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Medicine > Derma - Acne > Flashcards

Derma - Acne Flashcards

1
Q

Chronic inflammatory disease of the pilosebaceous follicles, characterized by comedones, papules, pustules, nodules, and often scars

A

Acne vulgaris

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2
Q

Primary lesion of the acne

A

Comedo

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3
Q

Seen as flat or slightly elevaed papule with dilated central opening filled with blackened keratin

A

Open comedo or blackhead

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4
Q

Are usually 1-mm yellowish papules that may require stretching of the skin to visualize

A

Closed comedones (whiteheads)

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5
Q

Uncommon comedo that can reach 3-4 mm in size

A

Macrocomedones

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6
Q

For these type of patients, lesions often resolve with reddish purple macule that is short-lived

A

Light-skinned patients

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7
Q

For these type of ptx, lesions may resolve to macular hyperpigmentation and may last several months

A

Dark-skinned individuals

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8
Q

Acne primary sites

A

Face
Neck
Upper trunk
Upper arms

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9
Q

On the face, acne primary site

A

Cheeks

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10
Q

Acne bgins at

A

Puberty

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11
Q

Neonatal acne has

A. Male
B. Female
Preponderance

A

A. Male

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12
Q

Acne that develops days after birth characterized by transient facial papules or pustules that usually clear spontaneously in a few days or weeks

A

Neonatal acne

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13
Q

Acne that persist beyond the neonatal period or that have an onset after the first 6 weeks of life

A

Infantile acne

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14
Q

In prolonged cases of infantile acne, what management is found effective

A

Topical benzoyl peroxide, erythromycin, or retinoids

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15
Q

For more inflammatory dse of prolonged infantile acne, this management is added to topical medications

A

Oral erythromycin, 125 mg twice daily, or

Trimethoprim, 100 mg twice daily

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16
Q

Can oral isotretinoin be prescribed for infantile acne

A

Yes and it is effective

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17
Q

Midchildhood acne may evolve from

A

Persistent infantile acne or begin after age 1 yr

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18
Q

Midchildhood has preponderance for

A. Males
B. Females

A

A. Males

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19
Q

Fh of acne

A

Strong family history of moderately severe acne

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20
Q

This workup is indicated fo midchildhood acne and for earlier-onset ptx with physical findings suggestive of a hormonal disorder

A

Perdiatric endocrinology workup

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21
Q

what physical findings in earlier-onset patients, are suggestive of a hormonal disorder

A

Sexual precocity
Virilization
Growth abnormality

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22
Q

Acne onset from age _______ is categorized as preadolescent acne

A

7-12 yo

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23
Q

Principal abnormality of acne vulgaris is

A

Comedo formation

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24
Q

What hormone stimulates the sebaceous gland that is critical in acne formation

A

Androgens

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25
Q

What other abnormalities appear in women with hyperandrogenic states, aside from acne

A 
Hirsutism
Menstrual abnormalities (irregular)
Seborrhea
Acanthosis nigricans
Androgenic alopecia
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26
Q

What tx can be used directed at reducing sebaceous secretion

A

Isotretinoin
Estrogens
Antiandrogens

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27
Q

This microorganism is particular to cause acne

A

Propionibacterium acnes

28
Q

causes a red, itchy rash and white scales

A

Seborrhea

29
Q

May be indicated in women who have acne resistant to conventional therapy (relapse quickly after a course of isotretinoin or who experience sudden onset of severe acne)

A

Gynecologic endocrine evaluation

30
Q

Screening tests to exclude a virilizing tumor inclue

A

Serum dehydroepiandrosterone sulfate (DHEAS) and testosterone, 2 weeks before onset of menses

31
Q

DHEAS level in adrenal tumors

A

Very high

>800 ug/dL

32
Q

DHES level in congenital adrenal hyperplasia

A

400-800 ug/dL

33
Q

Ovarian tumor is suggested by

A

testosterone levels greater that 200 ng/dL

34
Q

DHEAS level

Late-onset congenital adrenal hyperplasia

A

Normal levels

35
Q

PCOS expected hormone profile

A

High Testosterone level (150-200 ng/dL)

Inc in LH/FSH ratio (>2-3)

36
Q

Diagnosis of PCOS may ba made clinically by

A

Presence of anovulation (<9 periods per year or periods >40 days apart)
Signs of hyperandrogenism (acne, hirsutism)

