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Derm1 > Acne/follicular D/O > Flashcards

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
Q

Isotretinoin approved indications

A

Nodular acne

Recalcitrant acne

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26
Q

Isotretinoin pt requirements/screening

A

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

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27
Q

Isotretinoin pt instructions

A 
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
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28
Q

Stop isotretinoin if

A

HA not relieved w/ tylenol
HA w/ visual change
Mood swings

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29
Q

Check what if pt taking isotretinoin and has HA?

A

Retina for Papilledema (pseduotumor cerebri)

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30
Q

Isotretinoin TXT plan

A

20wk course w/ q4 wk f/u

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31
Q

Pomade/cosmetica Acne morphology

A

Small non-inflammed papules and comedones in pts using products plugging pores (oils/creams)

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32
Q

Pomade/cosmetica Acne distro

A

Forehead
Temples
Sides of face
Spares sebaceous areas

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33
Q

Pomade/cosmetica Acne management

A 
Patience/diplomacy
Change habits
D/C products
ADD - tretinoin/Benzoyl peroxide
Inflamed lesions - topical ABX (No (PO))
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34
Q

Adult female acne presents

A

Women - mid 20’s - late 30’s
Hormonally sensitive - Menses flares
Occ. starts w/ pregnancy
Few TTP lesions that heal slowly

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35
Q

Adult female acne morphology

A

Very inflamed red papules/comedones

Occ. small non-scarring cyst

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36
Q

Adult female acne distro

A

Chin/jawline

occ. neck

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37
Q

Adult female acne management

A

OCP
Tretinoin - 2nd line
FAILs = > Erythromycin - enteric coated (anti-inflam)

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38
Q

Steroid acne distro?

A

MC on chest, neck, back (+- face/arms)

uniform symmetric

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39
Q

Steroid acne morphology?

A

Follicular papules/pustules

no scarring

40
Q

Steroid acne presents

A

Sudden onset 2-4wks post PO CCS TXT
Teens and adults
Often pruritic

41
Q

Steroid acne management

A

D/C CCS
Topical Benzoyl peroxide and/or sulfacetamide/sulfur lotion
Hydroxyzine or benadryl - PRN itch
Heals w/out scarring

42
Q

MC infectious folliculitis? organisms?

A

Staphylococcus Folliculitis

S. Aureus or S. Epidermidis

43
Q

Staphylococcus Folliculitis morphology

A

Lone/grouped small pustules w/ erythema

44
Q

Staphylococcus Folliculitis distro?

A

Lower Face or around nares

Chest or anywhere hair follicles are present

45
Q

Staphylococcus Folliculitis ass/w S/S

A

TTP
low grade fever
injury related - shaving accident
Occl. topical steroid complication

46
Q

persistent Staphylococcus Folliculitis may indicate?

A

Nasal carrier
Seed skin w/ contact - URI/Sinusitis
HCP and family

47
Q

Staphylococcus Folliculitis management

A 
isolated eruption - Erythromycin/diclox
recurrent/persistent
- Cephalexin
- Rifampin
- Bactroban
- Wash w/ Hibiclens
- Change linen daily
48
Q

Perioral dermatitis presents

A

MC young women (fair delicate skin)
Mild pruritic
recurrent

49
Q

Perioral dermatitis morphology/distro

A

Small papules/pustules that occ. are red/scaly

50
Q

Perioral dermatitis distro

A

Pustules on cheeks adjacent to nasolabial folds = important characteristic
Clear zone around vermillion border
Run along chin

51
Q

Perioral dermatitis management

A

Doxycycline
Top-Metronidazole (reduce papules - not as effective)
Hydrocortisone cream - inflammation (CCS CI > pimecrolimus cream)
D/C cosmetics

52
Q

Acne Rosacea etiology

A

Demodex folliculorum

53
Q

Acne Rosacea morphology

A 
Erythema
Telangiectasia
papules/pustules
Rhinophyma - Enlarged nose
Swelling of cheek/forehead
54
Q

Acne Rosacea pop?

A

Fair skinned people

Mid 30s-40s

55
Q

Acne Rosacea distro

A

Areas of more sebaceous acitivity

mid-face, eyelids, chin (severe

56
Q

Pt w/ Acne Rosacea is easily what?

