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Me > (Ch38) Folliculitis > Flashcards

(Ch38) Folliculitis Flashcards

1
Q

Ddx for oedematous folliculitis?

A

Eosinophilic
Demodex
Pseudomonas

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2
Q

Gram -ve folliculitis other than hot tub causes

A

KEEP
Klebsiella
E.coli
Entrobacter
Proteus

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3
Q

Folliculitis that is common in in T zone of face, oily skin after long term abx Rx?

A

Gram -ve Folliculitis due to KEEP
Klebsiella
E.coli
Entrobacter
Proteus

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4
Q

Tx for gram -ve Folliculitis?

A
  • Topical: antibacteria soaps, BP, gentamicin
  • Systemic: Quinolones( Cipro)
  • Recurrent or Severe: isotretnoin.
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5
Q

Hot tub Folliculitis time interval?

A

12-48h
more on trunk

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6
Q

How to prevent Hot tub Folliculitis?

A

Add Chlorine
pH 7.2-7.4
Water change every 6-8w

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7
Q

Irritant Folliculitis trigger and tx?

A
  • Irritants: Coal tar and application against hair growth direction

Tx: Topical steroids

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8
Q

Folliculitis with crusting and loose hair in the beard area of a farmer?

A

Tinea barbae

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9
Q

causes and Rx of Tinea Barbae?

A

Trichophyton Mentagrophytes

T.Verrucosum

tx: Systemic antifungals

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10
Q

Filliculitis on the legs of women who shave their legs and is MC in immuncompermised ?

A

Majocchi granuloma

risk factors:
Immmunocompermised
Potent topical CS
Occlusion

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11
Q

Pathogen for Majocchi granuloma ?

A

Trichophyton rubrum

Tx: systemic antifungals

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12
Q

Folliculitis of beard area?

A
  • Irritant-> Irritant application
  • Tinea Barbae (Dermatophytes)-> Crust
  • Herpes -> Vesicles
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13
Q

mention 4 types of Folliculitis in Immunocompermised

A

Malassezia
Candida
HSV (generalized)
Demodex

CH-DM

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14
Q

Risk factors for Majocchi granuloma?

A
  • Female who shave their legs
  • Occlusion
  • topical potent steroids
  • Immunsupression
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15
Q

Malassezia( Pityrosporum) Folliculitis risk factors?

A
  • Young Adult
  • Warm weather
  • Increased sebum
  • Occlusion
  • tetracycline use
  • immunosuppression
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16
Q

Which fungal folliculitis require systemic tx?

A

Dermatophytes induced

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17
Q

Candida Folliculitis features ?

A

Folds look for stellate pustules
More in DM patients

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18
Q

Demodex folliculitis clinical features?

A

Facial follicular papules/pustules with erythematous background

Tx: ivermectin or permethrin

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19
Q

Drug induced folliculitis resembles ?

A

Acniform eruption

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20
Q

Folliculitis with wax papules on the forehead

A

Necrotizing infundibular crystalline folliculitis

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21
Q

Actinic folliculitis features?

A

Pustular
Spares face
not pruritic
initial summer sun exposure
Avoid sun
not prevented by sunscreens

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22
Q

what are the 3 eosinophilic folliculitis ?

A
  1. Eosinophilic pustular folliculitis (Ofuji).
  2. Immunosuppression-associated eosinophilic pustular folliculitis.
  3. Eosinophilic pustular folliculitis of infancy.
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23
Q

What type of folliculitis is treated with NSAIDs?

A

Ofuji disease

Prostaglandin D2 activates pilosebaceous units and recruitment of eosinophils hence, use of indomethacin

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24
Q

Clinical Characteristics of Ofuji disease?

A
  • Intensely pruritic
  • Recurrent crops of grouped, follicular papulopustules.
  • +/- Annular or figurate lesions
  • On sebaceous areas
  • Last ~7–10d & relapse q3–4 wks.
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25
Q

Histopathological Hallmark of Ofuji disease?

A

Micropustule then infundibular eosin pustule

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26
Q

Rx of Ofuji disease

A

Pruritus: TCS, tacrolimus & oral anti-H

  1. 1LRx: Oral indomethacin (50 mg/d).
  2. 2LRx: UVB
    Minocycline (100 mg BID)
    Dapsone (100 to 200 mg/d for ≥2 wks)
    Colchicine (0.6 mg BID).
    SCS
  • Refractory: CsA
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27
Q

Ofuji vs Immunosuppression-associated eosinophilic pustular folliculitis ?

A

Ofuji disease:
1. non immunosuppressed
2. recurrent rash Last ~7–10d & relapse q3–4 wks.
3. Responds to indomethacin
4. MC with Japanese young men.

Immunosuppression-associated eosinophilic pustular folliculitis:
1. AIDS or ART (IRIS)/ Lymphoma
2. Chronic rash
3. no response to NSAIDS.

