Acne Vulgaris and Acne Rosacea Flashcards
Acne is a disorder of what?
a skin disorder of the pilosebaceous unit
basically the presence of at least 5-10 comedones
What is the classic presentation you should think of when you think of acne?
comedones - black heads (open) and white heads (closed)
Besides the comedones, what can happen on the skin in acne?
papules, pustules, and nodules (cystic)
What are 4 myths about acne?
- diet
- lack of bathing
- haristyles (bangs)
- cosmetics
….cause acne
Nope - they don’t
WHat causes neonatal acne?
Neonates have pilosebaceous units that are active at birth and may react to maternal hormones
WHen does acne typically start?
in puberty - often precedes menarche in girls by one year
When do the highest number of cases of acne occur?
in the mid-late teens (affecting more boys than girls at this point, but girls are more likely to have persistence into 20s and 30s)
WHat are the 4 issues in the pathophysiology of acne?
- Excessive sebum production
- Follicular plugging
- colonization of sebaceous follicle with bacteria
- immune response with inflammation
What bacteria colonizes sebaceous follicles most often?
propionibacterium acnes
What hormones stimulate sebum secretion from sebaceous glands?
adrenal androgens
however, people who have acne proabably have sebaceous glands that are hyperresponsibe to androgens - not an overproduction of androgens
What causes a follicle to be plugged?
excessive keratinization in the follicular canal
the desquamating cells stick together in the canal rather than flowing to the surface with sebum.
What is the main cause of the inflammation seen in acne?
the colonization with P. acnes
It hydrolyzes the sebum into free fatty acids which serve as the primary pro-inflammatory substances of acne
also the lipases, proteases and hyaluronidases leading to inflammation
WHat is the relationship between stress and acne?
acne may flare during periods of stress because stress increases the outpur of adhrenal steroids which affects the sebaceous glands
What are the 5 main meds that can trigger acne?
anabolic steroids
corticosteroids
isoniazid
lithium
phenytoin
In the classificaiton of acne, what do the following mean?
mild
moderate
severe
mild = presence of few to several papules and pustules, no nodules
moderate = several to many papules and pustules, along with a few to severel nodules
severe = numerous or estensive papules an dpustules, plus many nodules
Besides mild, moderate and severe, what is antother way we can classify acne?
comedonal
papulopustular
nodulocystic
(each can be subdivided into mild, moderate and severe)
How is acne graded?
grade 1: superficial non-inflammatory (comedones, flesh-colored papules, NO inflammation, NO pustules, NO nodules, NO scars)
grade 2: superficial inflammatory (open and closed comedones, inflammation, few to several papules/pustules, NO nodules, NO scars)
grade 3: deep inflammatory (moderate to severe, open and closed comedones, papules/pustules, few nodules, little to no scar present)
grade 4: severe nodulocystic (comdones, papeuls/pustules, extensive nodules, variable degree of scar)
WHere on the body does acne occur?
usually face
lesser degree on back, chest, shoulders, neck and upper arms
this is the highest concentraiton of pilosebaceous glands on the body
When should you do laboratory tests with a presentation of acne?
WHen you suspect hyperandrogenism
especially in women, check serume DHEAS, total testosterone, lutenizing hormone to follicle stimulating hormone ratio
What should be in the differential diagnosis of acne?
acne rosacea
gram-negative folliculitis
perioral dermatitis
steroid-induced acne
WHat are the 4 main arms of acne treatment?
local therapy
systemic therapy
hormonal therapy
physical therapy
What would be the first line of treatment for grade 1, superficial noninflammatory acne?
topical benzoyl peroxie, ropical retinoides, alpha hydroxy acids, salicylic acid, physician directed extraction
What additional treatment can be considered in grade 2, superficial inflammatory acne?
topical antibiotics
What additional treatments can start to be considered in grade 3, deep inflamatory acne?
oral antibiotics
intralesional cotricosteroid injections
hormone therapy
oral retinoids like oral isotretinoin
What additional therapy can be considered for grade 4, deep inflammatory with scarring acne?
incision and drainage
WHat vehicle is better for dry skin? For oily skin? Over hair bearing skin?
dry: creams
oily: gels or solutions
hear-bearing: lotions (and pretty much an skin type)
What are retinoids good for?
Best choise for anti-comedonal treatment
suppress inflammation
tretinin 9retin A) tazarotene (tazorac), adapalene (differing), isotretinoin gel
What oral antibiotics are often used for acne?
tetracycline
erythromcin
DOXYCYCLINE
MINOCYCLINE
clindamycin
trimethorpime/sulfamethoxazole (bactrim)
What are some hormonal therapies we can use to treat acne?
oral contraceptives - estrogens
glucocorticoids
anti-androgens like spironolactone and flutamide
What is the only medication to suppress acne over the long term (works on all four factors)?
isotretinoin
accutane
What is acne rosacea characterized by?
chronic and progressive dermatosis
erythema
papules/pustules
telengiectasis
potential hyperplasis over central portion of the face - esp nose
Who does acne rosacea most often affect?
middle aged adults
What are the causes of acne rosacea?
pretty unknown still
commonly thought to be vascular, but there seems to be a relationship with helicobacter pylori infection (maybe related to gastrin secretion which may stimulate flushing)
WHere does rosacea occur on the face?
you get the papules, pustules and telangiectasis in the central third of the face, sparing the lateral aspects of the forehead and cheeks
What is the treatment for acne rosacea?
antibiotics for the papular/pustular components - sually tetracycline or doxycycline
metronidazole (metrogel)
Azelaic acid gel (finacea)
corticosteroid lotion to reduce background erythema
What are the 2 major complications of rosacea?
rhinophyma (hyperplasia of the sebaceous glands, CT and vascular bed of the nose)
Ocular complications (blepharitis, conjunctivitis or keratosis
