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acne and rosacea Flashcards

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Dermatology Board Prep flashcards
1
Q

vitamin a derivatives that act by normalizing desquamation of follicular epithelium to prevent formation of new comedones and promote the clearing of existing comedones

A

topical retinoids (tretinoin, trans retinoic acid)

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2
Q

adverse effects of topical retinoids

A

dryness, pruritus, erythema, scaling, photosensitivity

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3
Q

when applying topical retinoids do you combine with other treatments

A

no, you do not apply at the same time as benzoyl peroxide, but you should wear sunscreen

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4
Q

which retinoid is cat x

A

tazarotene

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5
Q

which retinoid is cat c

A

tretinoin and adapalene

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6
Q

topical medication w/ both antibacterial and comedolytic properties that acts via the generation of free radicals that oxidize proteins in the P acnes cell wall

A

benzoyl peroxide

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7
Q

adverse effects of benzoyl peroxide

A

bleaches hair and fabric, can irritate skin

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8
Q

reduces the number of P. acnes and reduces inflammation in inflammatory acne

A

topical abx

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9
Q

adverse effects of topical abx

A

irritating, dry skin

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10
Q

what should you instruct your pt to do when using topical abx

A

(1) when using w/ retinoids or benzoyl peroxide, use on alternating days (2) use a moisturizer

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11
Q

topical abx that comes in solution or gel

A

erythromycin 2%

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12
Q

topical abx that comes in solution, gel, lotion, or foam

A

clindamycin 1%

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13
Q

what can you use w/ topical abx to reduce the risk of abx resistance

A

benzoyl peroxide

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14
Q

which lesions should acne treatment target

A

new lesions, not present ones

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15
Q

most common cause of acne tx failure

A

lack of adherence (topical agents take 2-3 months to take effect) due to dryness, itching, etc., so have them use a ceramide containing moisturizer

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16
Q

how long should acne tx go on for until you can evaluate it

A

8 weeks at least

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17
Q

does diet effect acne

A

potentially yes

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18
Q

should pts using prescribed acne meds use OTC products too (like astringents, abx soaps, etc)

A

NO

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19
Q

what do you prescribe for moderate to severe inflammatory acne

A

tetracycline, doxycycline, minocycline + benzoyl peroxide (to prevent abx resistance)

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20
Q

adverse effects of oral tetra/doxy/mino-cyclines

A

GI upset, photosensitivity, + minocycline causes vertigo/dizziness and hyperpigmentation

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21
Q

oral tetra/doxy/mino-cycline contraindications

A

preggos, kids under 8

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22
Q

how should a pt take oral tetra/doxy/mino-cycline

A

with food/ milk/ full glass of water (to prevent GI side effects and esophageal erosions)

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23
Q

brown or blue grey skin pigmentation on the alveolar ridge, palate and sclera

A

hyperpigmentation caused by minocycline

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24
Q

what do you prescribe for refractory severe nodulocystic acne

A

oral isotertinoin

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25
Q

retinoic acid derivative that targets all 4 pathophysiologic factors involved in acne

A

oral isotretinoin

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26
Q

adverse effects of oral isotretinoin

A

xerosis (dry skin), chelitis (chapped lips), elevated liver enzymes, hypertriglyceridemia

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27
Q

what drug does the pt need to do the iPLEDGE program w/ b/c its toxic AF to preggos

A

oral isotretinoin

28
Q

w/ iPLEDGE, how long, and what type of contraception does someone need to take

A

2 forms of contraception for at least one month after tx has ended

29
Q

comedones w/ few inflammatory lesions

A

mild acne

30
Q

tx for mild acne

A

topical retinoid or benzoyl peroxide or combo therapy (topical retinoid + benzoyl peroxide +/- topical abx)

31
Q

comedones with marked number of inflammatory lesions

A

moderate acne

32
Q

tx for moderate acne

A

combo therapy (topical retinoid + benzoyl peroxide +/- topical abx)

33
Q

acne between the ages 1 and 7

A

mid childhood acne, rare

34
Q

what is mid childhood acne caused by

A

excess androgens (adrenal tumors/ gonadal tumors/ congenital adrenal hyperplasia/ cushings/ precocious puberty)- need to see endocrinologist

35
Q

acne from birth to 6 weeks

A

neonatal acne, self limiting, no comedones

36
Q

acne from 6 weeks to 1 year

A

infantile acne, true acne w/ comedones

37
Q

acne from 7-12 years

A

preadolescent acne

38
Q

acne from 12-19 years

A

adolescent acne

39
Q

how do you tx mid-childhood acne

A

same was as adults EXCEPT NO TETRACYCLINES

40
Q

PCOS must have ?/3 sxs, and what are they?

A

2/3… (1) oligo/anovulation (2) hyperandrogenism (3) polycystic ovaries on US

41
Q

women w/ PCOS can have a greater degree of insulin resistance which can cause

A

acanthosis nigricans

42
Q

increased circulating androgens in PCOS can cause ___ and ___

A

hormonal acne and hirsutism

43
Q

location of hormonal acne lesions

A

perioral and along jaw line

44
Q

when do women w. hormonal acne report a flare

A

pre-menstrual

45
Q

who should you consider hormonal acne in

A

pt w/ severe sudden onset/ hirsutism/ irregular menses

46
Q

how do you tell acne rosacea apart from acne vulgaris

A

acne rosacea has no comedones

47
Q

presents w/ flushing, erythema, papules, pustules, and/or phymatous changes

A

acne rosacea

48
Q

what are acne rosacea triggers

A

ETOH, sun, hot beverages, spicy food, stress, NOT HORMONES

49
Q

many patients w/ acne rosacea have ___ involvement

A

ocular

50
Q

acne rosacea tx

A

topical and oral tx, sunscreen, avoid triggers

51
Q

how do you tell periorificial dermatitis apart from acne vulgaris

A

periorificial dermatitis has no comedones

52
Q

erythematous papules and pustules w/ scaling located around the mouth, nose, and eyes (occasionally the rest of the face)

A

periorificial dermatitis

53
Q

periorificial dermatitis presents w/ what other sxs and hx

A

pruritis, burning, hx of topical steroids

54
Q

commonly used treatments for hormonal acne

A

spironolactone and oral contraceptives

55
Q

side effects of spironolactone

A

diuresis, hyperkalemia, irregular menses, feminization of male fetus

56
Q

side effects of oral contraceptives

A

N/V, abnormal menses, weight gain, breast tenderness, clots

57
Q

open and closed comedones, papules, pustules nodules and cysts

A

acne vulgaris

58
Q

what must you include when describing acne

A

severity and presence of scarring

59
Q

related to presence of androgens, excess sebum production, activity of P. acnes, and follicular hyperkeratinization

A

acne vulgaris

60
Q

location of acne vulgaris

A

face, neck, upper trunk, upper arms

61
Q

open comedones aka

A

blackheads

62
Q

closed comedones aka

A

whiteheads

63
Q

4 factors involved in the pathogenesis of acne vulgaris

A

(1) increased sebum production b/c of androgens (2) comedone formation (3) p-acnes proliferation (4) inflammatory response

64
Q

what causes comedone formation in acne vulgaris

A

keratin and sebum plug the hair follicle and accumulate

65
Q

what causes the release of pro-inflammatory cytokines in acne vulgaris

A

P. acnes proliferates in the sebacous follicle and releases enzymes

Derm (8 decks)

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