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msk-derm > Acne/Rosacea > Flashcards

Acne/Rosacea Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the four pillars of acne pathogenesis?

A

Follicular epidermal hyperproliferation that leads to excess sebum production, which feeds bacteria causing IL-1 inflammation and cutibacterium acnes overgrowth

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2
Q

What is the regulation of sebum production?

A

Regulated by androgens (testosterone, DHT) via androgen receptors from keratinocytes at follicle outer root sheath in the sebaceous gland basal layer

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3
Q

What are the contents of sebum?

A

Triglycerides, wax esters, squalene, cholesterol

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4
Q

What happens to sebum in acne vulgaris?

A

It acts as a nutrient source for bacteria, which converts triglycerides to free fatty acids

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5
Q

What bacteria that contributes to acne vulgaris is resident flora of follicles?

A

Cutibacterium acnes

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6
Q

What is the mechanism by which cutibacterium acnes promotes inflammation?

A

They promote inflammation, leading to antibodies that activate complement, produces lipases, proteases, hyaluronidases, and binds TLR2 to increase pro-inflammatory cytokines (IL1, 8, 12, TNFalpha)

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7
Q

What is this?

A

Closed comedone

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8
Q

What is this?

A

Open comedone (black head)

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9
Q

What is this?

A

Acne papule

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10
Q

What is this?

A

Acne pustule

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11
Q

What is this?

A

Acne nodules and cysts

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12
Q

What is this?

A

Acne sinus tracts

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13
Q

What are possible causes of drug-induced acne?

A

Dexamethasone, isoniazid

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14
Q

What is the most likely diagnosis?

A

Polycystic ovary syndrome

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15
Q

What is the most likely diagnosis?

A

Acne fulminans

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16
Q

What are treatments for acne?

A

Depends on severity. Mild cases are treated with topical retinoids, most severe cases are treated with oral isotretinoin.

17
Q

What is benzoyl peroxide used for?

A

It is an additive antimicrobial that does not allow for a resistance mechanism and is used in addition to oral antibiotics

18
Q

What is the mechanism of isotretinoin?

A

Reduced sebum production, decreased androgen synthesis, induces cell cycle arrest, apoptosis in sebocytes

19
Q

What are hormonal treatment options for acne?

A

Combination birth control pills that decrease LH and androgen production and spironolactone that is an androgen receptor blocker

20
Q

Who is most affected by acne rosacea?

A

Onset after age 30, higher female prevalance (but more severe in men)

21
Q

What is the pathogenesis of rosacea?

A

Neurovascular instability and increased reactivity (increased flushing/blushing), abnormalities in TLR2 signaling of innate immunity, inflammation of follicle/surrounding dermis

22
Q

What molecule is implicated in rosacea symptoms?

A

Cathelicidins

23
Q

What is the most likely diagnosis?

A

Erythematotelangiectatic rosacea

24
Q

What is the most likely diagnosis?

A

Papulopustular rosacea

25
Q

What is the most likely diagnosis?

A

Phymatous rosacea

26
Q

What is an important non-skin complication of rosacea?

A

Ocular rosacea - can lead to blindness

27
Q

What is the treatment for rosacea?

A

Topical and oral mediations that are antimicrobials

28
Q

What is the most likely diagnosis?

A

Periorificial dermatitis

29
Q

What is the treatment of periorificial dermatitis?

A

Topical and oral antimicrobials (not topical corticosteroids!)

30
Q

What is the most likely diagnosis?

A

Hidradenitis suppurativa

31
Q

What is hidradenitis suppurativa?

A

A disease with tender, red, draining nodules/abscesses that affects axillae, breasts, inguinal creases, buttocks, and perineum and has open comedones (frequently double comedones)

32
Q

What is the most likely diagnosis?

A

Hidradenitis suppurativa

33
Q

What is the treatment for hidradenitis suppurativa?

A

Weight loss/lifestyle

no great medications, maybe adalimumab

34
Q
A

msk-derm (41 decks)

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