37
Q

Acne neonatorum is explained by infantile production of androgens which wanes at

A

6-12 monthss

38
Q

Acne developing after age 1 and before age 7 (onset of adrenarche) may be a form of

A

Acne cosmetica
Acne venenata
Drug-induced acne
Part of an endocrinologic disorder

39
Q

Form of acne triggered by use of cosmetic products

A

Acne cosmetica

40
Q

Acne induced by external contact with a variety of chemicals including pomades and comstemics, oils, chlorinated hydrocarbons, and coal tar

A

Acne venenata

41
Q

Drugs that may worsen acne

A 
Corticosteroids
Anabolic steroids
Neuroleptics
Lithium
Cycosporine
42
Q

Family history of acne

Important

A

FH of acne

Tendency to scarring

43
Q

Diet that can worsen acne

A

High-glycemic diet

Large quantities of skim milk

44
Q

Acne tx

Comedonal

A

Topical retinoid +/- physical extraction (first line)

Alternate retinoid, salicylic acid, azelaic acid (second line)

45
Q

Acne tx

Mild, papular/pustular

A

Topical antimicrobial combination + topical retinoid, benzoyl peroxide wash if mild truncal lesions (first line)

Alternate antimicrobials + alternate topical retinoids, azelaic acid, sodium sulfacetamide-sulfur, salicylic acid (second line)

46
Q

Moderate acne

Papular. Pustular tx

A

Oral antibiotic + topical retinoid + benzoyl peroxide (first line)
Alternate antibiotic, alternate topical retinoid, alternate benzoyl peroxide (second line)
In women: spironolactone + oral contraceptive + topical retinoids +/- topical antibiotic and or benzoyl peroxide
Isotretinoin, if relapses quickly off oral antibiotics, does not clear or scars

47
Q

Severe acne

Nodular or conglobate tx

A

Isotretinoin

Oral antibiotic + topical retinoid + benzoyl peroxide

48
Q

A multifactorial disorder of the pilosebaceous unit characterized by comedones, papules, pustules, nodules, and cysts, with occasional scarring

A

Acne vulgaris (common acne)

49
Q

Predilection sites of acne vulgaris

A

Face, neck, chest, upper back

50
Q

Acne vulgaris more severe for this gender

A

Males

51
Q

acne severity grading

comedonal, few lesions , no scarring

A

I

52
Q

acne severity grading

Nodulocystic, severe scarring

A

IV

53
Q

acne severity grading

Papular, moderate number, +/- scarring

A

II

54
Q

Pustular, >25 lesions, moderate scarring

A

III

55
Q

Topical tx acne vulgaris

A 
Benzoyl peroxide
Clindamycin/ erythromycin
Retinoic acid
Adapalene
Azelaic acid
56
Q

Oral tx acne

Antibiotics

A

Antibiotics

Tetracycline, minocycline, doxycycline, lymecycline, erythromycin

57
Q

Oral tx hormones

A

Antiandrogen:
Cyproterone acetate
High estrogen OCP

58
Q

Types of oral tx acne vulgaris

A

Antibiotics
Anti-androgen hormones
Isotretinoin

59
Q

Drug effect
+ follicular keratinization
+++ P. Acnes
+ inflammation

  • sebum excretion
A

Benzoyl peroxide

60
Q

Drug effect

+ P. Acnes

  • sebum exretion
  • follicular keratinization
  • inflammation
A

Clindamycin

Erythromycin

61
Q

Drug effect
++ follicular keratinization
+ P. Acnes

  • inflammation
  • sebum excretion
A

Tretinoin

Adapalene

62
Q

Drug effect
++ follicular keratinization
++ P. Acnes
+ inflammation

  • sebum excretion
A

Azelaic acid

63
Q

Drug effect
+ sebum excretion

  • follicular keratinization
  • P. Acnes
  • inflammation
A

Antiandrogens

64
Q 
Drug effect
\+++ sebum excretion
\++ follicular keratinization
\+ P. Acnes
\++ inflammation
A

Isotretinoin

65
Q

Adjunctive procedures

Acne vulgaris

A 
Intralesional steroids
Acne surgery
Chemical peeling
Microdermabrasion
Lasers and light
66
Q

Pathogenesis of acne vulgaris

A

Colonization of pilosebaceous follicles by P. Acnes
Inflammation
Hyperplasia of sebaceous glands -> inc sebum production
Follicular hyperkeratinization

Medicine (29 decks)

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