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Acne/follicular D/O Flashcards

1
Q

Acne Vulgaris is?

A

Dz of pilosebaceous unit

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2
Q

Acne Vulgaris onset

A

Puberty

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3
Q

Acne Vulgaris morphology types

A

Non-inflam (open or closed comedones)

Inflammatory (Papules, pustules, or cysts/nodules)

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4
Q

Acne Vulgaris distro?

A

Sebaceous areas - Face, Chest, Back, Upper, Arms, groin

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5
Q

Acne Vulgaris pathophys

A

3- compenents

  • excess sebaceous gland secretion
  • Pilsosebaceous duct obstruction
  • Bacterial colonization/inflammation (P. Acnes)
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6
Q

Propionbacterium acne MOA

A

Breaks down sebum (chol/trig) to free fatty acids > causes irritation > inflammation

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7
Q

Acne Vulgaris basic management

A

Milds soap freq
Mild exfoliation - wash cloth, masks/peels, glycolic acid washes
Avoid occlusion (oil free or no make up, no hats)
Keep hands/hair off face
Avoid stress, caffeine, high sugar content

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8
Q

Acne Vulgaris Rx TXT Comedogensis

A 
Benzoyl peroxide
Salicylic acid
Azelaic acid
Alpha Hydroxy acid
Isotretinoin
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9
Q

Acne Vulgaris Rx TXT Sebum production

A

Antiandrogens - low dose OC

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10
Q

Acne Vulgaris Rx TXT inflammation

A

PO ABX

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11
Q

Acne Vulgaris Rx TXT P. Acnes

A

ABX

Benzoyl peroxide

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12
Q 
Acne Vulgaris Rx ultimate TXT acting on 
Comedogenesis
Sebum production
Inflammation
P. Acnes
A

Retinoids

Isotretinoin

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13
Q

Acne Vulgaris TXT philosphies

A

Most benign TXT 1st
Add TXTs one at a time
Wait 6-8waks for reeval

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14
Q

Acne Vulgaris TXT Comedogensis non-inflam process

A

1st - Retinoid - low/slow at bedtime (4-8wk)
2nd - add Benzoyl peroxide or topical ABX (Benzaclin - combo of both)
3rd - Increase Retinoid strength

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15
Q

Will comedones respond slowly or quickly to TXT?

A

Slowly

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16
Q

Acne Vulgaris TXT Comedogensis mild inflam process

A

1st - Retinoid and/or Benzoyl peroxide or top ABX
F/U - adjust PRN
2nd - Add Dozycycline or Tetracycline, or Minocycline
Age/Wgt adjust for 3month trial

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17
Q

Acne Vulgaris TXT Comedogensis mod-sev inflam process

A

1st - Topical ABX and Benzoyl peroxide
>10 pustules - start PO ABX (Doxy, TCN, Mino)
2nd - Topical retinoid
3rd - IL steroid injection for stubborn nodules (Triamcinolone)
FAILURE = culture pustules/cysts - ampicillin or Isotretinoin

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18
Q

Isotretinoin special considerations

A

Derm Rx only
Req IPLEDGE certification
Sig SE’s, teratogenic
Women CI if on OCP or Spironolactone

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19
Q

Acne Vulgaris TXT other options

A

Adapalene - 3rd gen topical retinoid
Azelaic acid
PO prednisone
Acne surgery

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20
Q

NoduloCystic Acne morphology

A 
Sig inflame
Papules/pustules
Cysts/Nodules
Scarring
Facial edema
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21
Q

NoduloCystic Acne presents

A

Family Hx - Male - Embarrased/psych

No response to typical treatmetns

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22
Q

NoduloCystic Acne distro?

A

Face, Neck, Chest, Back

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23
Q

NoduloCystic Acne management

A

Isotretinoin (PO)

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24
Q

Isotretinoin works on NoduloCystic Acne by?

