Derma - Acne Flashcards
Chronic inflammatory disease of the pilosebaceous follicles, characterized by comedones, papules, pustules, nodules, and often scars
Acne vulgaris
Primary lesion of the acne
Comedo
Seen as flat or slightly elevaed papule with dilated central opening filled with blackened keratin
Open comedo or blackhead
Are usually 1-mm yellowish papules that may require stretching of the skin to visualize
Closed comedones (whiteheads)
Uncommon comedo that can reach 3-4 mm in size
Macrocomedones
For these type of patients, lesions often resolve with reddish purple macule that is short-lived
Light-skinned patients
For these type of ptx, lesions may resolve to macular hyperpigmentation and may last several months
Dark-skinned individuals
Acne primary sites
Face
Neck
Upper trunk
Upper arms
On the face, acne primary site
Cheeks
Acne bgins at
Puberty
Neonatal acne has
A. Male
B. Female
Preponderance
A. Male
Acne that develops days after birth characterized by transient facial papules or pustules that usually clear spontaneously in a few days or weeks
Neonatal acne
Acne that persist beyond the neonatal period or that have an onset after the first 6 weeks of life
Infantile acne
In prolonged cases of infantile acne, what management is found effective
Topical benzoyl peroxide, erythromycin, or retinoids
For more inflammatory dse of prolonged infantile acne, this management is added to topical medications
Oral erythromycin, 125 mg twice daily, or
Trimethoprim, 100 mg twice daily
Can oral isotretinoin be prescribed for infantile acne
Yes and it is effective
Midchildhood acne may evolve from
Persistent infantile acne or begin after age 1 yr
Midchildhood has preponderance for
A. Males
B. Females
A. Males
Fh of acne
Strong family history of moderately severe acne
This workup is indicated fo midchildhood acne and for earlier-onset ptx with physical findings suggestive of a hormonal disorder
Perdiatric endocrinology workup
what physical findings in earlier-onset patients, are suggestive of a hormonal disorder
Sexual precocity
Virilization
Growth abnormality
Acne onset from age _______ is categorized as preadolescent acne
7-12 yo
Principal abnormality of acne vulgaris is
Comedo formation
What hormone stimulates the sebaceous gland that is critical in acne formation
Androgens
What other abnormalities appear in women with hyperandrogenic states, aside from acne
Hirsutism Menstrual abnormalities (irregular) Seborrhea Acanthosis nigricans Androgenic alopecia
What tx can be used directed at reducing sebaceous secretion
Isotretinoin
Estrogens
Antiandrogens
This microorganism is particular to cause acne
Propionibacterium acnes
causes a red, itchy rash and white scales
Seborrhea
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)
Gynecologic endocrine evaluation
Screening tests to exclude a virilizing tumor inclue
Serum dehydroepiandrosterone sulfate (DHEAS) and testosterone, 2 weeks before onset of menses
DHEAS level in adrenal tumors
Very high
>800 ug/dL
DHES level in congenital adrenal hyperplasia
400-800 ug/dL
Ovarian tumor is suggested by
testosterone levels greater that 200 ng/dL
DHEAS level
Late-onset congenital adrenal hyperplasia
Normal levels
PCOS expected hormone profile
High Testosterone level (150-200 ng/dL)
Inc in LH/FSH ratio (>2-3)
Diagnosis of PCOS may ba made clinically by
Presence of anovulation (<9 periods per year or periods >40 days apart)
Signs of hyperandrogenism (acne, hirsutism)
Acne neonatorum is explained by infantile production of androgens which wanes at
6-12 monthss
Acne developing after age 1 and before age 7 (onset of adrenarche) may be a form of
Acne cosmetica
Acne venenata
Drug-induced acne
Part of an endocrinologic disorder
Form of acne triggered by use of cosmetic products
Acne cosmetica
Acne induced by external contact with a variety of chemicals including pomades and comstemics, oils, chlorinated hydrocarbons, and coal tar
Acne venenata
Drugs that may worsen acne
Corticosteroids Anabolic steroids Neuroleptics Lithium Cycosporine
Family history of acne
Important
FH of acne
Tendency to scarring
Diet that can worsen acne
High-glycemic diet
Large quantities of skim milk
Acne tx
Comedonal
Topical retinoid +/- physical extraction (first line)
Alternate retinoid, salicylic acid, azelaic acid (second line)
Acne tx
Mild, papular/pustular
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)
Moderate acne
Papular. Pustular tx
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
Severe acne
Nodular or conglobate tx
Isotretinoin
Oral antibiotic + topical retinoid + benzoyl peroxide
A multifactorial disorder of the pilosebaceous unit characterized by comedones, papules, pustules, nodules, and cysts, with occasional scarring
Acne vulgaris (common acne)
Predilection sites of acne vulgaris
Face, neck, chest, upper back
Acne vulgaris more severe for this gender
Males
acne severity grading
comedonal, few lesions , no scarring
I
acne severity grading
Nodulocystic, severe scarring
IV
acne severity grading
Papular, moderate number, +/- scarring
II
Pustular, >25 lesions, moderate scarring
III
Topical tx acne vulgaris
Benzoyl peroxide Clindamycin/ erythromycin Retinoic acid Adapalene Azelaic acid
Oral tx acne
Antibiotics
Antibiotics
Tetracycline, minocycline, doxycycline, lymecycline, erythromycin
Oral tx hormones
Antiandrogen:
Cyproterone acetate
High estrogen OCP
Types of oral tx acne vulgaris
Antibiotics
Anti-androgen hormones
Isotretinoin
Drug effect
+ follicular keratinization
+++ P. Acnes
+ inflammation
- sebum excretion
Benzoyl peroxide
Drug effect
+ P. Acnes
- sebum exretion
- follicular keratinization
- inflammation
Clindamycin
Erythromycin
Drug effect
++ follicular keratinization
+ P. Acnes
- inflammation
- sebum excretion
Tretinoin
Adapalene
Drug effect
++ follicular keratinization
++ P. Acnes
+ inflammation
- sebum excretion
Azelaic acid
Drug effect
+ sebum excretion
- follicular keratinization
- P. Acnes
- inflammation
Antiandrogens
Drug effect \+++ sebum excretion \++ follicular keratinization \+ P. Acnes \++ inflammation
Isotretinoin
Adjunctive procedures
Acne vulgaris
Intralesional steroids Acne surgery Chemical peeling Microdermabrasion Lasers and light
Pathogenesis of acne vulgaris
Colonization of pilosebaceous follicles by P. Acnes
Inflammation
Hyperplasia of sebaceous glands -> inc sebum production
Follicular hyperkeratinization