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28
Q

Immunosuppression-associated eosinophilic pustular folliculitis Pathogenesis

A

Th2 response in AIDS;

↑Lesional IL-1, IL-4, IL-5, RANTES (CCL5) & eotaxin (CCL11) mRNA

↑Serum CCL17, CCL26 (eotaxin-3) & CCL27

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29
Q

Immunosuppression-associated eosinophilic pustular folliculitis Rx

A

HIV: Rx underlying viral infection
IRIS-exacerbations:
Goal is improvement despite ART.
Temporary interruption of ART is unlikely if eosinophilic folliculitis is primary Sx of IRIS.
All:
Oral & topical antipruritics + TCS
If inadequate; UVB.
Other Rx: TCI
Topical permethrin
Oral itraconazole (200–400 mg daily)
Oral metronidazole (250 mg TID)
Oral Abx
Isotretinoin (0.5–1mg/kg/d x1–4 wk)
INF (β and γ)

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30
Q

Eosinophilic pustular folliculitis of infancy characteristics?

A

Prior to age 14 mo
↑M > F

Characteristic: Chronic and recurrent last 1-12w

resolves by age of 3y

31
Q

Disseminate and Recurrent Infundibulofolliculitis vs KP or papular eczema?

A

No hx of ATOPY with Disseminate and Recurrent Infundibulofolliculitis

all common in SOC

Rx:
Topicals: TCS
12% lactic acid
20–40% urea
If topicals unsuccessful:
PUVA (3x/wk for 3wks then maintenance 2x/mo)
Vitamin A (50 000 IU BID)
Isotretinoin (0.5 mg/kg/day x16 wks).

32
Q

Erythromelanosis Follicularis Faciei As/w skin condition?

A

KP

33
Q

Erythromelanosis Follicularis Faciei location?

A

Lateral cheeks
pinhead- sized follicular papules relatively hypopigmented on red–brown-colored skin d/t vasodilation & hyperpigmentation.

34
Q

Erythromelanosis Follicularis Faciei Histopath Specific features?

A

↓Hair shafts & ORS diameters +↓ thickness of IRS

↑Superficial blood vessels a/w grading of erythema.

35
Q

Which ethnic group gets Erythromelanosis Follicularis Faciei?

A

Asian F 2nd decade

36
Q

Keratosis Pilaris Atrophicans pathogenic features and mention 4 of them?

A

Features:
1. Abnormal follicular keratinization
2. atrophy
3. scarring alopecia

list:
- Ulerythema ophryogenes
- Atrophoderma vermiculatum
- Keratosis follicularis spinulosa decalvans
- Folliculitis spinulosa decalvans.

37
Q

Keratosis Pilaris Atrophicans mode of inheritance?

A

AD:
- Ulerythema ophryogenes (18p) +/- AR
- Atrophoderma vermiculatum
- Folliculitis spinulosa decalvans.

XLR:
Keratosis follicularis spinulosa decalvans (MBTPS1)

38
Q

Keratosis Pilaris Atrophicans starts at infancy?

A

Ulerythema ophryogenes (Keratosis Pilaris Atrophicans Facei)

Papules+ lateral eyebrow Alopecia

39
Q

Ulerythema ophryogenes As/w syndromes ?

A

Noonan
Cardio-Facio-Cutnaous syn
Monosomy 18
Wooly hair syn

40
Q

Which of Keratosis Pilaris Atrophicans no As/w KP?

A

Atrophoderma vermiculatum

Childhood 5-12y
pitted/honey comb atrophy

As/W Rombo syn and if unilateral as/w unilateral cataract

41
Q

Which of Keratosis Pilaris Atrophicans As/w palmoplanter keratoderam and nail dystrophy + alopecia and papule ?

A

Keratosis follicularis spinulosa decalvans
and
Follicularis spinulosa decalvans

42
Q

XLR vs AD Follicularis spinulosa decalvans

A

AD more severe and exacerbate after puberty vs XLR remits after puberty

43
Q

XLR Follicularis spinulosa decalvans As/w conditions

A

Blephritis, keratitis , photophobia

44
Q

Lichen spinolsus clinical presentation

A

Sudden crops; enlarge in 1 wk, then remain stationary

45
Q

Lichen spinolsus As/w

A

Type VI PRP
Seborrheic dermatitis
Drug reaction (omeprazole)
BRAF inhibitors
systemic lithium
Hodgkin disease
Crohn, syphilis
Id reaction to fungal

46
Q

Phrynoderma “toad skin” As/w

A

vitamin A deficiency
malabsorption
anorexia nervosa
fad diets

Face is last site to be involved
Hands & feet are spared.
Associated SSx: e.g. ocular, CNS

47
Q

Pseudofolliculitis Barbae gene

A

Polymorphism in 1A α-helical subdomain of K75

48
Q

Pseudofolliculitis Barbae MOA

A

interfollicular or intrafollicular

49
Q

Area spared by Pseudofolliculitis Barbae vs Tinea barbae?