A

Reducing size/activity of sebaceous gland

Normalizing keratinization

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25
Isotretinoin approved indications
Nodular acne | Recalcitrant acne
26
Isotretinoin pt requirements/screening
6 months of F/U and pt reliablity D/C Tetracycline >4wks prior and all topicals Labs - CBC, UA, LFTs, Lipids, HCG (review prior) RPT all before next visit - HCG Q/mo + 1mo post D/C Hx/Fam hx of colitis Req two forms of OCP D/C all vitamins
27
Isotretinoin pt instructions
``` Lubrication of eyes/lips Bactroban - nose Oil free moisturizer and sunscreen No blood donation aware of mood swings Freq F/U and discuss SE's Low fat diet (decrease lipids) Avoid ETOH No more than 1 month supple to Childbearing aged W ```
28
Stop isotretinoin if
HA not relieved w/ tylenol HA w/ visual change Mood swings
29
Check what if pt taking isotretinoin and has HA?
Retina for Papilledema (pseduotumor cerebri)
30
Isotretinoin TXT plan
20wk course w/ q4 wk f/u
31
Pomade/cosmetica Acne morphology
Small non-inflammed papules and comedones in pts using products plugging pores (oils/creams)
32
Pomade/cosmetica Acne distro
Forehead Temples Sides of face Spares sebaceous areas
33
Pomade/cosmetica Acne management
``` Patience/diplomacy Change habits D/C products ADD - tretinoin/Benzoyl peroxide Inflamed lesions - topical ABX (No (PO)) ```
34
Adult female acne presents
Women - mid 20's - late 30's Hormonally sensitive - Menses flares Occ. starts w/ pregnancy Few TTP lesions that heal slowly
35
Adult female acne morphology
Very inflamed red papules/comedones | Occ. small non-scarring cyst
36
Adult female acne distro
Chin/jawline | occ. neck
37
Adult female acne management
OCP Tretinoin - 2nd line FAILs = > Erythromycin - enteric coated (anti-inflam)
38
Steroid acne distro?
MC on chest, neck, back (+- face/arms) | uniform symmetric
39
Steroid acne morphology?
Follicular papules/pustules | no scarring
40
Steroid acne presents
Sudden onset 2-4wks post PO CCS TXT Teens and adults Often pruritic
41
Steroid acne management
D/C CCS Topical Benzoyl peroxide and/or sulfacetamide/sulfur lotion Hydroxyzine or benadryl - PRN itch Heals w/out scarring
42
MC infectious folliculitis? organisms?
Staphylococcus Folliculitis | S. Aureus or S. Epidermidis
43
Staphylococcus Folliculitis morphology
Lone/grouped small pustules w/ erythema
44
Staphylococcus Folliculitis distro?
Lower Face or around nares | Chest or anywhere hair follicles are present
45
Staphylococcus Folliculitis ass/w S/S
TTP low grade fever injury related - shaving accident Occl. topical steroid complication
46
persistent Staphylococcus Folliculitis may indicate?
Nasal carrier Seed skin w/ contact - URI/Sinusitis HCP and family
47
Staphylococcus Folliculitis management
``` isolated eruption - Erythromycin/diclox recurrent/persistent - Cephalexin - Rifampin - Bactroban - Wash w/ Hibiclens - Change linen daily ```
48
Perioral dermatitis presents
MC young women (fair delicate skin) Mild pruritic recurrent
49
Perioral dermatitis morphology/distro
Small papules/pustules that occ. are red/scaly
50
Perioral dermatitis distro
Pustules on cheeks adjacent to nasolabial folds = important characteristic Clear zone around vermillion border Run along chin
51
Perioral dermatitis management
Doxycycline Top-Metronidazole (reduce papules - not as effective) Hydrocortisone cream - inflammation (CCS CI > pimecrolimus cream) D/C cosmetics
52
Acne Rosacea etiology
Demodex folliculorum
53
Acne Rosacea morphology
``` Erythema Telangiectasia papules/pustules Rhinophyma - Enlarged nose Swelling of cheek/forehead ```
54
Acne Rosacea pop?
Fair skinned people | Mid 30s-40s
55
Acne Rosacea distro
Areas of more sebaceous acitivity | mid-face, eyelids, chin (severe
56
Pt w/ Acne Rosacea is easily what?
Easily flushed - Vasodilation | ETOH, spicy/hot food/drink, emotions, sun
57
Acne Rosacea management mild-mod
Metronidazole topical (mites) Doxycycline, or Tetracycline, or Erythromycin Sunscreen avoid triggers
58
Acne Rosacea management severe
Isotretinoin | Rhinophyma - surgery
