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STEP Pathology > deck_5402862 > Flashcards

deck_5402862 Flashcards

1
Q

What are the four main factors in the development of acne?

A

-Sebaceous gland hyperplasia (especially via androgen)-Abnormal follicular desquamation-Proprionobacteriumacne colonization-Inflammation

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2
Q

What is a microcomedo?

A

Non-inflammatory comedones, which are small, below the surface clots below the surface of the skin which then progress into blackheads (open) or whiteheads (closed), which are non-inflammatory comedones

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3
Q

What happens to blackheads and whiteheads?

A

These trap debris and become inflammatory and turn into papules, nodules, cysts, etc.

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4
Q

What are some topical treatments of acne?

A

-OTC: Benzoyl peroxide or salicylic acidPrescription: Antimicrobials, retinoids

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5
Q

Which is more effective, benzoyl peroxide or salicylic acid?

A

Benzoyl peroxide

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6
Q

How does Benzoyl peroxide work?

A

Multiple MOA: killes P. acnes and mildly comedolytic and anti-inflammatory

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7
Q

Benzoyl peroxide is typically used in combination with ______.

A

retinoids

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8
Q

T or F. Benzoyl peroxide limits development of P. acnes ABX resistance

A

T.

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9
Q

What are the AEs of Benzoyl peroxide?

A

well-tolerated, but can get irritation, bleaching of fabric, and rarely allergic contact dermatitis

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10
Q

What are some topical ABX for acne?

A

Clindamycin and erythromycin (these have some anti-inflammatory effects- primary reason for use)

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11
Q

T or F. Topical ABX are not recommended for monotherapy for acne

A

T. This tends to increase ABX-resistance and these are not comedolytic so not that effective

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12
Q

How should topical ABX be used in acne?

A

Add topical BP or use a combo product

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13
Q

How do topical retinoids work?

A

The 1st line therapy for acnelately (and preferred for maintenance), and work by normalizing follicular desquamation (Comedolytic), anti-inflammatory, and enhance penetration of other compounds by getting rid of dead layers of skin

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14
Q

What are some topical retinoid options?

A

-Adapalene (milder and better tolerated)-Tretinoin-Tazarotene (more for severe, do not give in pregnancy)

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15
Q

What are systemic ABX given for acne?

A

These are more for cases of moderate to severe inflammatory acne (most are not FDA approved for acne except Solodyn (minocycline)the goal is maintenance with a topical (want to work people off PO ABX in 3-6 months)

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16
Q

Preferred systemic ABX for acne? over 8 yo

A

Tetracycline, Doxy, Mino

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17
Q

What are some AEs of systemic tetracycline?

A

GI upset, tooth staining

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18
Q

What are some AEs of systemic Doxycycline?

A

photosensitivity, esophagitis

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19
Q

What are some AEs of systemic Minocycline?

A

dyspigmentation, lupus-like rxns, SJS, pseudotumor cerebri, DHS

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20
Q

When are oral contraceptives used for acne?

A

consider for females with moderate to severe acne with flares aroundmenstration cycles

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21
Q

How do OCs help in acne?

A

they have an anti-androgen effect to suppress sebum production

22
Q

When are oral retinoids indicated (Isotretinoin)?

A

severe, scarring, and refractory acne

23
Q

How does Isotretinoin work?

A

affects all four main factors of acne production (decreases size/activity of sebaceous glands, normalizies follicular keratinization, inhibits P. acnes, anti-inflammatory)

24
Q

What are some commonAEs of oral retinoids?

A

-dry lips, skin, eyes-nosebleeds,-muscles aches-mild HA

25
Q

What are some rarer, more severe AEs of oral retinoids?

A

-teratogenic-depression, suicidal ideation-increased risk of fractures, epiphyseal closure-IBD (UC over CD)

26
Q

How should MILD comedonal acne be treated (typically pre-adolescent acne)?

A

topical retinoid

27
Q

How should mildinflammatoryacne be treated?

A

topical retinoid+ topical ABX

28
Q

How should moderateinflammatoryacne be treated?

A

topical retinoid + topical ABX + oral ABX

29
Q

How should SEVERE inflammatoryacne be treated?

A

Minimal scarring: topical retinoid + topical ABX + oral ABXScarring: Isotretinoin

30
Q

Basic skin care during acne treatment

A

-Gentle cleansing 1-2x day-Mild, fragrance-free cleanser-oil-free moisturizer with SPF 30+ bid-avoid OTC acne washes and topicals during treatment (too irritating)

31
Q

Myths of acne

A

-Acne is NOT caused by poor hygiene or diet-diet controversial (high glycemic index may lead to hyperinsulinemia and stimulate androgen synthesis-milk may actually be problematic

32
Q

When to refer to a dermatologist?

A

-severe acne (cysts, nodules)-no response to treatment after 12 weeks-if systemic ABX needed over 1yr-acne assoicated with a systemic disease

33
Q

What is the patient pop for rosacea?

A

This is a relapsing and remitting problem common in women over 30 with fair skin

34
Q

What things contribute to rosacea?

A

-Inflammation-Demodex folliculorum-genetics-vascular abnormalities-triggers

35
Q

What are some triggers of rosacea?

A

sunlight, exercise, hot/cold, stress, foods, alcohol

36
Q

What are the four types of rosacea?

A

-Erythematotelangiectatic-Papulopustular-Phymatous (swelling- can lead to a large nose)-Ocular

37
Q

Rosacea

A
38
Q

What are some topical treatments for rosacea?

A

-metronidazole (more anti-inflammatory)-azelaic acid-sodium sulfacetamide with sulfur

39
Q

Other treatments for rosacea?

A

-PO tetracycline-laser, surgery, IPL (intense pulse light)

40
Q

What is perioral dermatits (aka periorificial)

A

Variant of rosacea that affects primarily women 20-45 yrs (and some prepubertal children)

41
Q

Triggers for perioral dermatitis?

A

-Hx of topical steroid use in that area-menstruation, pregnancy-stress-fluorinated toothpaste-Candida, demodex mites

42
Q

How does perioral dermatitis present?

A

rash or ‘pimples’ around mouth or nose, eyes, labia rarely

43
Q

How is perioral dermatitis treated?

A

-dincontinue topical steroidsMild: Topical ABX (Metrocream)Severe: PO ABXand may need topical non-steroidal anti-inflammatory

44
Q

What is folloculitis?

A

Common sequlae of Staph aureus, Strep, or Pseudomonas infection

45
Q

What is a fungal cause of folliculitis?

A

Pityrosporum orbiculare

46
Q

Other causes of folliculitis?

A

-Mites (demodex)-Mechanical (areas of friction)-eosinophilic folloculitis (common inHIV ortransplant patients with immunosuppresstants)

47
Q

How is folliculitis treated?

A

-antibacterial soaps/washesor topical ABX/antifungals

48
Q

What is Hidradenitis suppurativa (HS)?

A

condiition affecting apocrine gland bearing areas (commonly in the axillary, inguinal, underneath the breasts, and other body folds) commonly affecting women more than men

49
Q

What are some risk factors for HS?

A

ObesityCigsFam Hx

50
Q

HS

A
51
Q

How is mild HS treated?

A

topical and/or oral ABX to suppress inflammation

52
Q

How is moderate to severe HS treated?

A

injected steroids, TNFa inhibitors, surgery

STEP Pathology (80 decks)

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