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Dermatology Pathology > Acne, Rosacea, and Related Disorders > Flashcards

Acne, Rosacea, and Related Disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

***What are the 4 factors that contribute the the Pathogenesis of Acne?
***Where is the source of acne?

A

LOCATION = PILOSEBACEOUS UNIT
Four Factors:
1. Sebaceous gland Hyperplasia
2. Abnormal follicular desquamation (skin clogs the pore)
3. Propionibacterium acnes colonizes
4. Inflammation

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2
Q

****What is the hair follicle called once it gets blocked?
• ****Is this an inflammatory Lesion?
• ****two types of blockage?

A

**MICROCOMEDO (1st step)
• Non-inflammatory lesion

2 Types of Microcomedo:
• Blackhead => OPEN
• Whitehead => CLOSED

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3
Q

What lesions follow the formation of a Microcomedo?

A

Inflammatory Lesions:
• Red: papules, pustules, nodules, cysts

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4
Q

We rate acne on the basis of (a)_____________ and (b)_____________. what are the subsets of these categories?

A

(a) MORPHOLOGY
• Comedonal
• Inflammatory
• Mixed => Majority of Acne

(b) SEVERITY
• Mild
• Moderate
• Severe

**site and presence of scarring or post-inflammatory hypo/hyperpigmentation (PIH), and erythema may also be taken into account***

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5
Q

What is shown here?
• are these lesions inflammatory or non-inflammatory?

A

Left: Closed Comedones (whiteheads)
Right: Open Comedones (blackheads)

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6
Q

What is shown here?
• are these lesions inflammatory or non-inflammatory?

A

Left: Papules/Pustules
Right: Nodules

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7
Q

T or F: often acne is treated BOTH topically and systemically.

A

True

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8
Q

What Topical Tx is often used for acne?

A

OTC:
• Benzoyl Peroxide
• Salicylic acid

Prescription:
• Antimicrobials
• Retinoids
• Combination Products

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9
Q

What systemic Products are often used in the Tx of acne?

A

Systemic:
• Antibiotics
• OCPs
• Isotretinoin

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10
Q

What is the general use of Benzoyl peroxide and Salicylic acid in the treatment of acne?
• Which is most effective?

A

As monotreatments these are only good for very mild acne. Benzyoyl Peroxide is more effective than Salicylic acid

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11
Q

Benzoyl Peroxide:
• How does it work?
• Why do we use it adjunctively with abx?
• Side Effects?

A

MOA:
• Kills P. acnes
• Mild comedoLYTIC
• Mild-Antiinflammatory

Adjunctive Use:
• Limits the development of P. acnes antibiotic Resistance.

Side Effects:
• Irritation
• Bleaching
• ACD 1:500

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12
Q

What topical Abx are used in the Tx of acne?
• MOA?
• Side Effects?

A

Clindamycin and Erythromycin use in ACNE topically

MOA: Work as antibacterials AND anti-inflammatories
Both inhibit 50S bacterial subunit

Side Effects:
• Irritation
• C. Diff with Clindamycin possible

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13
Q

Why are TOPICAL ABX not recommended as monotherapy in Acne treatment?

A

Why no topical Clindamycin or Erythromycin as Topical Abx:
• SLOW ONSET
• RESISTANCE
• NOT COMEDOLYTIC (pts. won’t see instant results)

COMBINE these with Benzoyl Peroxide with works rapidly, prevents resistance, and is comedolytic

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14
Q

While Benzoyl Peroxide and Topical Abx are okay treatments, what is THE FIRST LINE THERAPY FOR ALL TYPES OF ACNE?
• why?
• Side effects?

A

TOPICAL RETINOIDS => 1st line therapy in ALL acne

WHY?

  • *1. Normalizes Follicular Desquamation
    2. Anti-inflammatory
    3. Enhances penetration of other compounds**

Side Effects:
• local irritation

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15
Q

***What are the topical retinoids used in the treatment of acne?
• list them from strong to weak?

A
  1. ADAPALENE
  2. TRETINOIN
  3. TAZAROTENE (pregnancy category X)
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16
Q

When should you perscribe systemic antibiotics to a patient with Acne?
• what is your end goal?

A
  • *Moderate - Severe Acne** should get systemic Abx.
  • *• end goal it to get them off the abx. and on maintenance with topical therapy**
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17
Q

What are the 1st choices of Systemic Abx. to give patients with Acne? (which 1st line drug is the best)
• 2nd line drugs?
• what is the side effect profile of these drugs?

A

1st line systemic tx:
• DOXYCYCLINE (preferred)- lower side effects: photosenstivity an esophagitis (take with water)

  • Minocycline: Dyspigmentation, lupus-like rxns, pseudoturmor cerebri, SJS, DHS
  • Tetracycline: GI upset, TOOTH staining

2nd line systemic tx:
• Erythromycin- GI Upset
• Bactrime

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18
Q

Who benefits from the use of oral contraceptives in acne treatment?

A

Females with moderate to severe acne that flares with periods are good candidates
• Anti-androgen effect suppresses sebum production

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19
Q

What are the indications for the use of Oral Retinoids in the treatment of Acne?
• why is the oral use of this drug so effective?

A

SEVERE, SCARRING or REFRACTORY acne

WHY SO EFFECTIVE SYSTEMICALLY?

  • Attacks ALL 4 phases of acne*
  • *1. Decreases Sebaceous Gland Size (90% red.)
    2. Normalizes Follicular Keratinization (prevents new comedones)
    3. Inhibits P. acnes
    4. Anti-inflammatory**
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20
Q

What side effects do we have to worry about in a patient that we are giving oral retinoids to?

