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532 DERM > Acneiform Disorders > Flashcards

Acneiform Disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

What disease occurs on the face, neck and upper trunk?

Acne, rosacea, perioral dermatitis or folliculitis

A

Acne

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2
Q

What disease occurs only on the face?

Acne, rosacea, perioral dermatitis or folliculitis

A

Rosacea

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3
Q

What disease is characterized as comedones, inflammatory papules and/or pustules or nodules?
Acne, rosacea, perioral dermatitis or folliculitis

A

Acne

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4
Q

What disease appears as erythema, telangiectasia, inflammatory papules, and/or pustules on the central face?
Acne, rosacea, perioral dermatitis or folliculitis

A

Rosacea

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5
Q

What disease occurs around the lower face region, eyes, nostrils or mouth?
Acne, rosacea, perioral dermatitis or folliculitis

A

Perioral dermatitis

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6
Q

What disease presents with an erythematous base with or without scale, possibly with papules or pustules?
Acne, rosacea, perioral dermatitis or folliculitis

A

Perioral dermatitis

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7
Q

Which disease occurs in hair-bearing areas as inflammatory papules or pustules?
Acne, rosacea, perioral dermatitis or folliculitis

A

Folliculitis

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8
Q

Which disease begins after puberty?

Acne, rosacea, perioral dermatitis or folliculitis

A

Acne

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9
Q

Which disease begins after age 30 and has a chronic course?

Acne, rosacea, perioral dermatitis or folliculitis

A

Rosacea

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10
Q

Which disease occurs most commonly n females aged 20-45?

Acne, rosacea, perioral dermatitis or folliculitis

A

Perioral dermatitis

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11
Q

Which disease begins after puberty and occurs intermittently?
Acne, rosacea, perioral dermatitis or folliculitis

A

Folliclitis

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12
Q

What are the 4 key processes in the development of acne that lead to the production of proinflammatory cytokines?

A
  1. Inflammation
  2. Abnormal desquamation of keratinocytes
  3. Increased/altered sebum production
  4. Bacterial colonization with p. Acnes.
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13
Q

Which type of acne results from oil-based cosmetics, lotions and hair products?
Acne is worse is areas in contact with the substance.

A

Cosmetic acne

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14
Q

What type of acne is seen on the forehead and neck as a result of oily lotions and creams used to style hair?

A

Pomade acne

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15
Q

What type of acne results from friction from headbands, hats, helmets, chinstraps, collars and tight bras?

A

Mechanical acne

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16
Q

What type of acne is induced by scratching primary lesions?

A

Acne excoriee

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17
Q

Acne that covers less than 1/4 of the face without the presence of nodules or scaring.
Mild/Moderate/Severe

A

Mild

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18
Q

Acne that involves 1/2 the face with some nodules and a few scars.
Mild/Moderate/Severe

A

Moderate

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19
Q

Acne that involves at least 3/4 of the face with multiple nodules and scars.
Mild/Moderate/Severe

A

Severe

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20
Q

History taking questions to ask about acne are…

A 
Ask about skin care routine
perfumes, lotions, hair products
birth control pills or other medications
diet
family history
menstrual cycles (PCOS)
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21
Q

What is first line therapy for acne?

A

Topical
salicylic acid, or benzoyl peroxide (bleaches fabrics)
retinoids (photosensitivity, PG C)
antibiotics

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22
Q

Name two topical antibiotics for acne.

A

Clindamycin
Erythromycin
can combine with benzoyl peroxide

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23
Q

Can topical antibiotics be used as monotherapy?

A

No. They work synergistically with keratolytics and should be applied after cleansing.

Combinations of 5% BP + topical antibiotic may be more efficacious than either alone (can be bought as one solution but may be cheaper to prescribe 2 topical medications and have the patient combine them)

24
Q

When should oral antibiotics be used for acne?

A

Oral antibiotics should be used in severe cases, lesions unresponsive to topical therapy, patients at risk for scarring and lesions on the trunk or back.

25
Q

Name 3 oral antibiotics used to treat acne.

A

erythromycin/clindamycin (use for PG)

minocycline/doxycycline (teeth staining, PG D)

26
Q

How long before a patient can expect improvement after starting acne treatment?

A

4-6 weeks to months. Can get worse before it gets better.

27
Q

What are the best OCPs to use for acne?

A

Monophasic
POPs are best because they have low androgenic activity
Drosperinone

28
Q

What are some contraindications to isotretinoin therapy?

A

Teratogenic - use 2 forms of birth control, monitor PG monthly
Obtain an iPledge consent

29
Q

What is the Plus System for lesion count?

A 
To determine the severity:
1+ = up to 10
2+ = 11 to 20
3+ = 21 to 30
4+ = too many to count
30
Q

What is the mechanism of action for benzoyl peroxide?

A

Anti-inflammatory and anti-bacterial

31
Q

How is benzoyl peroxide applied?

A

Once-daily application of 5% BP is usually adequate. Use a pea-sized amount to all acne-prone areas (rather than individual lesions). Increasing the concentration does not usually improve outcomes, but causes increased dryness and irritation.

32
Q

What treatment is used for mild inflammatory or mixed (comedonal and inflammatory) acne?

A

Benzoyl peroxide

33
Q

What treatment is used to for mild to moderate inflammatory acne?

A

topical antibiotics - clindamycin or erythromycin

Drug resistance of P. acnes to topical macrolides is increasing

34
Q

What treatment is used for comedonal acne?

A

Topical retinoids - tretinoin, adapalene, tazarotene

Pregnancy class C but avoid in pregnancy because of theoretical risk of teratogenicity of retinoids

35
Q

What are the side effects of topical retinoids?

