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Andrews > Chapter 13 (Acne/Rosacea) > Flashcards

Chapter 13 (Acne/Rosacea) Flashcards

1
Q

Histologic features of rosacea

A

Pilosebaceous gland hyperplasia with fibrosis, inflammation, and telangiectasia

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2
Q

Diagnosis?

A

Morbihan’s Dx

-Edema of forhead, eyelids, and cheeks associated with rosacea (MC in papulopustular and glandular type)

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3
Q

Diagnosis?

A

Pyoderma Faciale aka rosacea fulminans

Fulminant onset of superficial and deep abscesses, cystic lesions, and sometimes sinus tracts. With edema and intense reddish/cyanotic erythema

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4
Q

Treatment for rosacea fulminans

A

(similar to acne fulminans)

  1. Oral steroids x weeks followed by, (can d/c after weeks on isotretinoin)
  2. Isotretinoin 10-20mg increasing to 0.5-1mg/kg (only after acute inflammatory component is controlled); Full 120-150 dose
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5
Q

Treatment for pregnant patient with rosacea fulminans

A

Consider Category B Antibiotics

  • Amoxicillin
  • Erythromycin
  • Azithromycin
  • Clindamycin
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6
Q

What is the most common cause of the disorder pictured

A

MCC of Perioral Dermatitis

Use of fluorinated topical corticosteroids (classes 1-3) in form of creams, ointments, and inhalers

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7
Q

Treatment of Perioral Derm due to steroids

A
  1. D/C steroid use and protecting skin from inhaled steroids
  2. Doxycycline
  3. Tacrolimus ointment 0.1% or Pimecrolimus cream to prevent flaring after steroid d/c
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8
Q

Treatment of perioral derm WITHOUT steroid exposure

A
  1. Oral/Topical Abx
  2. Topical Adapalene
  3. Azelaic Acid
  4. Metronidazole
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9
Q

Diascopic and histologic appeareance of disorder in image

A

Lupus miliaris disseminatus faciei (A FIGURE dx)

**Eyelid involvment

Diascopy-discrete papules appear yellowish-brown

Histology-Caseating epithelioid cell granulomas

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10
Q

Treatment of LMDF

A

Self-involution is expected (eventually, can take years)

1. Isotretinoin

2. Minocycline

  1. Tranilast (Not FDA approved)
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11
Q

Describe morphology and location of LMDF

A

Firm, yellowish-brown or red, 1-3mm, monomorphous smooth-surfaced papules

Butterfly area, lateral face, below mandible, and periorificially (Eyelids characteristically involved)

Pt lacks hx of rosacea (flushing, persistent erythema, or telangiectasia)

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12
Q

What is the folicular occlusion triad

A
  1. Acne conglobata
  2. HS
  3. Dissecting cellulitis
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13
Q

Diagnosis and typical morphology

A

Neonatal Acne

-Transient facial papules or pustules that clear spontaneously (MC in males)

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14
Q

Acne with onset after first 6 weeks of life or persists beyond neonatal acne period is termed:

A

Infantile Acne

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15
Q

Txt for infantile acne that persists

A

Usually remits in 1 year

For prolonged cases:

  • BPO
  • Erythromycin
  • Retinoinds
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16
Q

Txt for inflammatory infantile acne

A

Erythromycin 125 mg BID

Trimethoprim 100 MG BID

17
Q

Acne that evolves from persistant infantile acne or begins >1 year is termed

A

Midchildhood acne

-uncommon, MC in males

18
Q

Findings that merit pedi endo workup in pt with midchildhood acne/earlier onset

A

+PE findings suggestive of hormonal d/o

  • Sexual precocity (Development of secondary sexual characteristics prior to puberty)
  • Virilization
  • Growth abnormality
19
Q

Define preadolescent acne and typical workup

A

Acne with onset of 7-12

-This is time of adrenarce; unless signs of androgen excess–no workup needed

20
Q

Pathogenesis of Acne

A
  1. Hyperproliferation and abnml differentiation of keratinocytes (unknown cause)
  2. Forms a keratinous plug in lower infundibulum that causes impaction and distention of follicle
    - retained cells block follicular opening, lower protion of follicle is dilated by entraped sebum–follicular contents get d/c into dermis–combo of keratin, sebum, and p acnes leads to release of proinflammatory mediators & accumulation of lymphocytes, neutrophils, and FB giant cells
  3. Androgen stimulation of sebaceous gland
  4. P acnes
21
Q

