Acneiform lesions Flashcards
What percentage of Americans does Acne affect?
60%–70% of Americans at some point in life
20% (1/5) will have severe acne, resulting in permanent mental and physical scarring
ACNE MOST COMMON SKIN DISEASE IN US
if 2 parents had it, 3 of 4 kids will
if 1 parents had it, 1 of 4 kids will
What are 4 acneiform lesions that resemble Acne Vulgaris?
- comedones (plugged glands)
- papulopustules
- cysts
- nodules
Age of acne presentation?
-newborns due to maternal hormones and higher adrenal gland androgen production
-adolescents (gonads produce androgen @ puberty)
-5% adults men + women at age 45
20% women and 5% men at age 25
What is the clinical presentation of acne?
comedones: closed (whiteheads) and open (blackheads)
Inflammatory papules, pustules
-due to Propionibacterium acnes (p. acne)
What are blackheads?
comedones–open
they have melanin, not dirt!
What are the social impacts of acne?
depression- freezes personality in adolescence during first development
anger, hostility, antisocial behavior
Describe acne grades I, II, III, IV
grade I: comedones open (blackheads)
grade II: comedones closed (white heads)
grade III: papulopustules lesions
grade IV: comedones open, closed, papulopustules cysts
What factors aggravate acne vulgaris?
- cosmetics (for hair and face)
- pregnancy may aggravate
- medications: lithium, steroids, antiepileptics (for seizures), iodides
- sunlight may make better or worse
- occlusions (hats, hair, underwire bras)
- congenital adrenal hyperplasia, polycystic ovary syndrome + other endocrine disorders associated with adrenal gland
-NOT DIET!! chocolate, sodas, junk food will not make acne worse
Treatment for acne
- wash face 2x a day
- non-comedogenic make-up/moisturizers
- topical treatments (benzoyl peroxide, retinoids, adapalene, tazarotene), topical antibiotics, systemic antibiotics (tetracycline), systemic treatments (isotretinoin, oral contraceptives, spironolactone)
Describe all topical treatments for acne (topical GREAT FOR NON-INFLAMMATORY!!!)
- benzoyl peroxide: effective against P. acne, comes OTC (soap, wash, lotion, gel, cream), use 1-2x a day, MAY cause irritant contact derm especially if used w/ tretinoin, RARELY causes allergic contact derm
- retinoids: (include adapalene & tazarotene)- comedolytic, anti-inflammatory, normalize hyperproliferation & hyperkeratinization, can be used with other acne meds, use 1x a day or every other day, thins corneum, may cause redness, peeling, irritation, associated w/ sun sensitivity
- Adapalene (Differin)- naphthoic acid derivative that binds to retinoic acid receptor to normal epidermal differentiation– ANTI-INFLAMMATORY!
- Tazarotene (AVAGE, Tazorac)- retinoid prodrug that modulates proliferation & differentiation of epithelial tissue, may have anti-inflammatory and immunomodulatory properties
- topical antibiotics: against P. acne, anti-inflammatory, includes erythromycin & clindamycin, NOT comedolytic, bacterial resistance possible but LESS LIKELY if used with benzoyl peroxide, apply 1-2x daily, gel & solutions may be more irritating than cream or lotions
Describe Isotretinoin aka Accutane (systemic treatment for acne)
-used in severe, recalcitrant (stubborn) acne cases
-normalizes epidermal differentiation
-decreases sebum excretion by 70%
-anti-inflammatory, reduces presence of P. acne
-cumulative dose of 120-150mg/kg, administer W/ STEROIDS at onset
in severe cases
-Teratogen!!! pregnancy must be avoided (2 neg. preg. tests before starting, contraception counseling mandatory)
-lower intermittent dose schedules (1 wk a month) not effective
-baseline labs: cholesterol, triglycerides, CBC, HCG, hepatic transaminase levels
-may heighten feelings of depression/suicidal thoughts
-FDA-mandated registry for all people prescribing, dispensing, taking (iPLEDGE online)
-risk of abnormal healing, development of excessive granulation tissue, elective procedures must be postponed up to a yr after finishing isotretinoin
-during medication, cannot get piercings, tattoos, leg waxing, etc
Describe systemic antibiotics (tetracycline group) for acne
effect against P. acnes & anti-inflammatory
- lipophilic medications more effective (doxycycline & minocycline)
- P. acnes resistance is becoming more common w/ antibiotics
- subantimicrobial therapy or treatment with topical benzoyl peroxide may reduce emergent or resistant strains
- other antibiotics: azithromycin, sulfamethoxazole, trimethoprim
Describe systemic treatments (oral contraceptives & Spironolactone) for acne
Oral contraceptives (OCP): increase sex hormone-binding globulin, decreasing circulating free testosterone, a requirement for many dermatologists before isotretinoin, combination (triphasic) birth control pills
Sprionolactone: reduces androgen production, could cause dizziness, breast tenderness, dysmenorrhea (painful menstrual cycle) which could be cured by taking birth control, periodic evaluation of blood pressure and potassium is appropriate, avoid pregnancy because of risk of feminization of male fetus while taking this med
What is a papulopustular drug reaction?
