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*Dermatology > Acneiform Eruptions > Flashcards

Acneiform Eruptions Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the pathophysiological mechanism of inflammation in acne?

A
  1. Hyperkeratosis occurs due to hyperproliferation of ductal keratinocytes or reduced separation of ductal corneocytes which leads to blockage of pilosebaceous duct
  2. Sebum excretion increases via androgen stimulation and builds up
  3. Propionibacterium acnes overpopulates duct along with shed keratin and sebum
  4. Stimulates inflammatory mediators
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2
Q

How does sebum excretion rate change in acne?

A

Increases (androgen stimulates it)

increases in puberty

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3
Q

What are the 2 types of comedones?

A

Open (blackheads)

Closed (whiteheads)

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4
Q

What are blackheads?

A

Dilated keratin filled follicles which appear as black papules due to keratin debris

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5
Q

What are whiteheads?

A

Accumulation of sebum and keratin deeper in the pilosebaceous ducts

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6
Q

What is the most common peak age for acne vulgaris?

A

15-18yrs (90% of teens)

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7
Q

What happens to the squamous epithelium in acne?

A

Hypercornification/hyperkeratinisation - develops into tough protective layers

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8
Q

What are the 3 variants of acne?

A

Mild
Moderate
Severe

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9
Q

How is mild acne described?

A

Non-inflammatory
Open + closed comedones
Lesions <30; <15 inflammatory

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10
Q

How is moderate acne described?

A

Inflammatory (papules, pustules, nodules, cysts)
20-100 comedones
Lesions 30-125; inflammatory 15-50

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11
Q

What can early treatment of moderate acne prevent?

A

Scarring

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12
Q

How is severe acne described?

A

> 5 pseudocysts
Comedones >100
Lesions >125; Inflammatory >50

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13
Q

Severe acne is difficult to treat, may need lasers, but what is left once it is treated?

A

Permanent scarring and post-inflammatory pigmentation

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14
Q

Give 3 acne variants

A

Acne Fulminans
Drug induced acne
Acne excoriee

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15
Q

How is acne fulminans characterised?

A

Most severe form of cystic acne

Abrupt onset of nodular and suppurative acne with systemic manifestations

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16
Q

What systemic manifestations accompany acne fulminans?

A

Fever
Arthralgias
Myalgias
Hepatosplenomegaly

17
Q

What medications cause drug induced acne?

A 
Anabolic steroids
Corticosteroids
Phenytoin
Lithium
Isoniazid
18
Q

What is the cause of acne excoriee?

A

Neurotic excoriation of papules and comedones leaving crusted lesions which may scar

19
Q

Why might you enquire about menstrual history in acne?

A

Polycystic Ovary Syndrome

20
Q

What are some topical treatments for acne?

A

Topical retinoids
Benzoyl peroxide
Topical abx (clindamycin/erythromycin)
Azelaic acid

21
Q

What are some oral treatments for acne?

A

Abx tablets (lymecycline, tetracycline)
Combined oral contraceptive pill in women
Isotretinoin (last resort)

22
Q

What populations is rosacea most common in?

A

3rd and 4th decades of life

Fair-skinned

23
Q

Is there a known pathogenesis of rosacea?

A

No; in contrast to acne it is not associated with sebhorrhoea

24
Q

What is increased in rosacea?

A

Sensitivity to noxious stimuli

25
Q

What is the mite which is increased in number in rosacea?

A

Demodex folliculorum

26
Q

Describe a common presentation of rosacea

A

Central convex areas of face affected
Episodic flushing with no sweating
Erythema/burning sensation triggered by minor irritants
Persistent tissue thickening due to oedema, fibrosis + glandular hyperplasia

27
Q

What can be present in more advanced rosacea?

A

Papules and pustules (NO COMEDONES)

28
Q

What are some triggers for rosacea?

A

Stress
Hot drinks
Alcohol
Spices

29
Q

Give the 2 features of vascular rosacea

A

Recurrent blush

Telangiectasis (initially in nose)

30
Q

Give some (4) features of inflammatory rosacea

A

Small papules/pustules
Absence of comedones
Deeper red colour compared to acne
Soft/solid facial oedema

31
Q

Describe phymatous rosacea

A

Overgrowth of sebaceous glands
Skin swollen and smoother; pores more apparent
Lumpy surface gradually develops (nose)

32
Q

What is the incidence of ocular rosacea?

A

50% of rosacea patients

33
Q

What are some possible symptoms of ocular rosacea?

A 
Dryness/tired eyes
Oedema
Tearing
Pain
Chalazia
Corneal damage
34
Q

What are the topical treatments for rosacea?

A

Metronidazole cream/gel (major therapy)
Azelaic acid cream/gel
Ivermectin cream

35
Q

What are the non-topical treatments for rosacea?

A

Tetracyclines most common
Avoidance of obvious vasodilators/irritants
Surgery for rhinopymas

*Dermatology (11 decks)

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