Acne & Rosacea -JKB

Question 1

Acne is a disease of what?

Answer 1

the philosebaceous unit

Question 2

Do males or females have a higher chance of more severe forms of acne vulgaris?

Answer 2

males

Question 3

What is the pathophysiology of acne vulgaris?

Answer 3

1) sebum production
2) abnormal desquamation obstructs opening to the folliculosebaceous apparatus
3) intrafollicular bacteria proliferate
4) Proinflammatory mediators result in the development of inflammatory lesions

Question 4

What is a closed comedone?

Answer 4

• “white head”
• white or skin colored papule
• obstructed follicle filled with cellular debris

Question 5

What is an open comedone

Answer 5

• “black head”
• papule with dark center
• obstructed follicle with a dilated orifice

Question 6

Which inflammatory lesion are the most likely to lead to scarring?

Answer 6

papules and pustules

obstructed hair follicle with surrounding inflammation

Question 7

What are the characteristics of mild acne?

Answer 7

• Think non-inflammatory lesions only
• Open or closed comedones
• Low risk of scarring

Question 8

What are the characteristics of moderate acne?

Answer 8

• more extensive comedonal disease than in mild acne

- inflammatory lesions: papules and pustules

Question 9

What are the characteristics of severe acne?

Answer 9

• Nodulocystic lesions, often with scarring = severe

- Lesions can be seen alongside the other lesions (comedones, papules, and pustules)

Question 10

What are treatment options for acne?

Answer 10

1) Topical Therapy
- Benzoyl peroxide
- Topical Antibiotics
- Salicyclic acid
2) Systemic Therapy
- Oral Abx
- Hormonal therapy
- Oral retinoids
3) Light or laser therapy?

Question 11

What topical antibiotics can be used to treat acne, and what should it be used in conjunction with to prevent the development of antibiotic resistance?

Answer 11

Erythromycin & Clindamycin (should be used with benzoyl peroxide)

Question 12

What are topical retinoids derived from and what are their contraindications?

Answer 12

Retinoids = Vitamin A derivatives

contraindicated in pregnancy

Question 13

How long does it take to see improvement of acne with antibiotic therapy?

Answer 13

2-3 months (patient compliance is important)

Question 14

What are FDA approved hormonal therapy treatments for contraception and acne vulgaris?

Answer 14

• Norgestimate (ortho-tri cyclen)
• Drospirenone (Yaz)
• Norethindrone (Estrostep)

Question 15

What is accutane (oral retinoid) indicated for?

Answer 15

severe or refractory inflammatory or nodulocystic acne

Question 16

What are the characteristics of steroid acne?

Answer 16

-Sudden onset of follicular pustules and papules may occur 2 to 5 weeks after starting oral corticosteroids

Question 17

What is acne mechanica?

Answer 17

acneiform eruption resulting from mechanical pressure

Question 18

What is hidradenitis suppurativa?

Answer 18

chronic, suppurative subcutaneous process resulting from occlusion of follicles, secondary inflammation, and sometimes infection of pilosebaceous and apocrine glands
-Occurs in areas where there is skin-to-skin contact

Question 19

Where is rosacea most commonly manifested, what population/gender?

Answer 19

• Typically manifested in the center of the face
• Celtic and Northern European origin
• More common in women > 30 y.o.

Question 20

What are the 4 subtypes of Rosacea?

Answer 20

1) Erythematotelangiectactic rosacea
2) Papulopustular rosacea
3) Phymatous rosacea
4) Ocular rosacea

Question 21

What are the characteristics of Erythematotelangiectatic rosacea?

Answer 21

• Recurrent episodes of facial flushing
• Persistent centrofacial erythema of the nose and medial cheeks
  3) telangiectasias
  4) roughness and scaling
  5) skin sensitivity

Question 22

What are the characteristics of papulopustular rosacea?

Answer 22

• presence of papules and pustules located in the central face
• no comedones

Question 23

What are the characteristics of phymatous rosacea?

Answer 23

• Tissue hypertrophy
• Thickened skin with irregular contours
• oily skin
• adult men
• nose, chin, forehead, and cheeks

Question 24

What are the characteristics of ocular rosacea?

Answer 24

• conjunctival hyperemia
• anterior blepharitis
• keratitis
• lid margin telangiectases
• abnormal tearing
• dry eye

Question 25

What are treatment options for rosacea?

Answer 25

• Frequent skin moisturizing
• Gentle cleansing w/ lukewarm water
• avoid irritants
• sun protection (SPF30)
• Topical Agents (metronidazole and azelaic acid)

Question 26

Can topical steroids be used as a treatment option for rosacea?

Answer 26

NO, they may aggravate rosacea