Acne Vulgaris/Rosacea

Question 1

Inflammatory disease of pilosebaceous unit

Answer 1

acne vulgaris

Question 2

Ages for acne

Answer 2

Neonatal d/t maternal hormones
Puberty (early)
Mid to late teens most common
And later… especially for women

Question 3

Pathophysiology of acne

Answer 3

Excessive sebum production
** Follicular plugging
Colonization of seb. follicle w/ Propionibacterium acnes
Immune response w/ inflammation

Question 4

Causative agent most acne

Answer 4

Propionibacterium acnes

Question 5

Open comedo

Answer 5

blackhead

Question 6

Closed comedo

Answer 6

whitehead

Question 7

Grade 1 Acne

Answer 7

superficial non-inflammatory
open/closed comedones
Flesh colored papules
NO inflammation, pustules, nodules, scars

Question 8

Grade 2 acne

Answer 8

superficial inflammatory
open/closed comedones
inflammation
Papules/pustules - few to several
NO nodules/scars

Question 9

Grade 3 acne

Answer 9

Deep inflammatory
Moderate to severe
open/closed comedones
Papules/pustules
Few nodules
Little to no scar present

Question 10

Grade 4 acne

Answer 10

Severe nodulocystic
Deep/inflammatory
open/closed comedones
papules/pustules
extensive nodules
variable degree scarring

Question 11

Lab testing for acne

Answer 11

Not indicated unless hyperandrogenism is suspected

DHEAS, FSH-LH ratio

Question 12

Differential Dx

Answer 12

Acne rosacea
Gram-negative Folliculitis
Perioral Dermatitis
Steroid-induced acne

Question 13

Tx principles

Answer 13

Decrease seb. gland activity
Correct alterned keratinization
Decrease follicular bacteria
anti-inflammatory

Question 14

Tx: Grade 1

Answer 14

Topical retinoid
Topical benzoyl peroxide
Extraction

AHA, Sal. acid products

Question 15

Tx: Grade 2

Answer 15

Topical retinoid
Benzoyl peroxide
Topical abx

Azelaic acid

Question 16

Tx: Grade 3

Answer 16

Topical Retinoids
Oral abx

2nd line - BP, intralesional corticosteroid injections
Hormone therapy
Oral isotretinoin

Question 17

Tx: Grade IV

Answer 17

Oral isotretinoin
Oral contraceptives

2nd line - intralesional corticosteroid injections
I&D

Question 18

For dry skin type, use ____

Answer 18

creams

Question 19

For oily skin type, use _____

Answer 19

Gels, solutions (maybe with alcohol)

Question 20

For areas with hair, use _____

Answer 20

lotion

Question 21

What do retinoids do?

Answer 21

Alter keratinization and decrease stickiness in cells

Question 22

Systemic therapy options

Answer 22

Abx
Hormones
Synthetic retinoids

Question 23

Preferred oral abx for acne

Answer 23

doxycycline, minocycline

tetracycline

Question 24

Spirolactone and Flutamide?

Answer 24

Anti-androgens

Lots of side effects

Question 25

Isotretinoin

Answer 25

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)

Question 26

Chronic and progressive dermatosis characterized by erythema, papules and pustules, telangiectasia, potential hyperplasia over central portion of face
middle aged adults

Answer 26

Acne Rosacea

Question 27

Causes of A. rosacea

Answer 27

Unknown, possibly vascular

Heliobacter pylori relationshop

Question 28

Pre-Rosacea

Answer 28

Erythema or irritation in response to topical medications, especially anti-acne meds

Question 29

Stage 1 AR

Answer 29

Transient facial erythema similar to normal flushing or blushing, more persistent
Fine telangiectasia

Question 30

Stage 2 AR

Answer 30

Persistent spreading erythema
Edema papules pustules
Enlarged pores

Question 31

Stage 3 AR

Answer 31

Tissue hyperplasia

Rhinophyma

Question 32

Rosacea subtypes

Answer 32

Erythematotelangiectatic, papulopustular, phymatous, ocular

Question 33

AR treatment

Answer 33

Abx for papular/pustular (tetracycline)
Metronidazole (Metrogel)
Azelaic Acid Gel - new (Finacea)

Question 34

Complications of Acne Rosasea

Answer 34

Rhinophyma, ocular complications (blepharitis - conjunctivitis - keratosis)