Acne Vulgaris Flashcards
Acne vulgaris is a chronic inflammatory disease of pilosebaceous unit ( hair follicle and its associated oil gland). Which of the following can occur as a result of acne vulgaris?
1 - comedones (black head)
2 - inflammation (erythema)
3 - pustules
4 - all of the above
4 - all of the above
- pustule refers to a small, pus-filled cutaneous lesion that can develop anywhere on the body but is more common on the face, chest, and back.
Acne vulgaris is one of the most common skin conditions in the world. Which age group accounts for almost 80% of all cases?
1 - babies
2 - teenagers
3 - adults
4 - older adults
2 - teenagers
- linked to peak in hormones during puberty
- can also affect all ethnicities
Androgens are steroid hormones that act as agonist on androgen receptors. Which of the following is the most common androgen?
1 - testosterone
2 - bicalutamide
3 - dihydrotestosterone
4 - apalutamide
1 - testosterone
Sebum is produced by the pilosebaceous glands. Which of the following are pilosebaceous glands NOT typically found in high amounts on the body?
1 - face
2 - back
3 - soles of feet
4 - chest
3 - soles of feet
Seborrhoea is the term used to describe excessive production of sebum from the sebaceous glands. Is this increased production of sebum due to high, low or normal levels of plasma androgens?
- normal levels of plasma androgens
- patients susceptible to acne vulgaris have excessive sebum despite normal plasma androgens
Comedones or comedogenesis are hallmarks of acne vulgaris. What are Comedones more commonly known as?
1 - cyst
2 - abscess
3 - white/black heads
4 - fistula
3 - white/black heads
- comedogenesis = abnormal proliferation and differentiation of ductal keratinocytes, which is linked to androgen
- black heads = open comodones
- white heads = closed comodones
Colonisation of the pilosebaceous duct can occur in acne vulgaris. What bacteria causes this colonisation that results in inflammation?
1 - cutibacterium acnes
2 - staphylococcal
3 - streptococcus
4 - candida albicans
1 - cutibacterium acnes
Hormonal factors play an important role in patients acne vulgaris. Which time of a woman’s menstrual cycle accentuates patients acne vulgaris?
1 - immediately before period
2 - day 15 of periods
3 - day 21 of period
4 - immediately before and during first few days of period
4 - immediately before and during first few days of period
Which of the following conditions, if present, has been linked to patients having the worst acne vulgaris symptoms?
1 - Coeliac disease
2 - Polycystic Ovarian Syndrome (PCOS)
3 - Gout
4 - Endometriosis
2 - Polycystic Ovarian Syndrome (PCOS)
- oil based cosmetics have also been linked to acne
Although only a loose association, what diet has been suggested to be helpful in alleviating acne symptoms?
1 - vegan
2 - low fat
3 - low glycemic
4 - gluten free
3 - low glycemic
There is a large list of drugs that have been linked to causing acne. Which of the following well known drugs has been linked?
1 - ACI-I
2 - bisoprolol
3 - aspirin
4 - prednisolone
4 - prednisolone
When patients present with acne vulgaris, is this always inflammatory?
- no, can be non-inflammatory and cause comedones
- if inflammatory leads to papules, pustules, pseudocysts and nodules
Which 2 of the following are typically present in a patient who has inflammatory acne vulgaris?
1 - pustules
2 - scales
3 - wheals
4 - papules
1 - pustules
- white/yellow pus filled tip
4 - papules
- solid inflamed bumps with no white/yellow tip
- can become pustules
Called Papulopustular acne
BOTH OF THESE ARE RAISED AND INFLAMED SKIN LESIONS
Which 2 of the following can present in a patient who has inflammatory acne vulgaris?
1 - nodules
2 - scales
3 - cysts
4 - wheals
1 - nodules
- deep lesions
3 - cysts
- deep fluid filled lesions
Called Nodulocystic acne
Secondary lesions (caused by primary lesions) of acne vulgaris can include all of the following EXCEPT which one?
1 - excoriations (picked spots)
2 - scars
3 - pigment changes
4 - fistulas
4 - fistulas
- atrophic - Ice-pick / rolling / boxcar
- hypertrophic /
- keloidal scars can occur in anyone, but more common in people with darker skin colour
Do patients with darker skin colour typically present with the same levels of inflammation associated with acne?
