Acne Vulgaris/Rosacea Flashcards
Inflammatory disease of pilosebaceous unit
acne vulgaris
Ages for acne
Neonatal d/t maternal hormones
Puberty (early)
Mid to late teens most common
And later… especially for women
Pathophysiology of acne
Excessive sebum production
** Follicular plugging
Colonization of seb. follicle w/ Propionibacterium acnes
Immune response w/ inflammation
Causative agent most acne
Propionibacterium acnes
Open comedo
blackhead
Closed comedo
whitehead
Grade 1 Acne
superficial non-inflammatory
open/closed comedones
Flesh colored papules
NO inflammation, pustules, nodules, scars
Grade 2 acne
superficial inflammatory open/closed comedones inflammation Papules/pustules - few to several NO nodules/scars
Grade 3 acne
Deep inflammatory Moderate to severe open/closed comedones Papules/pustules Few nodules Little to no scar present
Grade 4 acne
Severe nodulocystic Deep/inflammatory open/closed comedones papules/pustules extensive nodules variable degree scarring
Lab testing for acne
Not indicated unless hyperandrogenism is suspected
DHEAS, FSH-LH ratio
Differential Dx
Acne rosacea
Gram-negative Folliculitis
Perioral Dermatitis
Steroid-induced acne
Tx principles
Decrease seb. gland activity
Correct alterned keratinization
Decrease follicular bacteria
anti-inflammatory
Tx: Grade 1
Topical retinoid
Topical benzoyl peroxide
Extraction
AHA, Sal. acid products
Tx: Grade 2
Topical retinoid
Benzoyl peroxide
Topical abx
Azelaic acid
Tx: Grade 3
Topical Retinoids
Oral abx
2nd line - BP, intralesional corticosteroid injections
Hormone therapy
Oral isotretinoin
Tx: Grade IV
Oral isotretinoin
Oral contraceptives
2nd line - intralesional corticosteroid injections
I&D
For dry skin type, use ____
creams
For oily skin type, use _____
Gels, solutions (maybe with alcohol)
For areas with hair, use _____
lotion
What do retinoids do?
Alter keratinization and decrease stickiness in cells
Systemic therapy options
Abx
Hormones
Synthetic retinoids
Preferred oral abx for acne
doxycycline, minocycline
tetracycline
Spirolactone and Flutamide?
Anti-androgens
Lots of side effects
Isotretinoin
Synthetic oral retinoid
Category X drug - very teratogenic
iPledge program
Works on all 4 factors
Requires a lot of lab monitoring (CBC, liver, triglycerides, pregnancy)
Chronic and progressive dermatosis characterized by erythema, papules and pustules, telangiectasia, potential hyperplasia over central portion of face
middle aged adults
Acne Rosacea
Causes of A. rosacea
Unknown, possibly vascular
Heliobacter pylori relationshop
Pre-Rosacea
Erythema or irritation in response to topical medications, especially anti-acne meds
Stage 1 AR
Transient facial erythema similar to normal flushing or blushing, more persistent
Fine telangiectasia
Stage 2 AR
Persistent spreading erythema
Edema papules pustules
Enlarged pores
Stage 3 AR
Tissue hyperplasia
Rhinophyma
Rosacea subtypes
Erythematotelangiectatic, papulopustular, phymatous, ocular
AR treatment
Abx for papular/pustular (tetracycline)
Metronidazole (Metrogel)
Azelaic Acid Gel - new (Finacea)
Complications of Acne Rosasea
Rhinophyma, ocular complications (blepharitis - conjunctivitis - keratosis)