Not acne because NO COMEDONES! looks like acne
-patients have fever, have leukocytosis
caused by: penicillin & macrolides
others: co-trimoxazole, doxycycline, ofloxacin, chloramphenicol
*others on slide that produce acne-like eruption-don’t need to know?
What are eruptive vellous hair (peach fuzz/bum bluff) cysts?
many vellous (fine, non pigmented) hair follicles
mid-dermal epithelial cyst containing vellous hairs, keratinous material
may be hereditary
-cysts may spontaneously regress, form connection to epidermis, or be degraded by foreign body granulomatous reaction
-flesh colored papules
-face, thigh, chest, neck, groin, axillae, butt
What are treatments for vellous hair cyst?
incise & drain (risk of scarring)
CO2 laser ablation–difficult with large surface area
topical retinoids + 12% lactic acid preparations
What is steroid acne?
- caused by steroid use (ex: anabolic steroids)–topical or systemic steroid use, including intravenous and inhaled
- monomorphous papulopustules
- trunk, extremities
- eruption resolves after STOPPING steroid
- MAY respond to usual treatments of acne vulgaris!!
What is chloracne?
- cutaneous eruption of polymorphous comedones or cysts
- possible pigmentary changes and xerosis
- may cause nervous, ophthalmic, hepatic system effect, and possible oncogenic
- due to exposure to halogenated aromatic hydrogen compounds (ex: chlorinated dioxins & dibenzofuranes)
- inhalation, ingestion, or direct contact through foods or contaminated compounds
Describe secondary syphilis (great pox)
- papulopustules and nodules, some crusted
- face, trunk, extremities
- caused by: spirochete Treponema pallidum
How is secondary syphilis diagnosed?
- biopsy
- serologic tests and presents of spirochetes on darkfield microscopy
What is erythematotelangiectatic (ETR) type rosacea?
- central facial blushing
- butterfly effect (across central face)
- burning or stinging
- redness spares periocular skin
- triggers to flush include emotional stress, hot drinks, alcohol, spicy foods, exercise, hot or cold weather
- burning or stinging exacerbated when topical agents applied
Describe papulopustular rosecea (PPT)
- more pronounced inflammation
- more common in white women in 30-40 yrs of age
- classic presentation of rosacea: red central portion of face containing small erythematous papules surmounted by pinpoint pustules
- telangectasis hidden by surrounded erythema
Describe phymatous rosacea
- marked skin thickening
- irregular surface nodularities on nose, chin, forehead, ears, eyelids
Describe ocular rosacea
- ocular signs may precede rosacea by years or develop together
- eyes: conjunctivitis, blepharitis (swelling of eyelids), meibomian glands, inflammation of lids, interpalpebral conjunctival hyperemia, conjunctival telangiectasias
- symptoms of eye stinging, burning, dryness, irritation with light, feeling of foreign body in eye
- -REQUIRES DERMATOLOGIST: antihistamine drops do not work
