ACNE VARIANTS

Question 1

Most common skin disorder of adolescence

Effects essentially 100% of the population

Can persist into adult life

Genetics unclear

Severe acne a little more common among males

Disorder of pilosebaceous unit

Highest concentration on the face, chest and back (seborrhic areas)

Sensitive to androgenic stimulation

Answer 1

Acne Vulgaris

Question 2

Increased androgens just prior to puberty

Sebaceous glands vary in sensitivity to androgens

Androgens cause gland to hypertrophy and produce more sebum

Abnormal keratinization of sebaceous follicle

Keratinocytes clump together and obstruct pore

Comedones

Contain melanin, not dirt

Sebum builds up behind comedone

Triglycerides hydrolyzed to fatty acids

Causes inflammation

Leads to red papules, nodules and pustules

Bacteria hydrolyze triglycerides, leading to more inflammation

Role of P. acnes

Bacterium also acts as a chemoattractant

Answer 2

Acne, found on the face, chest, back, buttocks

comedones
papules
nodules
pustules
scars
picking

Question 3

Most severe form of cystic acne WITH systemic symptoms

abrupt onset

osteolytic bone lesions, esp in the clavicle and sternum

isotretinoin induced but avoided with prednisone

Answer 3

Acne fulminans

Question 4

Severe, eruptive nodulocystic acne WITHOUT systemic symptoms

Follicular occlusion tetrad:
+ hidradenitis suppurativa, dissecting cellulitis,& pilonidal sinus/cysts

Answer 4

Acne conglobata

Question 5

Mechanical factors
Rubbing, helmets, chin straps etc.

Fiddler’s neck, young athletes (back, forehead, chin)

Linear, geometrically distributed involvement

Answer 5

Acne mechanica

Question 6

Young women

Self-mutilation and excoriation

Linear excoriations and crusts should be a clue

Psychiatric treatment

Answer 6

Acne excoriee

Question 7

Abrupt monomorphous of inflammatory papules

Common offenders:
Anabolic and corticosteroids, iodides, bromides, anticonvulsants

Less common offenders: PUVA, PTU, vitamins B1, B6, B12

Typically resolve with removal of offending agent

Answer 7

Drug-induced acne

Question 8

Neonatal cephalic pustulosis

Starts at 2 weeks of age, resolves by 3 months

Which organism is now implicated?
Malassezia furfur

Topical ketoconazole, BPO; parental reassurance BID

Answer 8

Neonatal acne

Question 9

Classify as infantile if in which age groups?
3-6 months

+++ comedones; may scar

Male infants = elevated LH and testosterone

Adrenal gland immaturity and a large zona reticularis lead to increased DHEAS

Usually resolves within 1-2 years
Tx: tretinoin, BPO
May require isotretinoin therapy

Answer 9

Infantile acne

Question 10

Cutting oils, petroleum products, etc.

Answer 10

occupational acne

Question 11

Chlorinated hydrocarbons

Malar, retroauricular, mandibular

Answer 11

chloracne

Question 12

PCOS…elevated total testosterone

Elevated DHEAS…indicates source in _______?

Answer 12

endocrine abnormalities

adrenal glands

Question 13

characterized by:

facial redness
bumps and pimples
skin thickening
eye irritation

*subtypes?

Answer 13

rosacea

*Erythemato-telangiectatic (Vascular)

Phymatous

Papulopustular (Inflammatory)

Ocular

Question 14

Perioral and periocular dermatitis often present in patients with vascular rosacea, but minimal malar inflamm

Small, pink papules, which often recur

Likely linked to rosacea

Same path, same treatments

Answer 14

Periorificial dermatitis

Question 15

What medications can help reduce the paradoxical flare upon corticosteroid withdrawal?

Answer 15

Doxycyclines, isotretinoin, and topical tacrolimus

Question 16

Stimulated by intense emotion/stress during waking hours

Increased neural impulses from cerebral cortex to eccrine glands

At least 6 months

two forms: volar*, axillary

Answer 16

Primary Hyperhidrosis

*most common