Acneiform Diseases Flashcards
Best time period to manage acne
During early adolescent years (10-13)
How can estrogen and testosterone cause acne?
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.
Difference between white heads and black heads.
White heads are comedones that are closed by skin.
Black heads are comedones that are open, exposing the accumulated melanin
Main infectious agent in acne.
Propionibacterium acnes
Describe the 4 grades of acne
Grade 1: comedones
Grade 2: comedones, papules, pustules (non-inflammatory)
Grade 3: comedones, papules, pustules (inflammatory)
Grade 4: grade 3 along with cysts/nodules
Treatment for Grade 1 acne
Retinoid cream applied at night.
Can also use benzoyl peroxide or topical antibiotics
Treatment for Grade 2 acne.
Combination medication: usually benzoyl peroxide with a topical antibiotic
Retinoid creams can also be used
Treatment for Grade 3 acne
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
Treatment for Grade 4 acne
Systemic AND topical antibiotics
Grade the acne
Grade 3: starting to see inflammation
Grade the acne
Grade 1: just closed comedones visible
Grade the acne
Grade 2: comedones with papules and pustules but no inflammation
Grade the acne
Grade 4: nodule is visible
What are 3 physical treatments that can be done for acne lesions?
- Comedone Extraction
- Intralesional Steroid Injection
- Dermabrasion
Last resort drug treatment for severe scarring cystic acne
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)
What should a PCP suspect if a 40 year old patient presents with a CC of acne?
Rosacea: often looks like acne, but rosacea commonly presents in middle aged patients
Etiology of rosacea
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.
How is Rosacea diagnosed?
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)
Name the 4 subtypes of rosacea.
- Erythematotelangiectatic
- Papulopustular
- Phymatous
- Ocular
Most frequent sign of ocular rosacea.
Blepharitis: inflamed eyelid (usually the margins)
4 medications that can aggravate rosacea.
Corticosteroids
vasodilators
ACE-Is
Simvastatin
Major factor differentiating rosacea from acne
Rosacea doesn’t have comedones
Acne has comedones
Major factor differentiating Rosacea from SLE.
Rosacea does not have sickness or fever
What is the management strategy for rosacea?
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
What are the 5 topical agents that can be used in rosacea therapy?
Metronidazole
Azelaic Acid
Clindamycin
Erythromycin
Sulfacetamide/Sulfur
What are the 4 first line oral antibiotics used to treat rosacea?
Tetracycline
Minocycline
Doxycycline
Erythromycin