A

DRYNESS RELATED SYMPTOMS
• lips, skin, eyes, nosebleeds
ACHES:
• Back, Muscle (athletes), head

SEVERE EFFECTS:
• Suicidal Ideation
• TERATOGENIC
• Skeletal Fractures
• Inflammatory Bowel Disease

21
Q

How would you treat the following types of acne:
• Mild Comedonal
• Mild inflammatory/Mixed
• Moderate inflammatory/Mixed
• Severe inflammatory

A

Note: inflammatory just means they are starting to get papules and pustules

22
Q

What would you give this patients for their acne?

A

This is severe mixed acne:

Minimal Scarring then:
• Topical Retinoid + topical antimicrobial + oral Abx

More Severe Scarring then:
• Isoretinoin

23
Q

What would you give this patient for her acne?

A

Mild Mixed Acne
Topical Retinoid + Topical Abx

24
Q

What would you give this patient for their acne?

A

Mild Closed Comedones

• Topical Retinoid

25
Q

What would you give this patient for his acne?

A

Isoretinoin (oral)

Minimal scarring probably not the case for this guy:
• Retinoid + Topical antimicrobial+ oral Abx

26
Q

What would you give this guy for his acne?

A

Mixed-Moderate Acne
• Oral Abx + Topical retinoid + topical Anti-microbial

27
Q

Your patient wants to continue to use their OTC ance face wash after beginning treatment for thier acne. Can they?

A

This is NOT RECOMMENDED because it can lead to overdrying and irritation of the skin

28
Q

What is the recommended basic skin care for acne?

A
29
Q

T or F: Acne is caused by poor hygiene or dirt

A

FALSE, but a high glycemic index diet and MILK may perpetuate acne

30
Q

Who is your typical patient that comes in with Rosacea?
• signs of rosacea?

A

A 1fair skinned 2women 3over 30 that has had 4**relapsing and remitting (chronic) bouts

Signs: Redness, Flushing, Pimples**

31
Q

What are 4 causes of ROSACEA?

A
  1. Inflammation
  2. Demodex folliculorum - MITE that lives in the skin
  3. Vascular Abnormalities => people who tend to flush
  4. Genetic
32
Q

What some Triggers of Rosacea?

A
  1. Sunlight
  2. Exercise
  3. Hot/Cold
  4. Stress
  5. Foods (spicy foods, hot coffee)
  6. EtOH
33
Q

What are the 4 types of Rosacea?
• key features of each?

A
  1. Erythematotelangiectatic (more flat and rash-like)
  2. Papulopustular (looks like acne)
  3. Phymatous (Giant nose)
  4. Ocular (Red eyes)
34
Q

What type of Rosacea is shown here?

A

Papulopustular - resemble acne

35
Q

What type of Rosacea is shown here?

A

Phymatous - often manifests in the nose causing enlargment

36
Q

What type of Rosacea is shown here?

A

Ocular - look how red the right eye is

37
Q

What type of rosacea is shown here?

A

Erythromatotelangiectatic - rash-like

38
Q

What are the Topical, Systemic, and invasive treatment options for these people?

A

Topical
• Metronidazole
• Azelaic Acid
• Sodium sulfacetamide with Sulfur

Systemic:
• Oral Tetracyclines

Other: IPL, Laser, Surgery

39
Q

What is this?
• who is most commonly affected?

A

Perioral Dermatitis:
• Affects Women 20-45 years old
• Perpubertal Children

40
Q

What are believed to be some of the causes of this condition?

A

Perioral Dermatitis Possible causes:
• Steroids
• OCP (oral contraceptive pills)
• Menstruation, pregnancy
• Fluorinate toothpaste
• Stress
• Candida, demodex mites

41
Q

What are the key features of the condition shown here?

A

Perioral Dermatitis
Key Features:
• NOSE, EYES, and LABIA often affected
• Papules, pustules, vesicles

42
Q

What is the treatment for Perioral Dermatitis?

A

#1 Discontinue ALL topical Steroids

Mild - topical abx
Severe - oral abx

NSAIDs can be used too

43
Q

What are the 3 most common causes of Folliculitis?
• where is it typically found?

A
  1. Staph aureus
  2. Streptococcus
  3. Pseudomonas

Typically found in:
• Hair Bearing Areas (no shit)

44
Q

What are some non-bacterial causes of folliculitis?

A

Fungal:
• Pityrosporum obiculare

Mites:
• Demodex folliculorum

Mechanical

Eosinophilic Folliculitis: HIV and Transplant pts.

45
Q

What is this?

A

Folliculitis - notice that it typically occurs prominently in areas of friction

46
Q

What is this?
• how would you treat it?

A

Folliculitis

Tx:
• Antibacterial soaps
• Topical antibiotics/antifungals

47
Q

HIDRADENTITIS SUPPRUATIVA (HS)
•what is it?
• who does it occur in?

A

Recurrent painful abscesses of apocrine gland bearing areas like AXILLA, INGUINAL, INFRAMAMMARY FOLDS causing formation of sinus tracts leading to chronic damage. This is most common in women but can be in either sex (most often after puberty).

48
Q

What risk factors are there for getting Hidradentitis Suppurativa?

A

Smoking
Obestity
Family Hx

49
Q

How do you treat this disease?

A

Hidradentitis Suppurativa (HS)

Mild:
• Topical and/or Oral antibiotics

Moderate to Severe:
• Intralesional Steroids, TNF-alpha inhibitors, Surgery

Dermatology Pathology (10 decks)

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