Acne & Rosacea

Question 1

Acne Fulminans

• Systemic signs?
• X-ray findings?

Answer 1

• leukocytosis, fever, arthralgia, myalgia

- lytic changes, sterile osteomyelitis, sternoclavicular joint and chest wall

Question 2

Industrial Acne (Chloracne)

• Locations
• Morphologies
• Most frequent cause

Answer 2

• Malar cheeks, postauricular scalp, scrotum
• Large comedones, inflammatory lesions, cysts
• Insoluble cutting oils

Question 3

Acneiform Eruptions

- Name oral agents

Answer 3

• halogens, bromides, iodide
• testosterone, ACTH, corticosteroids
• INH, lithium, erbitux, phenytoin, cyclosporine
• vitamins B2, B6, B12

Question 4

Which retinoid receptor is the most important one in the skin?

Answer 4

RARgamma

Question 5

Pregnancy category and subtypes

• tretinoin
• adapalene
• tazarotene
• bexarotene

Answer 5

• C, RARa/b/g
• C, RARb/g
• X, RARa/b/g, but selective for beta and gamma
• X, RXR

Question 6

Azelaic Acid

• mechanism of action
• pregnancy category

Answer 6

• weak activity against p. Acne

- inhibits tyrosinase

Question 7

Acne Treatment- Tetracyclines

• moa
• tetracycline: how to take it, risk
• risk of photosensitivity
• which one for renal pt?
• which one causes photo-onycholysis?

Answer 7

• inhibit rna-dependent protein synthesis by binding to bacterial 30s ribosomal subunit
• empty stomach, chelation by bi- and trivalent cations (calcium, bismuth, iron); children under 8 causes permanent brown teeth discoloration
• demecycline > doxycycline > tetracycline > minocycline
• doxycycline
• tetracycline

Question 8

Minocycline therapy

- associations

Answer 8

CNS symptoms (vertigo, HA), autoimmune hepatitis, drug-induced anti-histone ab positive SLE-like syndrome, hyperpigmentation

Question 9

Minocycline hyperpigmentation

- describe 3 types and path stains

Answer 9

• blue black: prior injury such as acne scars, stains for both iron (Perls) and melanin (Fontana Masson).
• blue grey: anterior lower legs and forearms, stains for both iron and melanin
• muddy brown: sun-exposed areas, least common, increased melanin at the basal layer and within macrophages

Question 10

Psoriasis Th1 or 2?

What kind of cytokines?

Answer 10

TH1, TNFalpha, IL-2

Question 11

Which HLA, name 5

Answer 11

HLA-B13
HLA-Bw57
HLA-B17 (earlier onset, more serious)
HLA-Cw6 (most definitive, RR 9-15x normal)
HLA-B27 (psoriatic arthritis, spondylitis)

Question 12

Woronoff Ring

Answer 12

Blanching around psoriatic lesion due to decrease in prostaglandin (PGE2)