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Bolognia Book Club > Chapter 37 - Acne Vulgaris > Flashcards

Chapter 37 - Acne Vulgaris Flashcards

1
Q

Are P. acnes organisms Gram positive or negative? Motile or non-motile?

A
  • Gram positive

- Non-motile

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2
Q

What are the three species of Propionibacterium?

A
  • P. acnes, P. granulosum, and P. parvum (rare)

- All three can contribute to acne

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3
Q

What causes P. acnes to fluoresce under Wood’s light?

A

They produce porphyrins, primarily coproporphyrin III

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4
Q

If dihydrotestosterone stimulates sebum production, does estrogen decrease sebum production?

A

Yes; however, the dose of estrogen required to suppress sebum production is greater than the dose required to suppress ovulation, thus oral contraceptive pills may help with acne, but higher doses are required to clinically reduce sebum production

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5
Q

What is the name for the most severe form of cystic acne?

A

Acne fulminans

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6
Q

What does SAPHO stand for?

A

Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis

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7
Q

When osteolytic bone lesions occur in the context of acne fulminates, which joints are most commonly affected?

A

The clavicles and sternum

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8
Q

Which entities comprise the follicular occlusion tetrad?

A

Acne conglobata, dissecting cellulitis of the scalp, hidradenitis suppurativa, and pilonidal cysts

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9
Q

What are the 3 bacteria involved in acne?

A

1) Propionibacterium acnes, 2) P. granulosum, 3) P. parvum. They fluoresce under Wood’s lamp due to porphyrins (coproporphyrin III)

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10
Q

Where are androgen receptors located in the skin?

A

Basal layer of sebaceous glands, ORS of hair follicles

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11
Q

What is the black color in open comedones due to?

A

Melanin deposition and lipid oxidation of packed keratin

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12
Q

What is the difference between acne fulminans and acne conglobata?

A

Both have nodulocystic acne. Acne fulminans have systemic symptoms whereas acne conglobata does not

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13
Q

What is the follicular occlusion tetrad?

A

1) Acne conglobata, 2) dissecting cellulitis, 3) HS, 4) pilonidal cysts

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14
Q

What is the gene mutation in PAPA syndrome?

A

PSTPIP1, proline serine threonin phosphatase interacting protein 1, aka CD2 Ag-binding protein 1

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15
Q

What is the treatment for solid facial edema?

A

Isotretinoin 0.2-0.5 mg/kg/d +/- ketotifen 1-2 mg/d x 4-5mths

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16
Q

What is “fiddler’s neck” (ie. well defined lichenified hyperpigmented plaques with comedones) an example of?

A

Acne mechanica

17
Q

What psychiatric disorders are at higher risk of acne excoriee des jeunes filles?

A

Anxiety, OCD, personality disorders

18
Q

What are some drugs that can cause drug induced acne?

A

Anabolic steroids, corticosteroids, corticotropin, phenytoin, lithium, isoniazid, iodies, bromides and EGFR inhibitors

19
Q

What are some agents that can cause occupational acne?

A

Cutting oils, petroleum based products, chlorinated aromatic hydrocarbons, coal tar derivatives

20
Q

What % of healthy newborns are affected by neonatal acne?

A

20%

21
Q

How is infantile acne different from neonatal acne?

A

Presents at 3-6mths old (vs. 2wks old), more prominent comedones, may lead to pitted scars

22
Q

What does HAIR-AN syndrome stand for?

A

Hyperandrogenism, insulin resistance, acanthosis nigricans. These patients have an increased risk of CVD, DM

23
Q

What are some examples of systemic treatment options for acne? Note: broad categories

A

Antiobiotics, OCP, diuretic/spironolactone

24
Q

Which OCPs are FDA approved in the treatment against acne?

A

Yaz, Ortho Tri-Cyclen, Estrostep

25
Q

What initial bloodwork is needed before starting a patient on PO isotretinoin?

A

TGL, cholesterol, LFTs, CBC, ESR, pregnancy test

26
Q

What are the factors that increase risk of developing acne?

A
  1. XYY chromosomal genotype
  2. PCOS
  3. Hyperandregenism
  4. Hypercortisolism
  5. Precocious puberty
27
Q

What porphyrin does P. acnes primarily produce?

A

Coproporphyrin III

28
Q

In respect to acne, where are the androgen receptors located?

A
  1. Cells of basal layer of sebaceous glands

2. Outer root sheath of hair follicle

29
Q

Where are the androgens produced?

A
  1. Gonads
  2. Adrenal gland
  3. Sebaceous glands
30
Q

What is the DDx for acne eruption in an oncology patient?

A
  1. Steroid induced acne
  2. Neutrophilic eccrine hidradenitis
  3. Folliculodystrophy of immunosupression
  4. Other folliculitis
31
Q

What topical retinoid is photo-stable?

A

Adapalene

32
Q

Which systemic tetracycline has the least resistance to P. acnes?

A

Minocycline

33
Q

What is the half life of isotretinoin?

A

18 hours

Bolognia Book Club (29 decks)

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