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Year Two - Dermatology > Acne Vulgaris > Flashcards

Acne Vulgaris Flashcards

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Dermatology Board Prep flashcards
1
Q

What is acne vulgaris?

A

It is defined as a condition in which there is disorder of the pilosebaceous unit, characterised by pustules, papules and comedones

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2
Q

What is a pilosebacous unit?

A

It consists of a hair follicle and its associated sebaceous gland

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3
Q

What is the most common dermatological condition?

A

Acne Vulgaris

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4
Q

What is the pathophysiology of acne vulgaris?

A

There is follicular epidermal hyperproliferation – which results in the formation of a keratin plug

This keratin plug causes obstruction of the pilosebaceous unit

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5
Q

Acne vulgaris is multifactorial. What are the three pathophysiological factors that contribute to its development?

A

Increased sebum production due to androgenic hormones

Bacterial colonisation with Propionibacterium acnes

Increased inflammatory mediators due to innate immune system activation

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6
Q

What are the four classification of acne vulgaris?

A

Mild Acne Vulgaris

Moderate Acne Vulgaris

Severe Acne Vulgaris

Acne Fulminans

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7
Q

What is mild acne vulgaris?

A

It is defined as the formation of open and closed comedones with or without sparse papules and pustules

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8
Q

What is moderate acne vulgaris?

A

It is defined as the formation of widespread non-inflammatory lesions and several papules and pustules

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9
Q

What is severe acne vulgaris?

A

It is defined as the formation of extensive inflammatory lesions, including nodules, cysts and scarring

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10
Q

What is acne fulminans?

A

It is defined as a severe form of acne, which is associated with systemic upset

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11
Q

What are the three systemic clinical features associated with acne fulminans?

A

Malaise

Fever

Joint Pains

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12
Q

What is the management option of acne fulminans?

A

It usually requires hospital admission with oral steroids

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13
Q

What are the six risk factors associated with acne vulgaris?

A

Adolescent Age

Polycystic Ovarian Syndrome

Congenital Adrenal Hyperplasia

Topical Skin Products

High Glycaemic Index Foods

Drug Administration

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14
Q

What four drugs are associated with acne vulgaris?

A

Testosterone

Steroids

Antiepileptics

EGFR Inhibitors

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15
Q

How is polycystic ovarian syndrome, congenital adrenal hyperplasia, steroid/testosterone administration associated with acne vulgaris?

A

They cause excess androgen levels

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16
Q

What are the seven clinical features of acne vulgaris?

A

Comedones

Papules

Pustules

Nodules

Cysts

Scarring

Pigmented Macules

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17
Q

What are comedones?

A

They are blocked, dilated hair follicles

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18
Q

What are the two classifications of comedones?

A

Whiteheads

Blackheads

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19
Q

What are whiteheads?

A

They are defined as blocked hair follicles covered by skin

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20
Q

What are blackheads?

A

They are defined as blocked dilated hair follicles not covered by skin

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21
Q

What are papules?

A

They are defined as < 1cm, erythematous, solid inflammatory lesions

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22
Q

What are pustules?

A

They are defined as < 1cm, well-circumscribed, erythematous epidermal lesions filled with pus

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23
Q

What are nodules?

A

They are defined as > 1cm, well-circumscribed, erythematous epidermal lesions filled with pus

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24
Q

What are cysts?

A

They are defined as firm, encapsulated lesions containing fluid or fluid-like material

25
Q

What are the seven classifications of acne scars?

A

Ice Pick Scars

Box Scars

Saucer Scars

Anetoderma Scars

Atrophic Scars

Hypertrophic Scars

Keloid Scars

26
Q

What are pigmented macules?

A

They are defined as < 1cm in diameter spots, altered in colour, not raised and fade with time

27
Q

How is acne vulgaris diagnosed?

A

Clinically

28
Q

When are investigations used to diagnose acne vulgaris?

A

In cases where individuals present with persistent or unusual acne vulgaris

29
Q

What investigation is used to diagnose acne vulgaris?