A

Moustache spared in Pseudofolliculitis Barbae

50
Q

Treatment Recommendations for Pseudofolliculitis Barbae?

A

Compress
Topical or ILK Rx
2ndry infection Rx
Resistant disease
PIH rx

51
Q

shaving care for Pseudofolliculitis Barbae

A

Do not pull the skin taut.

Do not shave against the grain/direction of hair growth.

Use a sharp razor each time, preferably multi-blade.

Take short strokes (with the grain of the hair) and do not shave over the same areas more than twice

52
Q

Acne Keloidalis As/w

A

2/3 have concomitant seborrheic dermatitis

1/3 have concomitant pseudofolliculitis barbae.

?↑Mast cell density of neck/occipital scalp

rubbing & manipulation → Acne keloidalis.

clinically band-like distribution on posterior hairline

53
Q

Acne Keloidalis vs Acne

A

No comedones

54
Q

Acne keloidalis histopath

A

Naked hair shaft in dermis

Perifollicular fibrosis

Surrounding multi giant cells granuloma

⇓⇓Sebaceous glands in all stages.

Inflammation in upper 1/3 of follicle

55
Q

What size of Acne keloidalis rx with 1ry intention ?

A

Plaques 1.0–1.5 cm in vertical diameter.

56
Q

What size of Acne keloidalis rx with 2ndry intention ?

A

Plaques >1.5 cm in vertical diameter

57
Q

Acne keloidalis Rx ladder

A
  • Non-inflamed Papules and Plaques:
    Mixture of tretinoin gel and potent corticosteroid gel, applied twice daily.
  • Inflamed Lesions with
    Pustules:
    Perform bacterial culture.
    Administer appropriate systemic antibiotics or a course of oral isotretinoin.

Small Papules:
Perform punch excision to a depth below the level of hair follicles, followed by either primary closure or second intention healing.
Laser hair removal for permanent hair reduction.

Plaques ≤1.5 cm in Vertical Diameter:
Excise and close primarily.
Larger Plaques and Nodules

(>1.5 cm in Vertical Diameter):
Excise with a horizontal ellipse.
Extend excision below the posterior hairline to include fascia or deep subcutaneous tissue.
Allow healing by second intention.
Do not inject corticosteroids into the postoperative site.
Laser excision and cryosurgery are sometimes successful.

Postoperative Care:
Apply topical imiquimod daily for 6 weeks (or every other day for 8 weeks if irritation occurs).

Maintenance:
Use a tretinoin–corticosteroid gel mixture.
Apply intermittent intralesional corticosteroids and/or oral or topical antibiotics as needed.

58
Q

what is a must when taking excision for Acne keloidalis

A

Punch must extend below level of follicle.

59
Q

group at risk of HS?

A

↑♀ of African descent at puberty (F:M 3:1)

60
Q

What could exacerbate HS?

A

Both smoking & lithium exacerbate HS

61
Q

Familial HS mode of inheritance and genes

A

AD Mx

γ-secretase complex:
-Presenilin-1
-presenilin enhancer-2
-nicastrin
-Anterior pharynx-defective 1;

62
Q

which cytokines increased in lesion of HS?

A

⇑ IL-1β & TNF-α

63
Q

Which cytokines As/w disease activity?

A

⇑ Serum IL-2

64
Q

Complications of HS?

A

Anemia
2° amyloidosis
lymphedema

Fistulae to urethra, bladder, peritoneum or rectum.

Hypoproteinemia
nephrotic syndrome

65
Q

Microbiome in HS:

A

↓commensal microbiome (specifically Cutibacterium)
↑anaerobic bacteria (e.g. Prevotella)

66
Q

Genetic disorders in which HS can be an associated finding

A

Dowling–Degos disease
Down syndrome
Pachyonychia congenita
Familial Mediterranean fever
Darier disease
Keratitis–ichthyosis–deafness

67
Q

Trichostasis Spinulosa

A

Asymptomatic comedo-like lesions w/ keratin & vellus hairs

Rx for cosmetic appearance;
Keratolytics
Depilatories
Topical tretinoin
Lasers; long- pulsed Alex, short-pulsed Alex, pulsed diode
Periodic application of hydroactive adhesive pad

68
Q

Viral-Associated Trichodysplasia risk factors

A

CsA tx
?In transplant patients

69
Q

Viral-Associated Trichodysplasia cause

A

polyomavirus

70
Q

Viral-Associated Trichodysplasia histopath

A

H&E:
Enlarged distended anagen-type follicles
↑IRS cells

71
Q

Viral-Associated Trichodysplasia rx

A

If immunosuppressive Rx cannot be reduced:
Topical cidofovir or tazarotene gel
Oral valganciclovir (900 mg OD-BID)

72
Q

Mention forms of sycosis

A
  1. Barbe
  2. Lupoid
  3. Mycotic
  4. Herpetic
73
Q

which sycosis presents with scarring alopecia ?

A

Lupoid

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