Dermatology/ Acne and Rosacea Flashcards
Acne is characterized by inflammation of what type of tissues?
Pilosebaceous units
Who gets acne?
Can affect all ages, but peaks in adolescence
What are the primary causes of acne?
- Increased sebum production
- Follicular hyperkeratinization leading to follicle obstruction
- Growth of the bacteria Propionibacterium acnes in an anaerobic, lipid-rich environment
- Inflammatory response
What are comedones?
Sebaceous follicles plugged with keratin and sebum
What does acne look like?
- open comedones (blackheads) or closed comedones (whiteheads)
- with papules, pustules, and cysts
- with or without inflammation
What is the difference between open and closed comedones? exacerbations?
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
What are some of the late manifestations of acne?
- Scarring
- postinflammatory hyperpigmentation
Is acne caused by chocolate and fatty foods?
No
Can stress cause acne exacerbations?
Yes, likely due to corticotropin-releasing hormone’s effect on sebaceous glands
What medications can be associated with acne exacerbations?
- Lithium
- phenytoin
- glucocorticoids
- androgens
What is concerning about a patient with persistent acne and hirsutism?
- 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.
Where on the body does acne most commonly occur?
- Areas with a high density of sebaceous glands:
- face
- neck
- upper arms
- chest, back
What are initial topical regimens for acne?
- Retinoid (adapalene, tazarotene, tretinoin) and benzoyl peroxide
What topical medications can be added for inflammatory acne?
- 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).
What can be used for more severe acne?
- Oral antibiotics (minocycline, tetracycline, erythromycin, or doxycycline).
- To decrease antibiotic resistance, use for less than 6 months and add topical benzoyl peroxide
What is isotretinoin?
A 13-cis retinoic acid that is a highly effective oral treatment for acne
What are the indications for isotretinoin therapy?
- 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
What are the FDA pregnancy risk categories for acne medications?
Class B: erythromycin, clindamycin
Class C: benzoyl peroxide
Class X: isotretinoin and tazarotene
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)?
Acne rosacea
Who gets rosacea?
The age of onset is 30-50 years and is more common in females than males.
Are acne vulgaris and acne rosacea related?
- No. But they can coexist.
- Rosacea has no comedones.
What triggers can exacerbate the vasodilatation associated with rosacea?
- hot/spicy foods
- alcohol
- temperature extremes
- stress
What is the treatment for rosacea?
- avoiding triggers
- topical and oral antibiotics (metronidazole, tetracycline, minocycline)
- isotretinoin for severe disease
- surgery for rhinophyma