A

irritation, dryness, redness, hypo/hyperpigmentation

36
Q

How do you apply topical retinoids?

A

May need to work up to using it daily (use every third night, then every other night until the irritation resolves)
May initially worsen acne in the first 2 to 3 weeks of use

37
Q

Should Tretinoin be used as monotherapy?

A

Yes but, tretinoin is inactivated by BP. Apply BP in the am and topical retinoid at night (to avoid sun exposure).

38
Q

What treatment should be prescribed for moderate to severe acne or large areas on the back?

A

Tetracyclines

39
Q

What labs should be monitored during isotretinoin (Acutane) therapy?

A

CBC
Lipids
LFT

40
Q

What are the four subtypes of rosacea?

A

Erythematotelangiectatic
Papulopustular
Phymatous
Ocular

41
Q

What condition presents with flushing, facial erythema, inflammatory papules and pustules, telangiectasia, edema, and watery or irritated eyes?

A

Rosacea

42
Q

What is the treatment for erythematotelangiectatic rosacea?

A

Topical:metronidazole, azelaic acid and sulfacetamide/sulfur, brimonidine

Oral:doxycycline, tetracycline

43
Q

What is the treatment for papulopustular rosacea?

A

Topical:metronidazole, azelaic acid and sulfacetamide/sulfur, Ivermectin

Oral:doxycycline, tetracyclines

44
Q

What is the treatment for phymatous rosacea?

A

If mild, same as papulopustular

Severe, refer to derm for laser, cryotherapy with isotretinoin or topical tacrolimus

45
Q

What are some triggers for perioral dermatitis?

A

cosmetics, skin care moisturizers, fluorinated toohtpaste, steroids, OCPs, menstruation, PG and emotional stress.

46
Q

What is the treatment for perioral dermatitis?

A

Topical antibiotics
metronidazole, erythromycin, doxycycline x 6 wks
(use e-mycin if CI to doxy)

47
Q

What two organisms are typically responsible for folliculitis?

A

S. aureus, Pseudomonas (hot tub folliculitis)

48
Q

What is the treatment for male patients with folliculitis on the face?

A

Stop shaving until it gets better. Use a new blade each time.

49
Q

What is the treatment for folliculitis caused by S. aureus?

A

Benzoyl peroxide
Oral abx if large area
Dicloxacillin/cephalexin/doxycycline

50
Q

What is the treatment for hot tub folliculitis?

A

Ciprofloxacin for P. aeruginosa

51
Q

A patient has acne and the provider notes lesions on half of the face, some nodules, and two scarred areas. Which treatment will be prescribed?

a. Oral clindamycin for 6 to 8 weeks
b. Oral isotretinoin
c. Topical benzoyl peroxide and clindamycin
d. Topical erythromycin

A

ANS: C
This patient has moderate acne, based on symptoms of lesions on half of the face with nodules and a few scars. A combination of topical benzoyl peroxide and clindamycin is recommended. Oral antibiotics are reserved for severe cases. Oral isotretinoin is used only for recalcitrant cases which are severe and have not responded to other treatments. Topical antibiotics should be used as monotherapy.

52
Q

When counseling a patient with rosacea about management of this condition, the provider may recommend
Select all that apply.

a. applying a topical steroid.
b. avoiding makeup.
c. avoiding oil-based products.
d. eliminating spicy foods.
e. exposing the skin to sun.
f. using topical antibiotics.

A

ANS: C, D, F
Patients with rosacea should avoid oil-based products and eliminate spicy foods, alcohol, and hot fluids. Topical antibiotics may be used if pustules are present. Topical steroids are not recommended. Patients do not need to avoid makeup and should avoid the sun.

53
Q

A provider is considering an oral contraceptive medication to treat acne in an adolescent female. Which is an important consideration when prescribing this drug?

a. A progesterone-only contraceptive is most beneficial for treating acne.
b. Combined oral contraceptives are effective for non-inflammatory acne only.
c. Oral contraceptives are effective because of their androgen enhancing effects.
d. Yaz, Ortho Tri-Cyclen, and Estrostep are approved for acne treatment.

A

ANS: D
Three oral contraceptives have a labeled use for acne treatment: Yaz, Ortho Tri-Cyclen, and Estrostep. Progesterone-only contraceptives may worsen acne. Combined oral contraceptives are effective in reducing inflammatory and non-inflammatory acne. Oral contraceptives are effective because of their antiandrogen effects, since androgen induces sebum production.

54
Q

An adolescent who recently spent time in a hot tub while on vacation has discrete, erythematous 1­ to 2­mm papules that are centered around hair follicles on the thighs, upper arms, and buttocks. How will the primary care pediatric nurse practitioner manage this condition?

A. Culture the lesions and treat with appropriate IM antibiotics.
B. Hospitalize for incision and drainage and intravenous antibiotics.
C. Order an ant staphylococcal beta lactamase ­resistant antibiotic.
D. Prescribe topical keratolytics and topical antibiotics

A

ANS: D

55
Q
  1. An adolescent has acne with lesions on the cheeks and under the chin. Which distribution is this?

A. Athletic
B. Frictional
C. Hormonal
D. Pomadal

A

ANS: C

56
Q

An adolescent has acne characterized by papules and pustules mostly on the forehead and chin. What will the primary care pediatric nurse practitioner prescribe?

A. Azelaic acid applied daily at nighttime
B. Benzoyl peroxide applied twice daily
C. Topical erythromycin with benzoyl peroxide
D. Tretinoin applied nightly after washing the face

A

ANS: C

532 DERM (8 decks)

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