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Derm > Acne & Rosacea > Flashcards

Acne & Rosacea Flashcards

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Dermatology Board Prep flashcards
1
Q

What is Acne

A

(Acne Vulgaris)

-an inflammatory disorder, involving the pilosebaceous apparatus (hair follicles and associated glands)

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2
Q

When does acne occur (age)

A

any age, most often adolescents

-often clears at maturity

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3
Q

What is acne a problem with?

A

Pilosebaceous apparatus

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4
Q

Pathophys of Acne - what happens?

A
  • androgens activate pilosebaceous gland-> increases keratinocytes & sebum
  • hair follicles plug withkeratinocytes which cases sebum retention
  • P. acnes bacteria overgrow in gland and irritating fatty acids are released
  • get a foreign body reaction to sebum & develop inflammation
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5
Q

What is the end problem of acne that causes the reaction?

A

foreign body reaction to sebum and develop inflammation

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6
Q

primary lesion of acne

A

Comedone = acne vulgaris = sebum & keratin from hair follicle

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7
Q

Types of comedones

A

Blackheads - open &filled with debris

Whiteheads - closed, flesh colored center

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8
Q

Secondary lesions of acne?

A

Comedone can become:

-papules, pustules, deep nodules, cysts

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9
Q

Diagnosis of acne is based on what

A

clinical, based on history and PE

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10
Q

When would you use a blood test to dx acne?

A

Wouldn’t typically unless female with facial hair, bad acne, no menses
-(might have too much testosterone, but rare)

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11
Q

which type of acne is more likely to need treatment?

A

inflammatory acne

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12
Q

classifications of acne

A
  • there are many

- most important is inflammatory vs. noninflammatory

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13
Q

Nonpharmacological tx of acne

A
  • mostly pt. education: don’t pop (infection), no oils, don’t over scrub
  • use mild soap only if helps oily skin
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14
Q

pharmacologic treatment of acne

A
  • depends on severity & type of lesion

- start conservative

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15
Q

How long does it take to see improvement with acne tx?

A

4-6 weeks

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16
Q

Initial Comedonal acne tx

A

start with topical treatment like benzoyl peroxide (start low and gradually increase dose)
-max dose 10% 2x/day

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17
Q

If initial comedonal tx doesn’t work

A
  • continue benzoyl peroxide
  • topical retinoids or abx
    - only retinoids reduce the number of new lesions

-all three may be needed

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18
Q

what does benzoyl peroxide do?

A

removes plug, opens pores

-doesn’t prevent new comedonal formation

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19
Q

Mild Papular inflammatory acne treatment

A

topicals, usually start with abx and add benzoyl peroxide if needed

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20
Q

moderate papular inflammatory treatment

A
  • oral abx (tetracyxlines/erythromycin)

- taper dose of oral abs and add topical treatment

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21
Q

What is a problem with topical & oral retinoids

A

teratogenic

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22
Q

What treatment will reduce the number of new comedonal lesions?

A

retinoids

23
Q

Papular inflammatory acne treatment in females

A

-consider hormones with estrogen and anti-androgens

24
Q

Severe Papular (cystic & nodular) inflammatory acne treatment

A
  • treat aggressively to minimize scarring

- oral & topical abx AND oral retinoids

25
Q

What are signs of severe acne

A

-cysts and scarring are signs of severe acne

26
Q

complications of acne

A

more often seen with severe acne

  • abx resistant P. acne
  • scarring
  • pigment changes
27
Q

Problems with oral retinoids

A
  • difficult to prescribe
  • teratogenic
  • legal issues
  • suicidal thought side effect
28
Q

What is Rosacea

A

another chronic inflammatory pilosebaceous problem

29
Q

what topical abx are used for acne tx

A

clindamycin & erythromycin

30
Q

What systemic abs are used for acne?

A

tetracycline & erythromycin

31
Q

What is rosacea sometimes called?

A

acne rosacea, adult acne

32
Q

Main group affected by rosacea?

A

women, 30-50 yo, fair skinned & light eyed

33
Q

Pathophys of rosacea, what happens/causes

A

Pilosebaceous units affected

-abnormalities caused by INCREASED activity of capillaries to certain areas of FACE

34
Q

Clinical S/S of Rosacea

A
  • episodic burning, stinging, flushing of skin
  • distribution: symmetric on cheeks, nose, chin, forehead
  • rarely seen on chest, back, scalp
35
Q

Early to late Lesions in rosacea?

A
  • flushing, telangiectasias, skin sensitivity
  • papulopustules & nodules, increased facial pores
  • hyperplasia, lymphedema, large inflammatory nodules with hypertrophy
36
Q

telangiectasis

A

small dilated blood vessels on surface of skin

37
Q

Large nodules with hypertrophy in rosacea are called?

A

-phyma

rhinophyma, blepharophyma, metophyma

38
Q

Dx of rosacea

A

based on H & PE

39
Q

acne vulgaris vs. rosacea (differences for dx)

A
  • red cheeks with telangiectasis –> think Rosacea

- if comedones present, think Acne Vulgaris

40
Q

nonpharmacologic tx of rosacea

A
  • self management to avoid triggers

- avoid heat, hot beverages, wear sunblock, decreased stress & chemical irritation

41
Q

Pharmacologic tx of rosacea are most useful to control what/

A

papules, pustules, erythema

42
Q

Topical Meds used for rosacea

A

metronidazole

43
Q

If topical meds for rosacea fail, use what?

A

oral abx - tetracyclines

-same as acne vulgarism b/c of anti-inflammatory effect

44
Q

Severe rosacea use what?

A

accutane, maybe even surgery (for rhinophyma, telangiectasias etc)

45
Q

complications/sequelae of rosacea

A
  • self esteem and cosmetic issues

- blepharitis and keratitis can interfere with vision

46
Q

Hidradenitis Suppurativa aka

A

acne inversa

47
Q

Hidradenitis Suppurativa epidemiology

A

between puberty and menopause

  • more if obese, acne, or severe bacterial skin infection
  • strong FH
48
Q

pathophys of Hidradenitis Suppurativa

A

apocrine gland areas (axilla, anogenital scalp)

  • involves abnormal hair follicle epithelium
  • idiopathic
49
Q

clinical presentations Hidradenitis Suppurativa

A

primary leasions include: painful or tender erythematous papules, painful abscesses inflamed discharging papules or nodules
-multiple lesions, bilateral, milk line

50
Q

complications with Hidradenitis Suppurativa

A

scarring, fibrosis, contractures

51
Q

pt treatment for Hidradenitis Suppurativa

A
  • good hygiene
  • weight loss
  • warm compress
  • loose clothing
52
Q

medical therapy for Hidradenitis Suppurativa

A

tetracycline (systemic antiinflammatory)

  • intralesional steroid injection (triamcinolone)
  • finasteride (antiandrogen)
  • biologic therapy TNF-a drugs
53
Q

physical treatments for Hidradenitis Suppurativa

A
  • -inject lesions with steroids
  • -I&D abscess
  • -excise sinus tract
54
Q

Why is tetracycline so good for Hidradenitis Suppurativa

A

antiinflammatory and antibacterial

more importantly anti-inflammatory

Derm (8 decks)

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