Acne, Rosacea, Hidradenitis Suppurativa

Question 1

What is Acne?
Who is M/C affected?
Where is it commonly located?

Answer 1

• Inflammatory disorder of the pilosebaceous unit (hair follicle + sebaceous gland)
• M/C age 12-24
• Face, chest, back, shoulders, upper arms

Question 2

What are key contributing factors of Acne (patho)?

Answer 2

• Micro-comedones (white heads = open, black heads = closed)
• Follicular hyperkeratinization
• Increased sebum production
• Cutibacterium acnes
• Inflammation

Question 3

RF for Acne?

Answer 3

• Genetics
• Diet (dairy, sugary foods)
• Stress
• Insulin resistance

Question 4

What medications (often used in combo) are good to treat Acne?

Answer 4

• Cleansers like Benzoyl Peroxide
• Topical abx like Minocycline
• Topical retinoids like Tretinoin or Adapalene
• Oral abx like Doxy or Minocycline
• Oral retinoids like Isotretinoin (Acutane)

Question 5

What must the pt do before starting and while taking Isotretinoin?
What are common side effects of Isotretinoin?

Answer 5

• Register for Ipledge (2 forms of birth control) + 2 negative pregnancy tests before starting
• Monthly labs (CBC, CMP, Lipid panel, Beta HCG)
• SE: dry skin, cracked lips, bloody nose, sun sensitivity, joint pain, depression

Question 6

T/F: Isotretinoin is teratogenic

Answer 6

True!!!! –> causes birth defects and spontaneous abortion

Question 7

What is Roseacea? Characteristic features?
Who is m/c affected?

Answer 7

• Chronic inflammatory disorder affecting blood vessels and pilosebacious unit
• Flushing, T-zone erythema, telangiectasias
• M/C in skin types 1-3 (fairer), 40-50 y/o

Question 8

RF for Rosacea?
Triggers?

Answer 8

• Steroid induced rosacea d/t abrupt d/c after long-term use, Mites, UV radiation, Genetics
• Extreme temp, Sun exposure, Hot drinks, Spicy foods, ETOH, Exercise, Stress, Drugs, etc.

Question 9

How do you treat Rosacea?

Answer 9

• Doxy!
• Metronizadole cream
• Pulse dye laser for telangiectasias
• Alpha adrenergic agonists for flushing

Question 10

What is Hidradenitis Suppurativa?
What is it associated with?

Answer 10

• Chronic inflammatory disorder primarily of apocrine-gland bearing body areas (axilla, groin, perianal, perineal, inframammary) d/t follicular occlusion
• Associated with smoking and obesity

Question 11

What are the main clinical features of Hidradenitis Suppurativa?

Answer 11

• Double comedones
• Recurrent inflamed tender nodules
• Sinus tracts (draining skin tunnels)
• Severe scarring

Question 12

What staging is used to classify Hidradenitis Suppurativa?

Answer 12

Hurley Staging (I-III)

Question 13

How do you treat Hidradenitis Suppurativa?

Answer 13

• Avoid friction, Weight loss
• I&D
• Intralesional steroids for discomfort
• Topical/Oral abx if bacterial infection