Dermatology/ Acne and Rosacea

Question 1

Acne is characterized by inflammation of what type of tissues?

Answer 1

Pilosebaceous units

Question 2

Who gets acne?

Answer 2

Can affect all ages, but peaks in adolescence

Question 3

What are the primary causes of acne?

Answer 3

1. Increased sebum production
2. Follicular hyperkeratinization leading to follicle obstruction
3. Growth of the bacteria Propionibacterium acnes in an anaerobic, lipid-rich environment
4. Inflammatory response

Question 4

What are comedones?

Answer 4

Sebaceous follicles plugged with keratin and sebum

Question 5

What does acne look like?

Answer 5

• open comedones (blackheads) or closed comedones (whiteheads)
• with papules, pustules, and cysts
• with or without inflammation

Question 6

What is the difference between open and closed comedones? exacerbations?

Answer 6

Open comedones are follicles with dilated openings from which sebum and keratin are easily expressed. They have a black appearance because melanin, in epithelial cells that were shed, is exposed to air and becomes oxidized. In contrast, closed comedones have microscopic openings so that materials are not easily expressed and melanin is not exposed to air, leading to skin colored papules

Question 7

What are some of the late manifestations of acne?

Answer 7

• Scarring
• postinflammatory hyperpigmentation

Question 8

Is acne caused by chocolate and fatty foods?

Answer 8

No

Question 9

Can stress cause acne exacerbations?

Answer 9

Yes, likely due to corticotropin-releasing hormone’s effect on sebaceous glands

Question 10

What medications can be associated with acne exacerbations?

Answer 10

• Lithium
• phenytoin
• glucocorticoids
• androgens

Question 11

What is concerning about a patient with persistent acne and hirsutism?

Answer 11

• An underlying diagnosis of hyperandrogenism should be considered.
• This presentation may be secondary to polycystic ovarian syndrome (PCOS) or androgen secreting tumors, including adrenal or ovarian tumors.

Question 12

Where on the body does acne most commonly occur?

Answer 12

• Areas with a high density of sebaceous glands:
  
  • face
  • neck
  • upper arms
  • chest, back

Question 13

What are initial topical regimens for acne?

Answer 13

• Retinoid (adapalene, tazarotene, tretinoin) and benzoyl peroxide

Question 14

What topical medications can be added for inflammatory acne?

Answer 14

• Antibiotics (erythromycin or clindamycin).
• These should be used with topical retinoids (due to the increased efficacy of combination therapy) or topical benzoyl peroxide (to decrease the incidence of antibiotic resistance).

Question 15

What can be used for more severe acne?

Answer 15

• Oral antibiotics (minocycline, tetracycline, erythromycin, or doxycycline).
• To decrease antibiotic resistance, use for less than 6 months and add topical benzoyl peroxide

Question 16

What is isotretinoin?

Answer 16

A 13-cis retinoic acid that is a highly effective oral treatment for acne

Question 17

What are the indications for isotretinoin therapy?

Answer 17

• recalcitrant acne (less than 50% improvement after 6 months of therapy with combined oral and topical antibiotics)
• scarring acne
• acne with undue psychological distress
• Gram-negative folliculitis

Question 18

What are the FDA pregnancy risk categories for acne medications?

Answer 18

Class B: erythromycin, clindamycin

Class C: benzoyl peroxide

Class X: isotretinoin and tazarotene

Question 19

What is the name for the chronic skin disease of the facial pilosebaceous units leading to flushing, telangiectasia, follicular papules, and in more severe cases, lymphedema and rhinophyma (enlarged nose)?

Answer 19

Acne rosacea

Question 20

Who gets rosacea?

Answer 20

The age of onset is 30-50 years and is more common in females than males.

Question 21

Are acne vulgaris and acne rosacea related?

Answer 21

• No. But they can coexist.
• Rosacea has no comedones.

Question 22

What triggers can exacerbate the vasodilatation associated with rosacea?

Answer 22

• hot/spicy foods
• alcohol
• temperature extremes
• stress

Question 23

What is the treatment for rosacea?

Answer 23

• avoiding triggers
• topical and oral antibiotics (metronidazole, tetracycline, minocycline)
• isotretinoin for severe disease
• surgery for rhinophyma