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Dermatology for MCCQE1 (class #1) > Acne Vulgaris/Common Acne > Flashcards

Acne Vulgaris/Common Acne Flashcards

1
Q

Clinical Feature

A

a common inflammatory pilosebaceous disease categorized with respect to severity

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2
Q

Type I:

A

comedonal, sparse, no scarring

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3
Q

Type II:

A

comedonal, papular, moderate ± little scarring

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4
Q

Type III

A

comedonal, papular, and pustular, with scarring

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5
Q

Type IV:

A

nodulocystic acne, risk of severe scarring

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6
Q

sites of predilection

A

face, neck, upper chest, and back

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7
Q

Pathophysiology of the lesion

A

hyperkeratinization at the follicular ostia (opening) blocks the secretion of sebum leading to the
formation of microcomedones

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8
Q

Hormones Pathophysiology

A

androgens promote excess sebum production

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9
Q

Pathophysiology Bacteria

A

Cutibacterium acnes metabolize sebum to free fatty acids and produces pro-inammatory mediators

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10
Q

Epidemiology Age of onset

A

in puberty (10-17 yr in females, 14-19 yr in males)

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11
Q

in prepubertal children consider

A

underlying hormonal abnormality (e.g. late onset congenital adrenal
hyperplasia)

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12
Q

incidence

A

decreases in adulthood

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13
Q

genetic predisposition

A

majority of individuals with cystic acne have parent(s) with history of severe
acne

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14
Q

Differential Diagnosis

A

folliculitis, keratosis pilaris (upper arms, face, thighs), perioral dermatitis, rosacea

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15
Q

Management MILD ACNE:

A

Topical Therapies OTC.
Benzoyl peroxide (BPO)
Salicylic acid

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16
Q

Salicylic acid

A

Used when patients cannot tolerate a topical retinoid

due to skin irritation

17
Q

Benzoyl peroxide (BPO)

A

Helps prevent C. acnes resistance, is a bactericidal

agent (targets P. acnes) and is comedolytic

18
Q

Management MILD ACNE

A

Prescription Topical Therapies
Antimicrobials
Retinoids
Combination products

19
Q

Antimicrobials

A

Clindamycin (Dalacin T), Erythromycin

High rate of resistance when used as monotherapy

20
Q

Retinoids

A

Vitamin A Acid (Tretinoin, Stieva-A,
Retin A), Adapalene (Differin)

Backbone of topical acne therapy
All regimens should include a retinoid unless patient
cannot tolerate

21
Q

Combination products

A 
Clindoxyl (Clindamycin and BPO)
Benzaclin (Clindamycin and BPO)
TactuPump (Adapalene and BPO)
Biacna (Clindamycin and Tretinoin)
Benzamycine (BPO and Erythromycin
22
Q

Combination products Function

A

Allows for greater adherence and efficacy
Combines different mechanisms of action to increase
efficacy and maximize tolerability

23
Q

Management MODERATE ACNE

A

Tetracycline/Minocycline/Doxycycline
Cyproterone acetate-ethinyl estradiol
Spironolactone

24
Q

Tetracycline/Minocycline/

Doxycycline

A

Use caution with regard to drug interactions: do not use
with isotretinoin
Sun sensitivity
Antibiotics require 3 mo of use before assessing efficacy

25
Q

Cyproterone acetate-ethinyl

estradiol

A

Diane-35®
After 35 yr of age, estrogen/progesterone should only be considered in exceptional circumstances, carefully
weighing the risk/benefit ratio with physician guidance

26
Q

Spironolactone

A

May cause hyperkalemia if concurrent renal dx

Black box warning for breast cancer

27
Q

SEVERE ACNE management

A

Isotretinoin

28
Q

Isotretinoin.
Side Effects, courses.
Tests

A

Most adverse effects are temporary and will resolve when the drug is discontinued
Baseline lipid profile (risk of hypertriglyceridemia), LFTs and β-hCG before treatment
May transiently exacerbate acne before patient sees
improvement
Refractory cases may require multiple courses of
isotretinoin

29
Q

Treatment of Acne Scars

A 
Tretinoin creams
• Glycolic acid
• Chemical peels for superficial scars
• Injectable fillers (collagen, hyaluronic
acid) for pitted scars
• Fraxel laser
• CO2 laser resurfacing
30
Q

Blackheads (comedones) are black

because of

A

oxidized fatty acids, not dirt

31
Q

Acne Exacerbating Factors

• Systemic medications:

A

lithium, phenytoin,
steroids, halogens, androgens, iodides,
bromides, danazol

32
Q

Acne Exacerbating Factors Topical agents:

A

steroids, tars, ointments,

oily cosmetics

Dermatology for MCCQE1 (class #1) (35 decks)

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