59
Acne Rosacea management resistant
Minocycline or Metronidazole (PO)
60
Hidradenitis Suppurativa is?
Chronic supporative scarring dz of skin/SQ
61
Hidradenitis Suppurativa etiology?
Fam Hx - scarring acne | Hyperkeratosis over apocrine glands 2/2 bacterial infection.
62
Hidradenitis Suppurativa pop?
``` 20-50yo (always post puberty) F >M Obesity Chronic Painfully debilitating ```
63
Hidradenitis Suppurativa distro
Axilla Groin (anogenital - suprapubic/anal) Under breasts
64
Hidradenitis Suppurativa morphology
Erythema, cysts, abscesses Double-comedone (>2 comm surface openings) Scars alters dermis permanently (cord like bands)
65
Hidradenitis Suppurativa mild dz management
D/C smoking (major trigger) Mainstay - Longterm ABX (TCN, E-mycin, Docy, mino) hot compresses I/D large cysts/abscesses Intralesional steroid injections (smal cysts)
66
Hidradenitis Suppurativa extensive dz management
Surgical excision/grafts | Isotretinoin (questionable efficacy)
67
Pseudofolliculitis Barbae Etiology
FOB Rxn causes inflammation | Chronic distortion of hair follicles
68
Pseudofolliculitis Barbae morphology
Inflammation Papules/pustules Post-inflammatory hyperpigmentation Scarring/keloids
69
Pseudofolliculitis Barbae distro
Beard area Axilla Groin
70
Pseudofolliculitis Barbae basic management
Modify shaving techniques - hydrate/soften beard - brush hair, with tooth brush/warm wash cloth - wash w/ BnzP - GLycolic acid or aveeno shaving cream in place 5m - shave w/ grain - bump fighter razor
71
Pseudofolliculitis Barbae Rx management
Top ABX after shave (PO ABX if pustules form/persist) Retin-A cream Add -- -Medicated after shave lotion -temp profile (no greater than 1/4 inch, no styles) -Laser hair removal
72
Acne Keloidalis Nuchae is?
Chronic scarring folliculitis of men only | Black > White
73
Acne Keloidalis Nuchae morphology
Same process/coexists w/ PFB | Nape more prone to keloid
74
Acne Keloidalis Nuchae distro
Nape of neck at hairline | occ. scalp
75
Acne Keloidalis Nuchae management
``` No short/shaved haircuts If pustular or exudative - Cx and ABX (TCN 3-6mo) 3 step plan for control otherwise 12 mo -Topical Clindamycin -Fluocinonide -Tretinoin (D/C steroid after 3-6mo) Laser therapy/excise ```
76
Epidermal inclusion Cyst etiology
Upper portion of follicle occluded and dysfx Implants under epidermis due to trauma Follicle filled w/ sebum and swells
77
EIC morphology
Soft, Round, protruding, smooth-surface mass | Mobile
78
EIC presents
Doesnt occur until puberty MC w/ oily sebaceous skin Fam Hx of acne or cysts Asymptomatic > Intense inflammation
79
EIC outcome
Non-inflamed EIC can spon resorb | Sometimes spon rupture externally
80
EIC Management
Asymptomatic - no TXT (or cosmetically acceptable) noninflamed lesion Excise - 11 blade along skin line Inflamed cyst - Intralesional Inj Triamcinolone (excise) Ruptured inflamed cyst - Excise after I/D
81
Milia morphology
Tiny white pea shaped epidermal cyst w/out openings Solitary or multiple Asymptomatic
82
Milia etiology
response to sun damage or other physical trauma
83
Milia distro
MC - face | Esp eyelids
84
Milia Management
Solitary - incise over lesion - extract | multiple - Treinoin
85
Miliaria Is known as?
Heat Rash or prickly heat
86
Miliaria morphology
Multiple diffusely scattered 1mm papules/vesicles Skin color = miliaria Crystallina Red = miliaria Rubra
87
Miliaria distro
Anywhere - esp Forehead, cheek, trunk
88
Miliaria presents
Sweat retention - due to occlusion of eccrine gland Common in babies 1wk post natal (over dressed) Stinging or pruritic
89
Miliaria TXT
Self limited Remove warm environment Cool compress AH
90
Pilar cyst aka
WEN
91
Pilar cyst morphology
Multiple, firm, smooth mobile 1-3cm SQ cysts
92
Pilar cyst S/S
Asymptomatic
93
Pilar cyst diff from EIC how?
Keratinizes differently - produces a compact homogenous material that can calcify
94
Pilar cyst distro?
MC - scalp
95
Which is MC, EIC or Pilar cyst?
Pilar cyst
96
Pilar cyst TXT
Excise

Derm1 (7 decks)

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