- yes
- but harder to see on their skin, but may see post hyperpigmentation
What is pomade acne typically caused by?
1 - hair products
2 - food types
3 - excessive exercise
4 - all of the above
1 - hair products
- typically more common in those of skin colour due to cultural differences
The severity of acne is graded on the number of lesions, ranging from mild, moderate to severe. What is the number of lesions that would mean a patient has moderate acne?
1 - <5
2 - <30
3 - 30-125
4 - >125
3 - 30-125
- mild = <30
- severe = >125
At what age does acne clear up by?
1 - >16
2 - >20
3 - >30
4 - >40
2 - >20
- can persist into the 4th decade of life
Are the scars caused by acne always caused by scratching?
- no
- can be, but may also be due to inappropriate treatment
Which of the following is NOT a pharmaceutical management option in acne?
1 - exercise
2 - phycological assessment (depression)
3 - avoid triggers (pomade, oily products)
4 - treat as per the severity of the acne
1 - exercise
Which is the only treatment option of the following used for mild acne?
1 - biologics
2 - topical creams
3 - oral antibiotics
2 - topical creams
- Azelaic acid (has antibacterial properties)
- Topical antibiotics, clindamyacin
- Topical retinoid (apply only at night due to photosensitive effect). Increase duration of keeping the topical on the skin
- Benzoyl peroxide (2, 5, 10%)
Which of the following are 1st treatment options if a patient has moderate acne?
1 - biologics
2 - topical creams
3 - oral antibiotics
3 - oral antibiotics
First-line:
Lymecycline 408 mg OD or
Doxycycline 100 mg OD
Second-line:
Clarithromycin 250-500 mg BD
Trimethoprim 300 mg BD
Erythromycin500mg BD
Oral antibiotics are typically used to treat moderate acne. Which 2 of the following are contraindicated in pregnant women and children <12 y/o?
1 - Lymecycline
2 - Doxycycline
3 - Clarithromycin
4 - Erythromycin
1 - Lymecycline
2 - Doxycycline
Oral antibiotics are typically used to treat moderate acne. Typically how long are they given a prescription for?
1 - 1 week
2 - 3 weeks
3 - 1 month
4 - 3 months
4 - 3 months
Which of the following is one of the most effective treatments for treating severe acne?
1 - azelaic acid
2 - clindamyacin
3 - isotretinoin
4 - benzoyl peroxide
3 - isotretinoin
- must be taken with food
- causes initial flare, then improve (can consider commencing with short course of oral prednisolone, or erythromycin)
Duration: cumulative dose 120-150mg/kg, versus clearance for 1-2months
Isotretinoin is one of the most effective treatments for treating severe acne. Which vitamin is this a derivative of?
1 - A
2 - B
3 - D
4 - K
1 - A
- HIGHLY teratogenic
Indication:
- severe acne
- recalcitrant acne
- risk of acne scarring
Contraindicated:
- Pregnancy and lactation
- Women of childbearing potential unless all of the conditions of Pregnancy - Prevention Programme are met
Hepatic insufficiency,
Hyperlipidemia
Allergic to peanut /soya
No blood donation
Isotretinoin is one of the most effective treatments for treating severe acne. Which of the following are common side effects of Isotretinoin?
1 - dryness and skin fragility
2 - muscle/joint pains
3 - abnormal LFTs/fasting lipids
4 - hair loss
5 - depression
6 - photosensitivity
7 - all of the above
7 - all of the above
Which 2 of the following are treatment options for severe acne?
1 - Combined oral contraceptive pills (COCPs)
2 - Spironolactone
3 - Amitriptyline
4 - Bumetanide
1 - Combined oral contraceptive pills (COCPs)
- lower oestrogen content (20 mcg)
2 - Spironolactone
Children <12 y/o:
Clarithromycin, Erythromycin
Topicals
Which 2 of the following can a pregnant women with acne use?
1 - Isotretinoin
2 - benzoyl peroxide preparations
3 - 2% topical erythromycin
4 - lymecycline
2 - benzoyl peroxide preparations
3 - 2% topical erythromycin
