Acne and Rosacea - Wright Flashcards
Pathogenesis of acne (4 things)?
1) Sebaceous Gland hyperplasia
2) Abnormal follicular desquamation
3) P. acnes colonization
4) Inflammation
What is a comedone?
A clogged hair follicle in the skin, producing a small papule; keratin and sebum combine to clog the follicle
What are the 2 general types of comedo?
Non-inflammatory and inflammatory
What are the 2 subtypes of non-inflammatory comedones
Blackhead (open) and whiteheads (closed)
What is the primary physiologic basis for development of acne during puberty/adolescence?
Androgens increase sebum production
What is the “black” in the blackhead?
The central keratin plug
What are the 2 primary abx used in acne treatment?
Doxycycline and Minocycline
What treatment would you use for very mild acne?
Benzoyl peroxide and salicylic acid
What abx is used in patients that cannot tolerate tetracyclines? What is a problem with this abx?
Erythromycin; resistance develops rapidly
Benzyl peroxide mechanism of action?
Kills P.acne, mild comedolytic properties, and mild anti-inflammatory properties
What is the benefit of combining benzyl peroxide with abx?
Benzyl peroxide decreases the emergence of resistance
What is benzyl peroxide most commonly combined with (most common acne therapy used)?
Combined with retinoids, they work synergistically
Resistance to benzyl peroxide?
None reported
Primary goal of therapy when treating acne (I know this is a shitty question, but she specifically mentioned this)?
Need the therapy to be comedolytic
What abx is most associated with development of colitis (C.diff especially)?
Clindamycin
Should you use topical abx alone? Why/Why not?
No; they have a slow onset, resistance emerges quickly, and they’re NOT comedolytic
Topical retinoid mechanism of action?
Normalize follicular desquamation (comedolytic), anti-inflammatory, and enhance penetration of other compounds (benzyl peroxide/topical abx)
What is the first line therapy for ALL types of acne?
Topical retinoids
Side effects seen with benzyl peroxide and topical retinoids?
Local cutaneous irritation (dryness, peeling, redness); bleaching (benzyl peroxide only)
Which topical retinoid is category X in pregnancy?
Tazarotene
What type of acne would you use systemic abx in?
Moderate to severe inflammatory acne
Which tetracycline would you start with first?
Doxycycline
Which patients can you not use tetracyclines in? Why?
Patients less than 8 yrs old
it negatively affects bone/cartilage, teeth development
Significant ADE of tetracycline?
Stains your teeth
also photosensitivity
Significant ADE(s) of minocycline (4)
Dyspigmentation, lupus-like reaction, pseudotumor cerebri, Steven Johnson
Which patients/type of acne would you consider oral contraceptives in?
Females with moderate to severe inflammatory/mixed acne
How do oral contraceptives help acne?
Anti-androgen effects suppress sebum production
Indication for oral retinoids (isotretinoin)
Severe, scarring, or refractory acne
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
Common, not severe side effects of oral retinoids? (5)
Dry lips/skins/eyes, nosebleeds, mild HA, myalgias, backaches
Severe side effects of oral retinoids? (4)
SEVERE teratogen, depression/suicidal ideation, skeletal changes, and development of inflammatory bowel disease
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
Common therapy for back acne?
Benzyl peroxide body wash
Is acne linked to poor hygiene, dirt, or poor diet?
No; the diet part is controversial
What food product can exacerbate acne in teenage boys?
Milk
Epidemiology of Rosacea?
Fair skin women, over the age of 30
What is rosacea?
chronic skin condition characterized by facial erythema, papules/pustules, and swelling
What are some common triggers of rosacea?
Sunlight, exercise, hot/cold. stress, food, alcohol
Where does rosacea most commonly occur?
On the central face; cheeks, across the bridge of the nose
What is the course of disease in rosacea?
Chronically relapsing and remitting
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
Treatment for rosacea?
Topcial therapy (metronidazole, azelaic acid); Systemic tetracyclines; Laser/surgery
What is periorificial dermatitis?
A disease of multiple small papules developing around orifices, most commonly the mouth
2 common patients periorificial dermatitis is seen in?
Women ages 20-45 and prepubertal children
Treatment for periorificial dermatitis?
D/C all topical steroids; tx with either topical or systemic abx; maybe topical NSAIDs
What is folliculitis?
follicular based papules on hear-bearing areas (trunk, thigh, buttocks, etc)
Most common cause of folliculitis?
Bacterial; Staph aureus (most common), streptococcus, pseudomonas
Which patients do you see eosinophilic folliculitis in?
HIV and transplant patients
Tx for folliculitis?
Abx soaps, topical abx
What is hidradenitis suppurativa?
chronic condition with formation of painful abscesses involving the apocrine gland bearing areas
Common places for hidradenitis suppurativa to occur?
axillary, inguinal, inframammary folds
Risk factors for hidradenitis suppurativa?
Being female, obesity, cigarettes, family hx
Pathogenesis of hidradenitis suppurativa?
Follicular keratin plugs cause hair follicle rupture–> follicle contents spilled into dermis–> local inflammation and abscess formation
Age when hidradenitis suppurativa presents?
Early 20s
