Dermatitis and Acne Vulgaris--Westra - Sheet1

Question 1

Common Acne

Answer 1

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.

Question 2

What is the pathophysiology of acne vulgaris?

Answer 2

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

Question 3

Comedone

Answer 3

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

Question 4

bulla

Answer 4

Large fluid-containing blister > 5 mm, Bullous pemphigoid

Question 5

papules

Answer 5

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

Question 6

Myths of acne

Answer 6

diet, lack of bathing/shampoo, hairstyles, cosmetics

Question 7

puberty and acne

Answer 7

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

Question 8

Stages of Acne

Answer 8

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

Question 9

4 reasons for acne

Answer 9

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

Question 10

Common colonization of hte sebaceous follicle

Answer 10

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

Question 11

**Medications that trigger acne

Answer 11

Anabolic Steroids 
Corticosteroids 
Isoniazid
Lithium
Phenytoin

Question 12

GRADE I Acne

Answer 12

Superficial Non-Inflammatory

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

Question 13

Grade II Acne

Answer 13

Superficial Inflammatory

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

Question 14

Grade III Acne

Answer 14

Deep Inflammatory

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

Question 15

Grade IV Acne

Answer 15

Severe Nodulocystic

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

Question 16

Lab tests for Acne

Answer 16

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)

Question 17

Differential diagnosis for acne

Answer 17

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

Question 18

Grade I treatment for acne

Answer 18

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

Question 19

Grade II treatment for acne

Answer 19

First Line
 Topical Retinoids
 Benzoyl Peroxide
 Topical Antibiotics
Consider:
 Azelaic Acid

Question 20

Grade III treatment for acne

Answer 20

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

Question 21

Grade IV treatment for acne

Answer 21

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

Question 22

Treatment that inhibis the growth of P.acnes

Answer 22

Azelaic acid, Benzoyl Peroxide and topical antibiotics

Question 23

isotretinoin

Answer 23

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

Question 24

Acne Rosacea

Answer 24

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

Question 25

Treatment of Acne Rosacea

Answer 25

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

Question 26

Atopic Dermatitis (Eczema) *

Answer 26

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

Question 27

Contact Dermatitis *

Answer 27

(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.

Question 28

Seborrheic Dermatitis *

Answer 28

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)

Question 29

Photodermatitis*

Answer 29

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

Question 30

Impetigo*

Answer 30

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.

Question 31

Lichenification

Answer 31

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

Question 32

Hallmark fo seborrhic dermatitis*

Answer 32

flackiness

Question 33

poison ivy hallmark*

Answer 33

linear vesicles

Question 34

hallmark for eczima*

Answer 34

itch that rashes

Question 35

Type I hypersensitivity disorder

Answer 35

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

Question 36

Type II hypersensitivity disorder

Answer 36

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

Question 37

Type III hypersensitivity

Answer 37

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)

Question 38

Type IV hypersensitivity

Answer 38

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).