Acneiform Flashcards
What is the clinical presentation of acne?
- non-inflammatory, open or closed comedones
- inflammatory papules, pustules, and nodules due to P. acnes
What is the tactile difference between an acne nodule and a cyst?
- nodule is firm and hard
- cyst is soft
What are the aggravating factors for acne?
- cosmetic agents
- medications
- endocrine disorders associated with excess androgen
- pregnancy
- occlusion
- sunlight
What are the general treatments for acne?
- washing the face BID, not TID
- non-comedogenic make-up/moisturizers
What are the topical treatments for acne?
- benzoyl peroxide
- retinoids
- adapalene
- tazorac
- antibiotics
What is used in combination with antibiotics for the treatment of acne vulgaris and why?
- benzoyl peroxide
- less likely to get bacterial resistance
Which is the most prescribe group of abx for systemic treatment of acne?
- tetracyclines
What is isotretinion used for?
- severe, recalcitrant acne vulgaris
How is isotretinoin initially prescribed?
- with steroids
What is the major concern with using isotretinoin?
- teratogenic so pregnancy must be avoided
What is a risk of isotretinoin?
- risk of abnormal healing, development of excessive granulation tissue s/p procedures
- elective procedures should be postponed at least 1 year
What are the systemic treatments for acne vulgaris?
- systemic antibiotic
- isotretinion
- oral contraceptives
- spironolactone
What is the description of steroid acne?
- monomorphous papulopustules
When does steroid acne present?
- s/p topical or systemic steroids
What are the types of rosacea?
- erythamtotelangiectatic (ETR)
- papulopustular (PPR)
- phymatous
- ocular
How does erythmatotelangiectatic rosacea present?
- central facial flushing
- burning or stinging
- redness spares periocular skin
What is a ddx for erythmatotelangiectatic rosacea?
- lupus
How does papulopustular rosacea present?
- redness/flushing central portion of face
- small erythematous papules surmounted by pinpoint pustules
- telangectasias masked by surrounding erythema
Which is the classic presentation of rosacea?
- papulopustular
What triggers rosacea?
- weather extremes
- hot/spicy foods
- alcohol
- vit B
How is rosacea diagnosed?
- clinically
What is the treatment for rosacea?
- sunscreens
- topical abx i.e. metronidazole
- retinoids
- oral abx i.e. tetracycline/erythromycin
- contraceptives
- Elidel
- papsone laser
What is hidradenitis suppurativa?
- terminal follicular epithelium in the apocrine gland-bearing skin
What is the ratio of females to males with hidradenitis suppurativa?
- 2 to 5:1
What is the histopathology of hidradenitis suppurativa?
- same as acne vulgaris
- hyperkeratosis of infundibulum
What are the 3 key elements needed for a hidradenitis suppurativa diagnosis?
- typical lesions (papules to nodules to abscesses to contractures)
- distribution in axilla and groin
- active v. inactive lesions
What is the treatment for hidradenitis suppurativa?
- local hygiene with soaps, antiseptics, and antipersperants
- weight loss
- warm compress
- AIF or antiandrogen
- retinoids
- antibacterial
- surgery with a wide surgical excision
What is zero therapy?
- ceasing all topical medication and cosmetic use
What are the criteria for grade I acne vulgaris?
- multiple open comedones
What are the criteria for grade II acne vulgaris?
- closed comedones
What are the criteria for grade III acne vulgaris?
- papulopustules
What are the criteria for grade IV acne vulgaris?
- nodulocystic
- multiple open comedones
- closed comedones
- papulopustules
- cysts
What spares the nasolabial folds?
- rosacea
