Dermatitis and Acne Vulgaris--Westra - Sheet1 Flashcards
Common Acne
A SKIN DISORDER OF THE PILOSEBACEOUS (relating to hair and the sebaceous glands) UNIT
No precise definition but most authorities consider presence of 5-10
comedones or noninflammatory lesions as a requirement.
What is the pathophysiology of acne vulgaris?
ARISE FROM THE PILOSEBACEOUS UNITS – CONSISTS OF THE SEBACEOUS GLAND AND SMALL HAIR FOLLICLES. Greatest density of pilosebaceous units on the face, upper neck and chest. (9 times the concentration compared to rest of body)
OBSTRUCTION OF THE PILOSEBACEOUS CANAL IS THE PRIMARY CAUSE OF ACNE
Excessive Sebum Production
Follicular Plugging
Colonization of Sebaceous Follicle with Propionibacterium acnes
Immune Response with Inflammation
Comedone
a dilated (widened) hair follicle filled with keratin squamae (skin debris), bacteria, and sebum (oil). Comedones may be closed or open.
bulla
Large fluid-containing blister > 5 mm, Bullous pemphigoid
papules
Elevated solid skin lesion < 5 mm, Mole (nevus), acne
Myths of acne
diet, lack of bathing/shampoo, hairstyles, cosmetics
puberty and acne
early manifestation of puberty–**largest incidence period
often precedes menarche in girls one year
Predominant lesions are comedones
Stages of Acne
STAGES OF ACNE A – NORMAL FOLLICLE B – OPEN COMEDO (BLACKHEAD) C – CLOSED COMEDO (WHITEHEAD) D – PAPULE E - PUSTULE
4 reasons for acne
excessive sebum production, follicular plugging, colonization of sebaceous follicle with Propionibacterium acnes, immune response with inflammation
Common colonization of hte sebaceous follicle
**Propionibacterium acnes*
Propionibacterium granulosum
Coagulase-negative micrococci
Yeast – Pityrosporum ovale
**Medications that trigger acne
Anabolic Steroids Corticosteroids Isoniazid Lithium Phenytoin
GRADE I Acne
Superficial Non-Inflammatory
- Open and closed comedones
- Flesh colored papules
- NO inflammation
- NO pustules
- NO nodules
- NO scars
Grade II Acne
Superficial Inflammatory
- Open and closed comedones
- Inflammation
- Papules/pustules-few to several
- NO nodules
- NO scars
Grade III Acne
Deep Inflammatory
- Moderate to severe
- Open and closed comedones
- Papules/pustules
- Few nodules
- Little to no scar present
Grade IV Acne
Severe Nodulocystic
- Deep/Inflammatory
- Open and closed comedones
- Papules/pustules
- Extensive nodules
- Variable degree scar
Lab tests for Acne
NOT indicated, unless persistant problem. Hyperandrogenism could be consisdered and tested with Serum DHEAS=dehydroepiandrosterone sulfate, total testosterone, free testosterone, and luteinizing hormone (LH) to follicle stimulating hormone (FSH) ratio. TESTING DONE IN LUTEAL PHASE OF THE MENSTRUAL CYCLE (WITHIN 2 WEEKS PRIOR TO START OF MENSES)
Differential diagnosis for acne
acne rosacea, gram-neg folliculitis, perioral dermatitis, steroid-induced acne
Grade I treatment for acne
First Line (Topical Retinoids) Topical Benzoyl Peroxide Products Consider: Alpha hydroxy-Acid Products Salicylic Acid
Grade II treatment for acne
First Line Topical Retinoids Benzoyl Peroxide Topical Antibiotics Consider: Azelaic Acid
Grade III treatment for acne
First Line Topical Retinoid Oral Antibiotics Second Line Benzoyl Peroxide Intralesional corticosteroid injections Women: hormone therapy Oral Isotretinoin
Grade IV treatment for acne
First Line Oral Isotretinoin Oral Contraceptives for Women Second Line Intralesional corticosteroid injections Incision and Drainage
Treatment that inhibis the growth of P.acnes
Azelaic acid, Benzoyl Peroxide and topical antibiotics
isotretinoin
**Only medication to suppress acne over long term. Works on all four pathophysiologies. TERATOGENIC (both men and women). SEE WEBSITE.
Acne Rosacea
Chronic and progressive dermatosis characterized by erythema, papules and pustules, telangiectasia, and potential hyperplasia over the central portion of the face
Affects middle-aged adults
Casues: unknown
Treatment of Acne Rosacea
Antibiotics for papular and pustular components - Tetracycline (250-500mg daily)
Metronidazole (MetroGel)
Azelaic Acid Gel 15%(Finacea)
Atopic Dermatitis (Eczema) *
“The itch that rashes” Treat by Cutaneous hydration, Topical Glucocorticoid Rx, Identify and Eliminate Flare Factors. Avoid drying!
Chronic.
Contact Dermatitis *
(Type IV hypersensitivity) Follows exposure to allergen. Lesions include erythemitous vesicular rash, occur at site of contact (e.g., nickel, poison ivy, neomycin). Acute (linear–diff with Lichen planus) vs. chronic (lichenification). Treat by preventing contact.
Seborrheic Dermatitis *
FLAKINESS (DANDRUF) chronic, superficial, affects hairy regions. (associated with HIV and Parkinsons). Unknown cause. cradle cap is a form of SD. Treat w/ removing scales and management (secondary infection prevention)
Photodermatitis*
(Type IV hypersensitivity) UV light alters the antigen to make it an effective immunogen.
Impetigo*
Very superficial skin infection. Usually from S. aureus or S. pyogenes. Highly contagious. Honey colored crusting. Bullous impetigo [I) has bullae and is usually caused by S. aureus.
Lichenification
Thickening of the skin with hyperkeratosis caused by chronic inflammation resulting from prolonged scratching or irritation.
Hallmark fo seborrhic dermatitis*
flackiness
poison ivy hallmark*
linear vesicles
hallmark for eczima*
itch that rashes
Type I hypersensitivity disorder
Immediate, anaphylactic, atropic. Anaphylaxis (e.g., bee sting, some food/drug allergies)
Allergic and atopic disorders (e.g., rhinitis, hayfever, eczema, hives, asthma)
Type II hypersensitivity disorder
Disease tends to be specific to tissue or site where antigen is found. Autoimmune hemolytic anemia (AIHA), Pernicious anemia
Idiopathic thrombocytopenic purpura, Erythroblastosis fetalis, Acute hemolytic transfusion reactions, Rheumatic fever, Goodpasture’s syndrome, Bullous pemphigoid, Pemphigus vulgaris
Type III hypersensitivity
Can be associated with vasculitis and systemic manifestations. SLE, Polyarteritis nodosa, Poststreptococcal glomerulonephritis, Serum sickness, Arthus reaction (e.g., swelling and inflammation following tetanus vaccine)
Type IV hypersensitivity
Response is delayed and does not involve antibodies (vs. types I, II, and III), Multiple sclerosis, Guillain-Barre syndrome Graft-versus-host disease, PPD (test forM. tuberculosis), Contact dermatitis (e.g., poison ivy, nickel allergy).