A

A skin swab for microscopy and culture

30
Q

What is the first line management option of acne vulgaris?

A

Topical Therapies

It is recommended that single therapy is trialled, before stepping up to combination therapies

31
Q

What are the three topical therapies used to manage acne vulgaris?

A

Salicylic Acid

Benzoyl Peroxide

Retinoids

32
Q

When is salicylic acid used to manage acne vulgaris?

A

It is available without a prescription in cleansers and skincare products

33
Q

What is the mechanism of action of salicylic acid?

A

It is a keratolytic that unblocks pores by removing keratin plugs

34
Q

When is benzoyl peroxide used to manage acne vulgaris?

A

It is available without a prescription in in gel or wash formulations

35
Q

What is the mechanism of action of benzoyl peroxide?

A

It is an antibacterial agent

36
Q

When is topical retinoids used to manage acne vulgaris?

A

It is administered with a prescription

37
Q

How is it recommended that topical retinoids are applied?

A

They are administered in low strengths or for use on alternate days

This is due to the fact that it can be irritating to the skin due to the drying effect

38
Q

What is the mechanism of action of retinoids?

A

They inhibit sebum production, therefore reducing the likelihood of pore blockage

39
Q

What is a contraindication of topical reitnoids?

A

It is teratogenic, even when topical, and therefore contraindicated in those trying to conceive, pregnant or breastfeeding

40
Q

What is the second line management option of acne vulgaris?

A

Systemic Therapies

41
Q

What are the three systemic therapies used to manage acne vulgaris?

A

Tetracycline Antibiotics

Combined Oral Contraceptive Pill (COCP)

Isotretinoin

42
Q

When are tetracycline antibiotics used to manage acne vulgaris?

A

They are recommended to treat moderate acne

43
Q

Name four tetracyclines used to manage acne vulgaris

A

Lymecycline

Oxytetracycline

Doxycycline

Erythromycin

44
Q

How are tetracyclines used to manage acne vulgaris?

A

They are used due to their anti-inflammatory properties, rather than antibacterial

45
Q

What are the three contraindications of tetracycline antibiotics?

A

Pregnant

Breastfeeding Women

Children < 12 years Old

46
Q

What tetracycline antibiotic is not contraindicated in pregnancy?

A

Erythromycin

47
Q

What should tetracycline antibiotics be administered with? Why?

A

Topical Therapies

This is to reduce the risk of antibiotic resistance

48
Q

What is the maximum length of time that tetracycline antibiotics should be administered to manage acne vulgaris? Why?

A

3 months

This is due to the risk of gram-negative folliculitis

49
Q

How do we manage the development of gram-negative folliculitis?

A

High dose oral trimethoprim

50
Q

When is the COCP recommended to manage acne vulgaris?

A

It is recommended to treat moderate acne vulgaris in women, as an alternative to antibiotics

51
Q

How is COCP used to manage acne vulgaris?

A

It is used due to the fact that is contains cyproterone acetate and anti-androgenic progesterone

52
Q

What is another term for isotretinoin?

A

Roaccutane

53
Q

When is isotretinoin used to manage acne vulgaris?

A

It is recommended to treat severe acne vulgaris

It is particularly indicated in cases where acne is persistent, treatment resistant, cystic or scarring

54
Q

Who can administer isotretinoin?

A

It can only be administered by dermatologists and dispensed by hospital pharmacies

55
Q

What is the mechanism of action of isotretinoin?

A

It is used to reduce sebum production, reduce inflammation and induce remission

56
Q

What are the eight side effects of isotretinoin?

A

Teratogenicity

Depression

Dry Skin, Eyes, Lips & Mouth

Hair Thinning

Nose Bleeds

Intracranial Hypertension

Photosensitivity

Elevated Triglyceride Levels

57
Q

Due to the teratogenic effects of isotretinoin, what advice is given to women of childbearing age?

A

They should be using two forms of contraception - such as COCP and condoms

58
Q

What is the most common side effect of isotretinoin?

A

Dry Skin, Eyes, Lips & Mouth

Year Two - Dermatology (6 decks)

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