Acne and Rosaea Lecture Powerpoint Flashcards
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___% of young adults have acne
85
Acne vulgaris is not a physically threatening condition, but rather affects patients….
…psychologically
Hormone that controls sebum production
Androgens
Acne vulgaris pathophysiology mech of action (also state the organism responsible for the condition)
-androgens drive sebum production -anormal desquamation obstructs the opening to the folliculosebaceous apparatus -intrafollicular bacteria proliferate (propionibacterium acnes) -proinflammatory mediators result in the development of an inflammatory lesion
Is acne caused by dirt or poor hygiene?
NO!
Is acne exaggerated by stress?
YES
Open comedones vs closed comedones
Black headed pimples come from open comedones resulting from oxidation darkening the color, while white heads come from closed comedones
Papules and pustules presentation in acne vulgaris and how are they different from comedones?
Erythematous papules or yellow pustules from obstructed hair follicle with surrounding inflammation more likely to scar (nodular presentation), they are different from comedones in the level of inflammation present
3 classifications of acne presentation
Mild - noninflammatory lesions only, low risk of scarring Moderate - more extensive comedones and inflammatory lesions Severe - Moderate but also spread to back and other parts of body (or distressing), or nodulocystic lesions with scarring
It is important to stress to the patient receiving acne treatment that…
…it can take at elast 6-8 weeks to notice significant improvement
Acne vulgaris treatment options (5)
-benzoyl peroxide -topical retinoids -salicylic acid (ASA) -oral antibiotics -hormonal therapy
Bonzoyl peroxide for acne treatment mech of action
-antibacterial thru oxidizing activity on proteins of P. acnes, and comedolytic to treat mild to moderate acne
Topical antibiotics (erythromycin, clindamycin) for acne treatment mech of action
Used alongside benzoyl peroxide to prevent antibiotic resistance, decreases total number of P. acnes organisms
Topical retinoids (vit A derivatives) for acne treatment mech of action
-normalizes desquamation of folicular epithelium preventing formation of new comedones and clearing existing ones
Topical retinoids are contraindicated in…
…pregnancy
Oral antibiotics (minocycline) for acne treatment mech of action and ADR
-indicated for moderate or severe acne that doesn’t respond to topical therapy by inhibiting the inflammatory process and decreases P. acnes colonization -vertigo is the big ADR with minocycline
Tetracyclines are contraindicated in…
…children under 8 or in pregnancy
Hormonal therapy (estrogens) for acne treatment mech of action
-used in females who have failed standard acne therapies or demonstrate hirsutism to inhibit androgen synthesis and thus decrease sebum production
Oral retinoids (accutane) for acne treatment mech of action
-reserved for severe or nodulocystic acne, acts as an analogue to vit. A and is a teratogen and pregnancy category X
Placing a patient on oral retinoids requires that they undergo a…
…risk management program
Acne at home skin care recommentations (3)
-use water based lotions and products opposed to oil which are comedogenic -do not pick at lesions -daily moisturizer when using drying topical products
Most common cause of treatment failure for acne vulgaris
lack of patient compliance
Steroid acne, mechanical acne, and perioral dermatitis
-occurs due to oral steroid ingestion and appears similar to acne -appears from rubbing of clothes and such -occurs in young women and resembles acne but may actually be rosacea
Hidradenitis suppurativa
Chronic suppurative subcutaneous process that occurs in areas of skin to skin contact (often in groin, axilla, parianal region) where follicle occlusion and sweating create abscesses that are not infectious, take a long time to diagnose
Rosacea
Chronic, idiopathic skin disorder with many manifestations but typically occuring at the center of the face in fair skinned individuals
4 main subtypes of rosacea
-erythematotelangiectatic rosacea -papulopustular rosacea -phymatous -ocular
Erythematotelangiectatic rosacea
Recurrent episodes of facial flushing of the nose or medial cheeks and telangiectasias on cheeks with skin stinging or burning in affected areas, most common form of it
Papulopustular rosacea
Presence of papules and pustules localized to the central face that may be mistaken for acne vulgaris but lacks COMEDONES as inflammation can extend beyond follicular unit
Phymatous rosaces
Causes tissue hypertrophy and thickened skin often in adult men on the nose, chin, forehead and cheeks and can be markedly disfiguring
Occular rosacea
A subtype of rosacea that occurs in over 50% of patients with other rosacea, will manifest with eye issues such as conjunctival hyperemia, foreign body sensations, or abnormal tearing
Rosacea diagnosis
Clinical assessment is sufficient
Rosacea treatments (3) and what is one to avoid
-metronidazole -skin moisturizer -cosmetic camoflage -avoid topical steroids as they aggrivate the condition
How do you distinguish papulopustular rosacea with acne vulgaris?
A lack of comedomes in papulopustular rosacea
What condition is this?
Sever acne
What condition is this?
Hidradenitis suppurativa
