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Derm Rheum > Acne and Rosacea - Wright > Flashcards

Acne and Rosacea - Wright Flashcards

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Dermatology Board Prep 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
Q

Significant ADE(s) of minocycline (4)

A

Dyspigmentation, lupus-like reaction, pseudotumor cerebri, Steven Johnson

26
Q

Which patients/type of acne would you consider oral contraceptives in?

A

Females with moderate to severe inflammatory/mixed acne

27
Q

How do oral contraceptives help acne?

A

Anti-androgen effects suppress sebum production

28
Q

Indication for oral retinoids (isotretinoin)

A

Severe, scarring, or refractory acne

29
Q

Mechanism of oral retinoids

A

1) Decrease size/activity of sebaceous glands by 90%
2) Normalize follicular keratinization; prevents new comedones
3) Inhibits P. acnes
4) Anti-inflammatory

30
Q

Common, not severe side effects of oral retinoids? (5)

A

Dry lips/skins/eyes, nosebleeds, mild HA, myalgias, backaches

31
Q

Severe side effects of oral retinoids? (4)

A

SEVERE teratogen, depression/suicidal ideation, skeletal changes, and development of inflammatory bowel disease

32
Q

Simple treatment algorithm for acne management?

A

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
Q

Common therapy for back acne?

A

Benzyl peroxide body wash

34
Q

Is acne linked to poor hygiene, dirt, or poor diet?

A

No; the diet part is controversial

35
Q

What food product can exacerbate acne in teenage boys?

A

Milk

36
Q

Epidemiology of Rosacea?

A

Fair skin women, over the age of 30

37
Q

What is rosacea?

A

chronic skin condition characterized by facial erythema, papules/pustules, and swelling

38
Q

What are some common triggers of rosacea?

A

Sunlight, exercise, hot/cold. stress, food, alcohol

39
Q

Where does rosacea most commonly occur?

A

On the central face; cheeks, across the bridge of the nose

40
Q

What is the course of disease in rosacea?

A

Chronically relapsing and remitting

41
Q

What are the 4 types of rosacea?

A

1) Erythematoltelangiectatic: redness with telangiectasias
2) Papulopustular: you have papules and pustules
3) Phymatous: permanent swelling of the nose
4) Ocular: eye involvement

42
Q

Treatment for rosacea?

A

Topcial therapy (metronidazole, azelaic acid); Systemic tetracyclines; Laser/surgery

43
Q

What is periorificial dermatitis?

A

A disease of multiple small papules developing around orifices, most commonly the mouth

44
Q

2 common patients periorificial dermatitis is seen in?

A

Women ages 20-45 and prepubertal children

45
Q

Treatment for periorificial dermatitis?

A

D/C all topical steroids; tx with either topical or systemic abx; maybe topical NSAIDs

46
Q

What is folliculitis?

A

follicular based papules on hear-bearing areas (trunk, thigh, buttocks, etc)

47
Q

Most common cause of folliculitis?

A

Bacterial; Staph aureus (most common), streptococcus, pseudomonas

48
Q

Which patients do you see eosinophilic folliculitis in?

A

HIV and transplant patients

49
Q

Tx for folliculitis?

A

Abx soaps, topical abx

50
Q

What is hidradenitis suppurativa?

A

chronic condition with formation of painful abscesses involving the apocrine gland bearing areas

51
Q

Common places for hidradenitis suppurativa to occur?

A

axillary, inguinal, inframammary folds

52
Q

Risk factors for hidradenitis suppurativa?

A

Being female, obesity, cigarettes, family hx

53
Q

Pathogenesis of hidradenitis suppurativa?

A

Follicular keratin plugs cause hair follicle rupture–> follicle contents spilled into dermis–> local inflammation and abscess formation

54
Q

Age when hidradenitis suppurativa presents?

A

Early 20s

Derm Rheum (39 decks)

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