Acne & Rosacea -JKB Flashcards
Acne is a disease of what?
the philosebaceous unit
Do males or females have a higher chance of more severe forms of acne vulgaris?
males
What is the pathophysiology of acne vulgaris?
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
What is a closed comedone?
- “white head”
- white or skin colored papule
- obstructed follicle filled with cellular debris
What is an open comedone
- “black head”
- papule with dark center
- obstructed follicle with a dilated orifice
Which inflammatory lesion are the most likely to lead to scarring?
papules and pustules
obstructed hair follicle with surrounding inflammation
What are the characteristics of mild acne?
- Think non-inflammatory lesions only
- Open or closed comedones
- Low risk of scarring
What are the characteristics of moderate acne?
- more extensive comedonal disease than in mild acne
- inflammatory lesions: papules and pustules
What are the characteristics of severe acne?
- Nodulocystic lesions, often with scarring = severe
- Lesions can be seen alongside the other lesions (comedones, papules, and pustules)
What are treatment options for acne?
1) Topical Therapy
- Benzoyl peroxide
- Topical Antibiotics
- Salicyclic acid
2) Systemic Therapy
- Oral Abx
- Hormonal therapy
- Oral retinoids
3) Light or laser therapy?
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?
Erythromycin & Clindamycin (should be used with benzoyl peroxide)
What are topical retinoids derived from and what are their contraindications?
Retinoids = Vitamin A derivatives
contraindicated in pregnancy
How long does it take to see improvement of acne with antibiotic therapy?
2-3 months (patient compliance is important)
What are FDA approved hormonal therapy treatments for contraception and acne vulgaris?
- Norgestimate (ortho-tri cyclen)
- Drospirenone (Yaz)
- Norethindrone (Estrostep)
What is accutane (oral retinoid) indicated for?
severe or refractory inflammatory or nodulocystic acne
What are the characteristics of steroid acne?
-Sudden onset of follicular pustules and papules may occur 2 to 5 weeks after starting oral corticosteroids
What is acne mechanica?
acneiform eruption resulting from mechanical pressure
What is hidradenitis suppurativa?
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
Where is rosacea most commonly manifested, what population/gender?
- Typically manifested in the center of the face
- Celtic and Northern European origin
- More common in women > 30 y.o.
What are the 4 subtypes of Rosacea?
1) Erythematotelangiectactic rosacea
2) Papulopustular rosacea
3) Phymatous rosacea
4) Ocular rosacea
What are the characteristics of Erythematotelangiectatic rosacea?
- Recurrent episodes of facial flushing
- Persistent centrofacial erythema of the nose and medial cheeks
3) telangiectasias
4) roughness and scaling
5) skin sensitivity
What are the characteristics of papulopustular rosacea?
- presence of papules and pustules located in the central face
- no comedones
What are the characteristics of phymatous rosacea?
- Tissue hypertrophy
- Thickened skin with irregular contours
- oily skin
- adult men
- nose, chin, forehead, and cheeks
What are the characteristics of ocular rosacea?
- conjunctival hyperemia
- anterior blepharitis
- keratitis
- lid margin telangiectases
- abnormal tearing
- dry eye
What are treatment options for rosacea?
- Frequent skin moisturizing
- Gentle cleansing w/ lukewarm water
- avoid irritants
- sun protection (SPF30)
- Topical Agents (metronidazole and azelaic acid)
Can topical steroids be used as a treatment option for rosacea?
NO, they may aggravate rosacea
