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Derm Rheum > Acne and Rosacea - Wright > Flashcards

Acne and Rosacea - Wright Flashcards

1
Q

Pathogenesis of acne (4 things)?

A

1) Sebaceous Gland hyperplasia
2) Abnormal follicular desquamation
3) P. acnes colonization
4) Inflammation

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2
Q

What is a comedone?

A

A clogged hair follicle in the skin, producing a small papule; keratin and sebum combine to clog the follicle

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3
Q

What are the 2 general types of comedo?

A

Non-inflammatory and inflammatory

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4
Q

What are the 2 subtypes of non-inflammatory comedones

A

Blackhead (open) and whiteheads (closed)

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5
Q

What is the primary physiologic basis for development of acne during puberty/adolescence?

A

Androgens increase sebum production

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6
Q

What is the “black” in the blackhead?

A

The central keratin plug

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7
Q

What are the 2 primary abx used in acne treatment?

A

Doxycycline and Minocycline

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8
Q

What treatment would you use for very mild acne?

A

Benzoyl peroxide and salicylic acid

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9
Q

What abx is used in patients that cannot tolerate tetracyclines? What is a problem with this abx?

A

Erythromycin; resistance develops rapidly

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10
Q

Benzyl peroxide mechanism of action?

A

Kills P.acne, mild comedolytic properties, and mild anti-inflammatory properties

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11
Q

What is the benefit of combining benzyl peroxide with abx?

A

Benzyl peroxide decreases the emergence of resistance

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12
Q

What is benzyl peroxide most commonly combined with (most common acne therapy used)?

A

Combined with retinoids, they work synergistically

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13
Q

Resistance to benzyl peroxide?

A

None reported

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14
Q

Primary goal of therapy when treating acne (I know this is a shitty question, but she specifically mentioned this)?

A

Need the therapy to be comedolytic

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15
Q

What abx is most associated with development of colitis (C.diff especially)?

A

Clindamycin

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16
Q

Should you use topical abx alone? Why/Why not?

A

No; they have a slow onset, resistance emerges quickly, and they’re NOT comedolytic

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17
Q

Topical retinoid mechanism of action?

A

Normalize follicular desquamation (comedolytic), anti-inflammatory, and enhance penetration of other compounds (benzyl peroxide/topical abx)

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18
Q

What is the first line therapy for ALL types of acne?

A

Topical retinoids

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19
Q

Side effects seen with benzyl peroxide and topical retinoids?

A

Local cutaneous irritation (dryness, peeling, redness); bleaching (benzyl peroxide only)

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20
Q

Which topical retinoid is category X in pregnancy?

A

Tazarotene

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21
Q

What type of acne would you use systemic abx in?

A

Moderate to severe inflammatory acne

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22
Q

Which tetracycline would you start with first?

A

Doxycycline

23
Q

Which patients can you not use tetracyclines in? Why?

A

Patients less than 8 yrs old

it negatively affects bone/cartilage, teeth development

24
Q

Significant ADE of tetracycline?

A

Stains your teeth

also photosensitivity

25
Significant ADE(s) of minocycline (4)
Dyspigmentation, lupus-like reaction, pseudotumor cerebri, Steven Johnson
26
Which patients/type of acne would you consider oral contraceptives in?
Females with moderate to severe inflammatory/mixed acne
27
How do oral contraceptives help acne?
Anti-androgen effects suppress sebum production
28
Indication for oral retinoids (isotretinoin)
Severe, scarring, or refractory acne
29
Mechanism of oral retinoids
1) Decrease size/activity of sebaceous glands by 90% 2) Normalize follicular keratinization; prevents new comedones 3) Inhibits P. acnes 4) Anti-inflammatory
30
Common, not severe side effects of oral retinoids? (5)
Dry lips/skins/eyes, nosebleeds, mild HA, myalgias, backaches
31
Severe side effects of oral retinoids? (4)
SEVERE teratogen, depression/suicidal ideation, skeletal changes, and development of inflammatory bowel disease
32
Simple treatment algorithm for acne management?
1) Mild comedonal--> Topical retinoid 2) Mild inflammatory/mixed--> Topical retinoid + topical abx 3) Moderate inflammatory/mixed --> Topical retinoid + topical abx + oral abx 4a) Severe inflammatory (minimal scarring)--> Topical retinoid + topical abx + oral abx 4b) Severe inflammatory (scarring or multiple treatment failure)--> Isotretinoin
33
Common therapy for back acne?
Benzyl peroxide body wash
34
Is acne linked to poor hygiene, dirt, or poor diet?
No; the diet part is controversial
35
What food product can exacerbate acne in teenage boys?
Milk
36
Epidemiology of Rosacea?
Fair skin women, over the age of 30
37
What is rosacea?
chronic skin condition characterized by facial erythema, papules/pustules, and swelling
38
What are some common triggers of rosacea?
Sunlight, exercise, hot/cold. stress, food, alcohol
39
Where does rosacea most commonly occur?
On the central face; cheeks, across the bridge of the nose
40
What is the course of disease in rosacea?
Chronically relapsing and remitting
41
What are the 4 types of rosacea?
1) Erythematoltelangiectatic: redness with telangiectasias 2) Papulopustular: you have papules and pustules 3) Phymatous: permanent swelling of the nose 4) Ocular: eye involvement
42
Treatment for rosacea?
Topcial therapy (metronidazole, azelaic acid); Systemic tetracyclines; Laser/surgery
43
What is periorificial dermatitis?
A disease of multiple small papules developing around orifices, most commonly the mouth
44
2 common patients periorificial dermatitis is seen in?
Women ages 20-45 and prepubertal children
45
Treatment for periorificial dermatitis?
D/C all topical steroids; tx with either topical or systemic abx; maybe topical NSAIDs
46
What is folliculitis?
follicular based papules on hear-bearing areas (trunk, thigh, buttocks, etc)
47
Most common cause of folliculitis?
Bacterial; Staph aureus (most common), streptococcus, pseudomonas
48
Which patients do you see eosinophilic folliculitis in?
HIV and transplant patients
49
Tx for folliculitis?
Abx soaps, topical abx
50
What is hidradenitis suppurativa?
chronic condition with formation of painful abscesses involving the apocrine gland bearing areas
51
Common places for hidradenitis suppurativa to occur?
axillary, inguinal, inframammary folds
52
Risk factors for hidradenitis suppurativa?
Being female, obesity, cigarettes, family hx
53
Pathogenesis of hidradenitis suppurativa?
Follicular keratin plugs cause hair follicle rupture--> follicle contents spilled into dermis--> local inflammation and abscess formation
54
Age when hidradenitis suppurativa presents?
Early 20s

Derm Rheum (39 decks)

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