Acne & Hair (Wanat)

Question 1

This is the first lesion to occur in acne vulgaris, and occurs by the blockage of the pilosebaceous unit

Answer 1

comedones

Question 2

the relatively slow-growing, (typically) aerotolerant, anaerobic, gram-positive bacterium linked to the skin condition of acne

Answer 2

Propionibacterium acnes

*they produce lipases that split sebum triglycerides into glycerol and free fatty acids, which they use for their growth

Question 3

Which of the following statements is TRUE?

A. Acne scars exhibit alterations in collagen but do not contact inflammatory cell infiltrates

B. Follicular hyperkeratinization is the initial phenomenon observed in acne pathogenesis

C. Inflammatory acne lesions (papules, pustules) arise only from pre-existing comedones

D. IL-1 is released from keratinocytes and is thought to trigger follicular hyperkeratinization

E. Neutrophils are the initial leukocytes to infiltrate early acne lesions

Answer 3

D

A is incorrect: inflammatory cell infiltrates may persist after clinical resolution of acne lesions and have been detected in 77% of atrophic acne scars

B is incorrect: Follicular hyperkeratinization is preceded by an innate inflammation (cytokine production)

C is incorrect: studies have demonstrated that inflammatory acne vulgaris lesions arise from visibly uninvolved skin in approximately 28% of cases..

E is incorrect: in this case, studies of acne vulgaris have shown that lymphocytes (CD4+ t cells) and macrophages comprise the earliest responders in acne vulgaris lesions. Neutrophils come later (see diagram on slide 6)

Question 4

Which of the following is not a principle of acne therapy?

A. Correct defects in follicular keratinization

B. Decrease sebaceous gland activity

C. Reduce inflammation

D. Reduce population of P. acnes

E. All of the above are principles of acne therapy

Answer 4

E

Question 5

This is the most effective agent for severe inflammatory acne, treating all aspects of its pathophysiology, but is an extremely potent teratogen and may cause a variety of side effects including dryness, bone problems, hyperlipidemia, depression and IBD

Answer 5

Isotretinoin

Question 6

first line acne therapy for correcting defects in keratinzation

Answer 6

retinoids (+alph-hydroxy acids, + salicylic acid)

Question 7

first line acne therapy for reucing P. acnes population

Answer 7

benzoyl peroxide, which is a broad antimicrobial

(+azelaic acid, + topical antibiotics)

Question 8

intralesional corticosteroids, topical dapsone, and light therapy are all important therapeutics that address what particular component of acne therapy?

Answer 8

reducing inflammation

Question 9

this condition is caused by abnormal vasomotor lability, due to sun exposure that induces solar elastosis of the dermis leading to poor vascular support; it is most common in light skinned individuals and affects the central face

Answer 9

acne rosacea

Question 10

What clinical feature do you see in acne vulgaris but NOT in acne rosacea?

A. Comedone

B. Papule

C. Pustule

D. Cyst

E. Scarring

Answer 10

A

Question 11

Which of the following is not a characteristic associated with acne rosacea?

A. No comedones

B. Ocular involvement in half of individuals

C. Age of onset 30-50

D. Women more severely affected than men

E. Hypertrophy of sebaceous glands

Answer 11

D.

Women are more often affected, but less severely, than men

Question 12

Late stage of acne rosacea that results from lack of treatment, leading to severe hypertrophy of nasal and sebaceous glands and connective tissue

Answer 12

rhinophyma

*seen almost exclusively in men

Question 13

All of the following are important components of rosacea treatment EXCEPT:

A. Topical antibiotics

B. Systemic antibiotics

C. Corticosteroids

D. Isotretinoin

E. Sunscreen

Answer 13

C

Corticosteroids can induce rosacea and periorbital dermatitis - in general, no topical corticosteroid stronger than OTC 1% hydrocortisone should be used

Question 14

length of this phase determines how long a person can actually grow his/her hair

Answer 14

anagen

*it’s the longest pase of the hair cycle, lasting approximately 3 years

Question 15

All of the following conditions are associated with exclusively scarring forms of alopecia except which?

A. Discoid lupus

B. Tinea capitis

C. Neoplasia

D. Lichen planus

E. Cutaneous trauma

Answer 15

B

Tinea capitis may be scarring or non-scarring, depending on whether treatment of the inflammation occurs.

Question 16

hair loss brought on by an insult to the body causing an abrupt transition from anagen to telogen, which generally resolves in ~6 months

Answer 16

telogen effluvium

Question 17

t-cell mediated attack of hair bulbs (below), leading to patchy, generalized hair loss and may be associated with family history of autoimmune or thyroid diseases

Answer 17

alopecia areata

Question 18

Which of the following is NOT a treatment of alopecia areata?

A. Spironolactone

B. Allergic sensitization therapy

C. Intralesional corticosteroids

D. Topical minoxidil

E. Rogaine

Answer 18

A.

Spironolactone (like oral contraception pills) is a treatment for acne vulgaris, to reduce sebaceous gland activity by blocking androgen interactions with their receptors.

Question 19

This is an intense lymphocytic inflammation along the DEJ, attacking hair follicles, leading to inflammation, hyperpigmentation, patchy hair loss and scarring

Answer 19

discoid lupus

*this is the only form of lupus where scarring is observed.