Acne, Rosacea, Psoriasis Flashcards
Acne
-acne vulgaris- inflammatory disorder
-presence of open and closed comedones, pustules, nodules, papules, and cysts of the skin
-socially debilitating
-association with teenage depression
-mild moderate and severe
acne causes
-excess oil
-clogged hair follicles (hyperkeratinization and obstruction)
-bacteria (cutibacterium acnes-involved in pathogenesis-gram + rod)* -> C-acne*
-friction or pressure on skin (helmets cellphones tight collars) -> chin
-MC skin disorder
-often appears during changes of hormone levels (rise in androgen levels)
-also common in adults
-thick sebum gets trapped under -> clogs pores
-genetic component
-things that worsen, not cause…:
-stress
-chocolate!!
-diary
-certain oils found in hair and skincare
acne treatment
-MILD:
-OTC meds containing benzoyl peroxide - mainstay treatment** -> alcohol base (drying) -> breaks barrier
-salicylic acids
-sulfur
-azeleic acids
-retinols
-also RX meds containing more of above
-MODERATE TO SEVERE (RX plus):
-oral antibiotics-doxycycline, minocycline
-females-spironolactone (antiandrogenic)
-oral contraceptives
-isotretinoin- very high dose vitamin A -> thins sebum ONLY CURE
-most orals and topicals not used in pregnant or breast feeding women
oral antibiotic for acne: doxycycline
-sun sensitivity***
-upset stomach
-headache
-pseudotumor cerebri- excess water retention in brain (starts with headache) - RARE
oral antibiotic for acne: minocycline
-black stools
-diarrhea
-nausea/upset stomach
-headache
-blue/gray pigmentation of skin***
backne
-harder to treat (thicker skin)
-harder to reach
-stronger treatment
rosacea
-common disorder that mostly affects skin of face and eyes
-adults 30-50
-estimated 14 million people have disorder -> most dont know
-theories include -> microscopic skin mites, disorder of the blood vessels
-cause unknown
-flushing/telangiectasia, enlarged oil glands, pustules, and burning heat sensation
-diffuse erythema
-vessels that have come to the surface
-comodomes
-triggers!
rosacea: 3 stages
-1. flushing and diffuse redness
-2. add pustules papules and enlarged oil glands
-3. rhinophyma (most women dont progress to this stage) -> enlarged nose, folding
comedogenic
-pore clogging
-coconut oils
rosacea treatment
-cold compress
-Metronidazole- topical antibiotic*
-Azelaic acid
-Ivermectin
-Lasers- swells vessels -> stops blood flow - long term tx
-Topicals that reduce redness by constricting blood vessels
-Sodium Sulfacetamide for pustules- antibacterial, antinflammatory
-Oral antibiotics - doxy, minocycline lower doses -> antinflammatory without GI effects
–if you let it happen over and over -> vessels expand and you are always red
-Identify Triggers! -> alcohol, sunlight, heat, temperature change* chocolate, vinegar, spicy food
psoriasis
-Immune mediated disease characterized by inflammation caused by a disfunction of the immune system
-Overactive immune system speeds up skin cell growth
-Normal cells shed in about 28 days
-Psoriatic cells shed in about 4 days
-Plaques build up- harder to treat thick skin
-Burning, itching
-Most commonly found on the elbows, knees and scalp
-1/3 w/ psoriasis will also have Psoriatic Arthritis* - jack inhibitors
-silver
psoriasis S&S and mc variant
-Raised, Pink, Scale, Silvery Plaques**
-Extensor surfaces of elbows and knees but can be anywhere
-Variants- Vulgaris*, Pustular, Guttate (spares the palms and soles)
psoriasis treatment
-mild- topical steroids
-moderate- add UVB light, puva (makes you sensitive to light), descaler -> such as retin A, calcipotriene
-severe- methotrexate, biologics
-when psoriasis is diagnosed, look for signs of psoriatic arthritis and refer to rheumatologist accordingly
perioral dermatitis
-Common acneiform eruption
-Monomorphic papules, pustules around mouth and nose
-Pathogenesis unknown
-98% of the time caused by a topical cream or over exfoliating the skin in these areas -> tretinoin
-toothpaste, topical steroid or inhaled steroid use
perioral dermatitis treatment
-DC all topical creams
-non steroidal:
-Tacrolimus
-Pimecrolimus
-Topical erythromycin, clindamycin- can burn
-Metronidazole 1%*
-Sometimes miconazole with zinc (zinc soothes)
hidradenitis suppurativa
-chronic inflammatory follicular disorder of apocrine gland bearing skin
-axillae, skin folds, anogenital regions
-MC in women
-painful, persistent boil-like lesions
-follicular rupture release keratin and bacteria
-vigorous inflammatory response
-abscess and sinus tract formation with sometimes severe scarring
-TNF-a increase correlates with disease severity
-black heads
-sebaceous glands
hidradenitis suppurativa: comorbidity burden with:
-hypertension
-obesity*
-metabolic syndrome
-PCOS
-inflammatory bowel disease
-tobacco use
hidradenitis suppurativa treatment
-MILD-topical and oral antibiotics, intralesional steroid injections, oral antibiotics, spironolactone