A

Easily flushed - Vasodilation

ETOH, spicy/hot food/drink, emotions, sun

57
Q

Acne Rosacea management mild-mod

A

Metronidazole topical (mites)
Doxycycline, or Tetracycline, or Erythromycin
Sunscreen
avoid triggers

58
Q

Acne Rosacea management severe

A

Isotretinoin

Rhinophyma - surgery

59
Q

Acne Rosacea management resistant

A

Minocycline or Metronidazole (PO)

60
Q

Hidradenitis Suppurativa is?

A

Chronic supporative scarring dz of skin/SQ

61
Q

Hidradenitis Suppurativa etiology?

A

Fam Hx - scarring acne

Hyperkeratosis over apocrine glands 2/2 bacterial infection.

62
Q

Hidradenitis Suppurativa pop?

A 
20-50yo (always post puberty)
F >M
Obesity
Chronic
Painfully debilitating
63
Q

Hidradenitis Suppurativa distro

A

Axilla
Groin (anogenital - suprapubic/anal)
Under breasts

64
Q

Hidradenitis Suppurativa morphology

A

Erythema, cysts, abscesses
Double-comedone (>2 comm surface openings)
Scars alters dermis permanently (cord like bands)

65
Q

Hidradenitis Suppurativa mild dz management

A

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
Q

Hidradenitis Suppurativa extensive dz management

A

Surgical excision/grafts

Isotretinoin (questionable efficacy)

67
Q

Pseudofolliculitis Barbae Etiology

A

FOB Rxn causes inflammation

Chronic distortion of hair follicles

68
Q

Pseudofolliculitis Barbae morphology

A

Inflammation
Papules/pustules
Post-inflammatory hyperpigmentation
Scarring/keloids

69
Q

Pseudofolliculitis Barbae distro

A

Beard area
Axilla
Groin

70
Q

Pseudofolliculitis Barbae basic management

A

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
Q

Pseudofolliculitis Barbae Rx management

A

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
Q

Acne Keloidalis Nuchae is?

A

Chronic scarring folliculitis of men only

Black > White

73
Q

Acne Keloidalis Nuchae morphology

A

Same process/coexists w/ PFB

Nape more prone to keloid

74
Q

Acne Keloidalis Nuchae distro

A

Nape of neck at hairline

occ. scalp

75
Q

Acne Keloidalis Nuchae management

A 
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
Q

Epidermal inclusion Cyst etiology

A

Upper portion of follicle occluded and dysfx
Implants under epidermis due to trauma
Follicle filled w/ sebum and swells

77
Q

EIC morphology

A

Soft, Round, protruding, smooth-surface mass

Mobile

78
Q

EIC presents

A

Doesnt occur until puberty
MC w/ oily sebaceous skin
Fam Hx of acne or cysts
Asymptomatic > Intense inflammation

79
Q

EIC outcome

A

Non-inflamed EIC can spon resorb

Sometimes spon rupture externally

80
Q

EIC Management

A

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
Q

Milia morphology

A

Tiny white pea shaped epidermal cyst w/out openings
Solitary or multiple
Asymptomatic

82
Q

Milia etiology

A

response to sun damage or other physical trauma

83
Q

Milia distro

A

MC - face

Esp eyelids

84
Q

Milia Management

A

Solitary - incise over lesion - extract

multiple - Treinoin

85
Q

Miliaria Is known as?

A

Heat Rash or prickly heat

86
Q

Miliaria morphology

A

Multiple diffusely scattered 1mm papules/vesicles
Skin color = miliaria Crystallina
Red = miliaria Rubra

87
Q

Miliaria distro

A

Anywhere - esp Forehead, cheek, trunk

88
Q

Miliaria presents

A

Sweat retention - due to occlusion of eccrine gland
Common in babies 1wk post natal (over dressed)
Stinging or pruritic

89
Q

Miliaria TXT

A

Self limited
Remove warm environment
Cool compress
AH

90
Q

Pilar cyst aka

A

WEN

91
Q

Pilar cyst morphology

A

Multiple, firm, smooth mobile 1-3cm SQ cysts

92
Q

Pilar cyst S/S

A

Asymptomatic

93
Q

Pilar cyst diff from EIC how?

A

Keratinizes differently - produces a compact homogenous material that can calcify

94
Q

Pilar cyst distro?

A

MC - scalp

95
Q

Which is MC, EIC or Pilar cyst?

A

Pilar cyst

96
Q

Pilar cyst TXT

A

Excise

Derm1 (7 decks)

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