Acneiform Diseases

Question 1

Best time period to manage acne

Answer 1

During early adolescent years (10-13)

Question 2

How can estrogen and testosterone cause acne?

Answer 2

Increased levels of these hormones can cause increased activity of the sebaceous glands. The high levels of sebum produced eventually blocks the hair follicle (comedo) causing an accumulation of sebum below the epidermal surface. The sebum can be infected by bacteria and cause inflammation and pus formation leading to papule and pustule formation.

Question 3

Difference between white heads and black heads.

Answer 3

White heads are comedones that are closed by skin.

Black heads are comedones that are open, exposing the accumulated melanin

Question 4

Main infectious agent in acne.

Answer 4

Propionibacterium acnes

Question 5

Describe the 4 grades of acne

Answer 5

Grade 1: comedones

Grade 2: comedones, papules, pustules (non-inflammatory)

Grade 3: comedones, papules, pustules (inflammatory)

Grade 4: grade 3 along with cysts/nodules

Question 6

Treatment for Grade 1 acne

Answer 6

Retinoid cream applied at night.

Can also use benzoyl peroxide or topical antibiotics

Question 7

Treatment for Grade 2 acne.

Answer 7

Combination medication: usually benzoyl peroxide with a topical antibiotic

Retinoid creams can also be used

Question 8

Treatment for Grade 3 acne

Answer 8

Same as Grade 2 but with the addition of an oral antibiotic.

Tx: Benzoyl peroxide with retinoid cream and/or topical antibiotics. Add tetracycline or doxycycline

Question 9

Treatment for Grade 4 acne

Answer 9

Systemic AND topical antibiotics

Question 10

Grade the acne

Answer 10

Grade 3: starting to see inflammation

Question 11

Grade the acne

Answer 11

Grade 1: just closed comedones visible

Question 12

Grade the acne

Answer 12

Grade 2: comedones with papules and pustules but no inflammation

Question 13

Grade the acne

Answer 13

Grade 4: nodule is visible

Question 14

What are 3 physical treatments that can be done for acne lesions?

Answer 14

1. Comedone Extraction
2. Intralesional Steroid Injection
3. Dermabrasion

Question 15

Last resort drug treatment for severe scarring cystic acne

Answer 15

Isotretinoin: tertogenic and usually reserved for prescription by a dermatologist

MOA: unknown but it’s thought to induce apoptosis in certian cells in the body
(mainly sebaceous gland cells)

Question 16

What should a PCP suspect if a 40 year old patient presents with a CC of acne?

Answer 16

Rosacea: often looks like acne, but rosacea commonly presents in middle aged patients

Question 17

Etiology of rosacea

Answer 17

Not known, maybe immunologic inflammatory response (ex. response to cathelicidin which is an antimicrobial protein)

There is also correlation with increased amount of Demodex mites prompting an inflammatory response on the skin.

Question 18

How is Rosacea diagnosed?

Answer 18

It’s a clinical diagnosis.

At least one primary feature: flushing, nontransient erythema, papules and pustules, telangiectasia

At least one secondary feature: burning or stinging, plaque, dry appearance, edema, ocular manifestation, peripheral location, phymatous changes (swelling or mass)

Question 19

Name the 4 subtypes of rosacea.

Answer 19

1. Erythematotelangiectatic
2. Papulopustular
3. Phymatous
4. Ocular

Question 20

Most frequent sign of ocular rosacea.

Answer 20

Blepharitis: inflamed eyelid (usually the margins)

Question 21

4 medications that can aggravate rosacea.

Answer 21

Corticosteroids

vasodilators

ACE-Is

Simvastatin

Question 22

Major factor differentiating rosacea from acne

Answer 22

Rosacea doesn’t have comedones

Acne has comedones

Question 23

Major factor differentiating Rosacea from SLE.

Answer 23

Rosacea does not have sickness or fever

Question 24

What is the management strategy for rosacea?

Answer 24

1st line: lifestyle changes, avoid food, drinks, and environmental triggers

Step 1: oral antibiotic to alleviate symptoms AND daily use of topical medicine

Step 2: maintain remission with topical agents

Question 25

What are the 5 topical agents that can be used in rosacea therapy?

Answer 25

Metronidazole

Azelaic Acid

Clindamycin

Erythromycin

Sulfacetamide/Sulfur

Question 26

What are the 4 first line oral antibiotics used to treat rosacea?

Answer 26

Tetracycline

Minocycline

Doxycycline

Erythromycin