Acne & Rosacea Flashcards
What is Acne
(Acne Vulgaris)
-an inflammatory disorder, involving the pilosebaceous apparatus (hair follicles and associated glands)
When does acne occur (age)
any age, most often adolescents
-often clears at maturity
What is acne a problem with?
Pilosebaceous apparatus
Pathophys of Acne - what happens?
- 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
What is the end problem of acne that causes the reaction?
foreign body reaction to sebum and develop inflammation
primary lesion of acne
Comedone = acne vulgaris = sebum & keratin from hair follicle
Types of comedones
Blackheads - open &filled with debris
Whiteheads - closed, flesh colored center
Secondary lesions of acne?
Comedone can become:
-papules, pustules, deep nodules, cysts
Diagnosis of acne is based on what
clinical, based on history and PE
When would you use a blood test to dx acne?
Wouldn’t typically unless female with facial hair, bad acne, no menses
-(might have too much testosterone, but rare)
which type of acne is more likely to need treatment?
inflammatory acne
classifications of acne
- there are many
- most important is inflammatory vs. noninflammatory
Nonpharmacological tx of acne
- mostly pt. education: don’t pop (infection), no oils, don’t over scrub
- use mild soap only if helps oily skin
pharmacologic treatment of acne
- depends on severity & type of lesion
- start conservative
How long does it take to see improvement with acne tx?
4-6 weeks
Initial Comedonal acne tx
start with topical treatment like benzoyl peroxide (start low and gradually increase dose)
-max dose 10% 2x/day
If initial comedonal tx doesn’t work
- continue benzoyl peroxide
- topical retinoids or abx
- only retinoids reduce the number of new lesions
-all three may be needed
what does benzoyl peroxide do?
removes plug, opens pores
-doesn’t prevent new comedonal formation
Mild Papular inflammatory acne treatment
topicals, usually start with abx and add benzoyl peroxide if needed
moderate papular inflammatory treatment
- oral abx (tetracyxlines/erythromycin)
- taper dose of oral abs and add topical treatment
What is a problem with topical & oral retinoids
teratogenic
What treatment will reduce the number of new comedonal lesions?
retinoids
Papular inflammatory acne treatment in females
-consider hormones with estrogen and anti-androgens
Severe Papular (cystic & nodular) inflammatory acne treatment
- treat aggressively to minimize scarring
- oral & topical abx AND oral retinoids
What are signs of severe acne
-cysts and scarring are signs of severe acne
complications of acne
more often seen with severe acne
- abx resistant P. acne
- scarring
- pigment changes
Problems with oral retinoids
- difficult to prescribe
- teratogenic
- legal issues
- suicidal thought side effect
What is Rosacea
another chronic inflammatory pilosebaceous problem
what topical abx are used for acne tx
clindamycin & erythromycin
What systemic abs are used for acne?
tetracycline & erythromycin
What is rosacea sometimes called?
acne rosacea, adult acne
Main group affected by rosacea?
women, 30-50 yo, fair skinned & light eyed
Pathophys of rosacea, what happens/causes
Pilosebaceous units affected
-abnormalities caused by INCREASED activity of capillaries to certain areas of FACE
Clinical S/S of Rosacea
- episodic burning, stinging, flushing of skin
- distribution: symmetric on cheeks, nose, chin, forehead
- rarely seen on chest, back, scalp
Early to late Lesions in rosacea?
- flushing, telangiectasias, skin sensitivity
- papulopustules & nodules, increased facial pores
- hyperplasia, lymphedema, large inflammatory nodules with hypertrophy
telangiectasis
small dilated blood vessels on surface of skin
Large nodules with hypertrophy in rosacea are called?
-phyma
rhinophyma, blepharophyma, metophyma
Dx of rosacea
based on H & PE
acne vulgaris vs. rosacea (differences for dx)
- red cheeks with telangiectasis –> think Rosacea
- if comedones present, think Acne Vulgaris
nonpharmacologic tx of rosacea
- self management to avoid triggers
- avoid heat, hot beverages, wear sunblock, decreased stress & chemical irritation
Pharmacologic tx of rosacea are most useful to control what/
papules, pustules, erythema
Topical Meds used for rosacea
metronidazole
If topical meds for rosacea fail, use what?
oral abx - tetracyclines
-same as acne vulgarism b/c of anti-inflammatory effect
Severe rosacea use what?
accutane, maybe even surgery (for rhinophyma, telangiectasias etc)
complications/sequelae of rosacea
- self esteem and cosmetic issues
- blepharitis and keratitis can interfere with vision
Hidradenitis Suppurativa aka
acne inversa
Hidradenitis Suppurativa epidemiology
between puberty and menopause
- more if obese, acne, or severe bacterial skin infection
- strong FH
pathophys of Hidradenitis Suppurativa
apocrine gland areas (axilla, anogenital scalp)
- involves abnormal hair follicle epithelium
- idiopathic
clinical presentations Hidradenitis Suppurativa
primary leasions include: painful or tender erythematous papules, painful abscesses inflamed discharging papules or nodules
-multiple lesions, bilateral, milk line
complications with Hidradenitis Suppurativa
scarring, fibrosis, contractures
pt treatment for Hidradenitis Suppurativa
- good hygiene
- weight loss
- warm compress
- loose clothing
medical therapy for Hidradenitis Suppurativa
tetracycline (systemic antiinflammatory)
- intralesional steroid injection (triamcinolone)
- finasteride (antiandrogen)
- biologic therapy TNF-a drugs
physical treatments for Hidradenitis Suppurativa
- -inject lesions with steroids
- -I&D abscess
- -excise sinus tract
Why is tetracycline so good for Hidradenitis Suppurativa
antiinflammatory and antibacterial
more importantly anti-inflammatory
