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Acne & Rosacea 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?

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
What are signs of severe acne
-cysts and scarring are signs of severe acne
26
complications of acne
more often seen with severe acne - abx resistant P. acne - scarring - pigment changes
27
Problems with oral retinoids
- difficult to prescribe - teratogenic - legal issues - suicidal thought side effect
28
What is Rosacea
another chronic inflammatory pilosebaceous problem
29
what topical abx are used for acne tx
clindamycin & erythromycin
30
What systemic abs are used for acne?
tetracycline & erythromycin
31
What is rosacea sometimes called?
acne rosacea, adult acne
32
Main group affected by rosacea?
women, 30-50 yo, fair skinned & light eyed
33
Pathophys of rosacea, what happens/causes
Pilosebaceous units affected | -abnormalities caused by INCREASED activity of capillaries to certain areas of FACE
34
Clinical S/S of Rosacea
- episodic burning, stinging, flushing of skin - distribution: symmetric on cheeks, nose, chin, forehead - rarely seen on chest, back, scalp
35
Early to late Lesions in rosacea?
- flushing, telangiectasias, skin sensitivity - papulopustules & nodules, increased facial pores - hyperplasia, lymphedema, large inflammatory nodules with hypertrophy
36
telangiectasis
small dilated blood vessels on surface of skin
37
Large nodules with hypertrophy in rosacea are called?
-phyma | rhinophyma, blepharophyma, metophyma
38
Dx of rosacea
based on H & PE
39
acne vulgaris vs. rosacea (differences for dx)
- red cheeks with telangiectasis --> think Rosacea | - if comedones present, think Acne Vulgaris
40
nonpharmacologic tx of rosacea
- self management to avoid triggers | - avoid heat, hot beverages, wear sunblock, decreased stress & chemical irritation
41
Pharmacologic tx of rosacea are most useful to control what/
papules, pustules, erythema
42
Topical Meds used for rosacea
metronidazole
43
If topical meds for rosacea fail, use what?
oral abx - tetracyclines | -same as acne vulgarism b/c of anti-inflammatory effect
44
Severe rosacea use what?
accutane, maybe even surgery (for rhinophyma, telangiectasias etc)
45
complications/sequelae of rosacea
- self esteem and cosmetic issues | - blepharitis and keratitis can interfere with vision
46
Hidradenitis Suppurativa aka
acne inversa
47
Hidradenitis Suppurativa epidemiology
between puberty and menopause - more if obese, acne, or severe bacterial skin infection - strong FH
48
pathophys of Hidradenitis Suppurativa
apocrine gland areas (axilla, anogenital scalp) - involves abnormal hair follicle epithelium - idiopathic
49
clinical presentations Hidradenitis Suppurativa
primary leasions include: painful or tender erythematous papules, painful abscesses inflamed discharging papules or nodules -multiple lesions, bilateral, milk line
50
complications with Hidradenitis Suppurativa
scarring, fibrosis, contractures
51
pt treatment for Hidradenitis Suppurativa
- good hygiene - weight loss - warm compress - loose clothing
52
medical therapy for Hidradenitis Suppurativa
tetracycline (systemic antiinflammatory) - intralesional steroid injection (triamcinolone) - finasteride (antiandrogen) - biologic therapy TNF-a drugs
53
physical treatments for Hidradenitis Suppurativa
- -inject lesions with steroids - -I&D abscess - -excise sinus tract
54
Why is tetracycline so good for Hidradenitis Suppurativa
antiinflammatory and antibacterial | more importantly anti-inflammatory

Derm (8 decks)

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