Key feature of mechanical/frictional acne

A

Unusual distribution of acne lesions (MC distribution for typical acne is face, neck, chest)

-Factors causing this include: chin straps, violins, hats, collars, casts, chairs/seats–these factors irritate the follicular epithelium and exacerbate the changes that lead to comedogenesis and follicular rupture

22
Q

Findings that increase likelihood of hyperandrogenism and thus warrant workup

A
  • irregular menses
  • hirsuitism
  • seborrhea
  • acanthosis nigricans
  • androgenic alopecia
23
Q

What to consider in female patient that has acne resistnat to conventional therapy, who relapses shortly after isotretinoin, or expierences sudden onset of severe acne?

A

Virilizing tumor

24
Q

Test to r/o virilizing tumor

A
  • DHEAS: >800 in adrenal tumor; 400-800 congenital adrenal hyperplasia
  • Free/Total Testosterone: >200 suggests ovarian tumor;150-200 in PCOS

(both obtained 2 weeks prior to menses)

-LH/FSH (increased ration in PCOS)

25
Q

Clinical diagnosis of PCOS

A
  • Presence of anovulation (<9 pds per yr or pd>40 days apart)
  • signs of hyperandrogenism (acne and hirsuitism)
26
Q

Medications that can worsen acne

A
  • Corticosteroids
  • Anabolic steroids
  • Neuroleptics/Antipsychotics (Aripipazole(abilify), clozapine, lurasidone (latuda), olanzapine (zyprexa), quetiapine (seroquel), risperidone (risperdal)
  • Lithium
  • Cyclosporine
27
Q
A
28
Q

Diagnosis

A

Osteoma cutis

-Small, firm papules resulting from long standing acne vulgaris

29
Q

Complications of Acne

A
  1. Scarring/Keloids
  2. Residual hyperpigmentation
  3. PG (MC in acne fulminans and pt txt with high dose isotretinoin)
  4. Osteoma cutis
  5. Solid facial edema: persistent, firm facial swelling (uncommon)
30
Q

Acne that is nodular, cystic, and pustular occurring mainly on back, buttocks, and thighs. Abscesses often occur but comedones are sparse

A

Tropical Acne

31
Q

33 y/o femal presents with acne that starts in sprin and clears by fall. Lesions are dull-red, dome shaped, hard, small papules on cheeks, sides of neck, chest and shoulders, and upper arms. No comedones or pustules are noted. What is the diagnosis?

A

Acne estivalis (Mallorca Acne)

  • Exclusive to 25-40 y/o females
  • Starts in spring-progresses over summer-completely clear by fall
  • comedones and pusutules absent
  • characteristically on upper arms
32
Q

Diagnosis and treatment

A

Acne estivalis/Mallorca Acne

Does NOT respond to abx

Will benefit from topical retinoids

33
Q

Diagnosis and typical findings

A

Steroid acne

-Sudden outcropping of inflamed papules most numerous on trunk and arms (also face)

papules rather than comedones

-Can be cause with medium or high doses of steroids taken for as briefly as 3-5 days

34
Q

Diagnosis?

Pt has pmhx of inflammatory acne x years. He has been treated with abx (does not recall name) for ‘a long time’. Presents with superficial pustules flaring out from the nares.

A

Gram Negative Folliculitis

  • Occurs in patients who were treated for long periods of time with tetracylines
  • Can present with superficial pustules or fluctuant, deep seated nodules
35
Q

Bacteria cx from gram-negative folliculitis

A
  1. Klebsiella
  2. E. Coli
  3. Enterobacter
  4. Proteus (cx from deep seated nodules)
    - Due to long term abx use allowing nares to become colonized
36
Q

TOC for gram negative folliculitis

A

Isotretinoin (clears acne + eliminates colonization of nares)

If isotretinoin cannot be tolerated or is CI–Amoxicillin or Bactrim

37
Q
A

Andrews (9 decks)

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