. Isoniazid
  3. Rifampicin
  4. Antiepileptics
  5. Steroids
28
Q

General advice in acne treatment?

A
  1. Stop using very oily products!
    - No Vaseline, oils or cosmetics
  2. Keep the skin clean, but don’t wash it to often or with very warm water, use a gentle face wash, no aggressive soaps peelings and so on
  3. Don’t manipulate
29
Q

Acne treatment?

A
  1. Topical
    – Comedolytic
    – Anti inflammatory
  2. Oral antibiotics
  3. Retinoids
30
Q

Comedolytic topical acne treatment?

A
  1. Benzoylperoxide 2.5-5-(10)% gel (stains)
  2. Tretinoin 0.02%- 0.1% cream / gel
  3. Adapalene
    – Always be careful!!
31
Q

Anti inflammatory topical acne treatment?

A
  1. Clindamycin 1% lotion
  2. Erythromycin 1-2% lotion
32
Q

Postinflammatory hyperpigmentation topical treatment?

A
  1. Hydroquinone 2 (or 5) %
  2. Sun protection
33
Q

Antibiotic acne treatment?

A
  1. Tetracycline
  2. minocycline
  3. doxycycline (3 months)
    – Usually well tolerated, be careful with phototoxicity
34
Q

Retinoid acne treatment?

A

Isotretinoin (on average 6-9 months up to cumulative dose (120-150 mg/kg)
– Very teratogenic!

35
Q

Side effects of retinoids?

A
  1. dry skin - mainly mucsal
  2. headache
  3. muscle ache
  4. tiredness
36
Q

Lab test to do before beginning retinoid therapy?

A
  1. cholesterol/triglycerides/liver function
  2. pregnancy test in women
37
Q

What is rosacea?

A
  • A chronic inflammatory skin condition of unclear etiology that presents with persistent central facial erythema, telangiectasia, roughness/scaling, and possibly papules/pustules
  • which may be triggered by sun exposure, alcohol, or stress
  • In severe cases, the nose develops a large, bulbous shape (rhinophyma)
38
Q

Features of roacea?

A
  1. Erythematotelangiectatic
    – Diffuse erythema/telangiectasia
  2. Papulopustular
    – Papules, Pustules
    – NO comedones
  3. Phymatous
    – Rhinophyma
  4. Ocular involvement as well as erythema
39
Q

General measures in treatment of rosacea?

A
  1. Sun avoidance and photo protection
  2. Gentle skin care
  3. Avoiding triggers
40
Q

What triggers rosacea?

A
  1. ultraviolet radiation exposure
  2. spicy foods
  3. hot or alcoholic beverages
  4. stress
  5. extreme temperatures (hot or cold)
41
Q

Anti inflammatory treatment of rosacea?

A
  1. Metronidazole topical
  2. Oral tetracycline (doxycycline, minocycline)
  3. Oral isotretinoin
42
Q

Anti redness treatment of rosacea?

A
  1. Laser
  2. Brimonidine topical

MBBS 4 Dermatology (21 decks)

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