Acne & Rosacea

Question 1

What is the clinical presentation of acne vulgaris?

Answer 1

papular or pustular eruption on face, chest, and back. Can be comedonal or inflammatory or not.

Question 2

What are risk factors for acne vulgaris?

Answer 2

puberty, genetics, PCOS, makeup use, stress

Question 3

What’s the difference between inflammatory and non-inflammatory acne vulgaris?

Answer 3

non–inflammatory = open (black) or closed (white) comedones
inflamm = papules, pusutles, cysts

Question 4

How do you treat mild acne?

Answer 4

topical retinoids (NOT for pregnancy) - tretinoin, retinoic acid, adapalene, tazarotene
Use sunscreen!

Question 5

What’s your next step after treatment for mild acne?

Answer 5

try topical antibiotics - clindamycin or erythomycin AND BPO.

Question 6

How do you treat moderate acne?

Answer 6

systemic antibiotics - tetracyclines (recall that NO with renal disease, pregnancy, and <9 years of age), macrolides for pregnancy and children WITH BPO

Question 7

What should you consider for acne regarding alternative therapies?

Answer 7

oral contraceptives, limited corticosteroid use, antiadrogens (sprinolactone)

Question 8

How do you treat severe acne, including cystic, recurrent, or extremely painful?

Answer 8

oral isotretinoin WITH oral birth control

do not use with abx, as this increases your ICP

Question 9

What is the clinical presentation of perioral dermatitis?

Answer 9

acneiform like eruption around mouth. Pinpoint papules and pustules, sparing cheeks and forehead

Question 10

What is perioral dermatitis generally caused by and who is it more common in?

Answer 10

induced by topical steroid use, cosmetics, hormones… commonly in young women and children

Question 11

What’s the general treatment for perioral dermatitis?

Answer 11

discontinue ALL face creams – slow taper of steroidal creams

Topical antimicrobial/anti-inflammatory agents: metronidazole, azelaic acid, clindamycin, erythro

Question 12

What’s the treatment for severe perioral dermatitis?

Answer 12

PO tetracyclines sub-microbial dose. If children or pregnant = oral erythromycin
last resort = isotretinoin

Question 13

What is the clinical presentation of rosacea?

Answer 13

transient, recurrent, and persistent redness with triggers. non-comedonal rash, occasional telagiectasias, and commonly with a complication of rhinophyma

Question 14

In who is rosacea most commonly seen in?

Answer 14

30-60, fair skin, blue eyes, men

Question 15

What are lifestyle changes to help treat rosacea?

Answer 15

avoid hot/spicy foods, red wines, sunlight…use mineral based sunscreen, green tinted makeup. Keep face cool and minimize exposure

Question 16

What is the first line treatment for rosacea?

Answer 16

topical metronidazole cream, azelaic acid (safe for pregnancy), brimonidine gel

Question 17

What’s the treatment for more severe rosacea?

Answer 17

systemic antibiotics SUB MICROBIAL doxycycline, minocycline, tetracycline. Patients can consider laser, or surgery for rhinophyma

Question 18

What are the key symptoms of hidradenitis suppurativa?

Answer 18

blackheads (open comedones) with 2 openings “sinus tract”; boil-like nodules and abscesses that have pus-like discharge. Usually in interginious areas, MC in axilla

Question 19

What are risk factors of hidradenitis suppurativa?

Answer 19

females, genetics, obesity, smoking, inflammatory disorders

Question 20

What is the treatment for mild hidradenitis suppurativa?

Answer 20

topical clindamycin or PO doxycycline

Question 21

What is the treatment for moderate hidradenitis suppurativa?

Answer 21

oral tetracyclines or prolonged courses of antibiotics

Question 22

What is the treatment for severe hidradenitis suppurativa?

Answer 22

TNF inhibitors (-mabs) in high dose, with a combo clindamycin/rifampin. Surgery can help but this can reoccur.