-MODERATE- TNF (tumor) Inhibitors, dapsone, cyclosporine, oral retinoids, isotretinoin
-SEVERE- excisions and de-roofing
fungal infections- tinea
-Dermatophytes
-Closely resemble other skin infections
-Tinea- Latin word for worm
-Confirmation with KOH exam
tinea capitis: trichophyton tonsurans* (MC)
-Uncommon after puberty
-tinea of the head
-Areas of hair loss with broken hair fibers
-Danduff like grey scales with no alopecia
-pustules
-Can be spread from person to person contact, brushes, scissors and pillows
-Treat with oral Griseofulvin*, ketoconazole shampoo and oral steroids if significant hair loss is noted -> allows hair to grow
-oral antifungal
-Can be scarring
tinea corporis: trichophyton rubrum** (MC) pathogen
-ring worm
-tinea of body
-Annular lesion with central Clearing**
-Red scaly papule spreads outward
-Scaly slightly raised border
-wrestlers
-Widespread in immunocompromised and Diabetic patients
-Topical Antifungal medications
tinea
-Tinea Manuum- hands
-Tinea Cruris- inguinal folds
-Tinea Pedis- feet MOST COMMON TINEA
-Tinea Unguium- (aka Onychomycosis) nails
tinea versicolor- Malassezia furfur
-tan macule upper arms, chest, back
-fine powdery scales
-hypo hyperpigmented woodlight exam
-treat with 2.5% selenium sulfide, ketoconazole shampoo
-pigmentation problems resolve slowly
onychomycosis
-the nail plate is destroyed and replaced by mass of debris
-oral griseofulvin- 2nd line if other treatment fails
-laser
-topical treatment with ciclopirox- polish
-file down nail
candidiasis- candida albicans- yeast
-intertriginous areas and mucosal surfaces
-redness and itching
-warm moist environment
-BEEFY RED RASH
-moist erythematous plaques
-can show scaling and satellite pustules
-inframammary, axillary, abdominal folds, groin, and diaper area
-mouth- thrush
how to treat candidiasis
-depends on where
-on external skin keep areas dry
-anti fungal powders
-nystatin cream***
-oral- clotrimazole troches (swish), nystatin oral suspension, oral fluconazaole
dermatitis
-group of inflammatory skin disorders- ITCHING
-acute, sub acute or chronic
-Acute- Erythema, edema, vesicles
-Chronic- lichenification, fissures and scaling
-Endogenous, or exogenous
contact dermatitis: allergic
-Cell mediated type IV hypersensitivity reaction
-Specific contact with allergen in a sensitized individual
-Pruritic vesicles* or scaly lichenified plaques in areas of direct contact of allergen
-Patch Testing
contact dermatitis: irritant
-Most common
-Non immunologic response to chemicals or a physical agent
-vesicle
-Direct damage to keratinocytes
-Disrupts the skin barrier
-History*
-STOP OFFENDING IRRITANT*
atopic dermatitis- eczema
-chronic, pruritic, inflammatory skin condition
-NO VESSICLE (differential)
-Most have early onset in childhood
-Triad- asthma, allergic rhinitis and atopic dermatitis**
-Genetic, environmental and immunologic factors that lead to alterations of skin barrier
-Protein Fillaggrin is thought to play a role in some cases
-isolated gene mutation predisposing risk factor- other genes as well
-Immune dysregulation also plays a role
-pts with eczema are more susceptible to contact dermatitis: irritant
fliaggrin
-protein found in the skin
-Plays a crucial role in maintaining integrity of skin
-Deficiency of dysfunction can cause compromised barrier
-high fliaggrin - puffy water retention skin
-Water loss
-Involved in Natural moisturizing factor (NMF) production
-Increased dryness and increased susceptibility to irritants
atopic dermatitis
-Ill defined plaque with scale
-Yellow crusting
-Sparing of the nasal tip is common
-Clinical diagnosis but sometimes biopsy necessary
-Biopsy will show spongiosis, inflammatory cell infiltration within dermis
-Distribution varies-
-Babies- extensor surfaces
-Children and adults- flexoral
atopic dermatitis treatment
-Topicals- repair the barrier! Or keep it intact!
-Steroids
-Topical Calcineurin inhibitors tacrolimus, pimecrolimus
-Manage infections
-Bleach baths
-Immunosuppressants-cyclosporin, methotrexate
-Monoclonal antibody Dupilumab (Dupixant)
-Not oral steroids!
-Photo Therapy
monoclonal antibioties
-Target specific molecules in the immune system that are involved in the inflammatory response
-Dupilumab (Dupixant) 1st
-Blocks action of certain cytokines- interleukin 4(IL-4) Interleukin 13 (IL-13)
-Inhibition of these cytokines reduces inflammation
atopic dermatitis tx
-Moisturize
* Avoid Triggers- certain fabrics, detergents, extreme temperatures,
stress and certain foods
* Gentle skin care
* Water is the enemy!
* Avoid scratching- secondary infection
oral steroid risks
Increased risk of infections, especially with common bacterial, viral and fungal microorganisms. Bone fractures and thinning bones, called osteoporosis. Fatigue, loss of appetite, nausea and muscle weakness. Thin skin, bruising and slower wound healing
