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Skin/MS--Week 3 > Dermatitis and Acne Vulgaris--Westra - Sheet1 > Flashcards

Dermatitis and Acne Vulgaris--Westra - Sheet1 Flashcards

1
Q

Common Acne

A

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.

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2
Q

What is the pathophysiology of acne vulgaris?

A

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

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3
Q

Comedone

A

a dilated (widened) hair follicle filled with keratin squamae (skin debris), bacteria, and sebum (oil). Comedones may be closed or open.

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4
Q

bulla

A

Large fluid-containing blister > 5 mm, Bullous pemphigoid

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5
Q

papules

A

Elevated solid skin lesion < 5 mm, Mole (nevus), acne

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6
Q

Myths of acne

A

diet, lack of bathing/shampoo, hairstyles, cosmetics

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7
Q

puberty and acne

A

early manifestation of puberty–**largest incidence period
often precedes menarche in girls one year
Predominant lesions are comedones

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8
Q

Stages of Acne

A 
STAGES OF ACNE
A – NORMAL FOLLICLE
B – OPEN COMEDO (BLACKHEAD)
C – CLOSED COMEDO (WHITEHEAD)
D – PAPULE
E - PUSTULE
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9
Q

4 reasons for acne

A

excessive sebum production, follicular plugging, colonization of sebaceous follicle with Propionibacterium acnes, immune response with inflammation

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10
Q

Common colonization of hte sebaceous follicle

A

**Propionibacterium acnes*
Propionibacterium granulosum
Coagulase-negative micrococci
Yeast – Pityrosporum ovale

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11
Q

**Medications that trigger acne

A 
Anabolic Steroids 
Corticosteroids 
Isoniazid
Lithium
Phenytoin
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12
Q

GRADE I Acne

A

Superficial Non-Inflammatory

  • Open and closed comedones
  • Flesh colored papules
  • NO inflammation
  • NO pustules
  • NO nodules
  • NO scars
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13
Q

Grade II Acne

A

Superficial Inflammatory

  • Open and closed comedones
  • Inflammation
  • Papules/pustules-few to several
  • NO nodules
  • NO scars
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14
Q

Grade III Acne

A

Deep Inflammatory

  • Moderate to severe
  • Open and closed comedones
  • Papules/pustules
  • Few nodules
  • Little to no scar present
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15
Q

Grade IV Acne

A

Severe Nodulocystic

  • Deep/Inflammatory
  • Open and closed comedones
  • Papules/pustules
  • Extensive nodules
  • Variable degree scar
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16
Q

Lab tests for Acne

A

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)

17
Q

Differential diagnosis for acne

A

acne rosacea, gram-neg folliculitis, perioral dermatitis, steroid-induced acne

18
Q

Grade I treatment for acne

A 
First Line
 (Topical Retinoids)
 Topical Benzoyl Peroxide Products
Consider:
  Alpha hydroxy-Acid Products
  Salicylic Acid
19
Q

Grade II treatment for acne

A 
First Line
 Topical Retinoids
 Benzoyl Peroxide
 Topical Antibiotics
Consider:
 Azelaic Acid
20
Q

Grade III treatment for acne

A 
First Line
 Topical Retinoid
 Oral Antibiotics
Second Line
 Benzoyl Peroxide
 Intralesional corticosteroid injections
 Women: hormone therapy
 Oral Isotretinoin
21
Q

Grade IV treatment for acne

A 
First Line
 Oral Isotretinoin
 Oral Contraceptives for Women
Second Line
 Intralesional corticosteroid injections
 Incision and Drainage
22
Q

Treatment that inhibis the growth of P.acnes

A

Azelaic acid, Benzoyl Peroxide and topical antibiotics

23
Q

isotretinoin

A

**Only medication to suppress acne over long term. Works on all four pathophysiologies. TERATOGENIC (both men and women). SEE WEBSITE.

24
Q

Acne Rosacea

A

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

25
Q

Treatment of Acne Rosacea

A

Antibiotics for papular and pustular components - Tetracycline (250-500mg daily)
Metronidazole (MetroGel)
Azelaic Acid Gel 15%(Finacea)

26
Q

Atopic Dermatitis (Eczema) *

A

“The itch that rashes” Treat by Cutaneous hydration, Topical Glucocorticoid Rx, Identify and Eliminate Flare Factors. Avoid drying!
Chronic.

27
Q

Contact Dermatitis *

A

(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.

28
Q

Seborrheic Dermatitis *

A

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)

29
Q

Photodermatitis*

A

(Type IV hypersensitivity) UV light alters the antigen to make it an effective immunogen.

30
Q

Impetigo*

A

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.

31
Q

Lichenification

A

Thickening of the skin with hyperkeratosis caused by chronic inflammation resulting from prolonged scratching or irritation.

32
Q

Hallmark fo seborrhic dermatitis*

A

flackiness

33
Q

poison ivy hallmark*

A

linear vesicles

34
Q

hallmark for eczima*

A

itch that rashes

35
Q

Type I hypersensitivity disorder

A

Immediate, anaphylactic, atropic. Anaphylaxis (e.g., bee sting, some food/drug allergies)
Allergic and atopic disorders (e.g., rhinitis, hayfever, eczema, hives, asthma)

36
Q

Type II hypersensitivity disorder

A

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

37
Q

Type III hypersensitivity

A

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)

38
Q

Type IV hypersensitivity

A

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).

Skin/MS--Week 3 (8 decks)

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