Disease of the Follicles and Sweat Glands

Question 1

Acne vulgaris is caused by an overgrowth of what bacteria?

Answer 1

propionibacterium acnes. it causes breakdown of the sebaceous lipids, producing inflammatory products that initiate the sequence of lesion development.

Question 2

What is the sequence of lesion development for acne?

Answer 2

comedones–> papules –> pustules –> cysts–> scars

Question 3

What is a blackhead?

Answer 3

plug fully blocks the pore opening and becomes a comedone. If a comedone is open to air it becomes oxidized and turns black.

Question 4

what is a whitehead?

Answer 4

come done forms beneath the surface of the skin and is close to the outside air, so it does not discolor. Often leads to a papule or a pustule.

Question 5

What is a papule:

Answer 5

bacteria combines with sebum and results in inflammation and redness.

Question 6

pustule:

Answer 6

additional inflammation and pus may form causing a red, raised blemish that is often painful. pus is a mixture of white blood cells, dead skin, and bacteria.

Question 7

what is mild mod and severe acne:

Answer 7

mild : characterized by the presence of few to several ceomdones, puapules and pustules but NO nodules

mod: presence of several to may ppuales and pustuesl along with nodules
severe: presence of numerous papules and pustules as well as many cysts and nodules, possible scarring.

Question 8

Grade acne:

Answer 8

grade 1: superficial, non inflammatory comedone

grade 2: superficial, inflammatory papules, pustules

grade 3: superficial, paupules, pustules, comedones, nodules

grade 4: cystic acne.

Question 9

Keratolytics:

Answer 9

used mainly for comedonal acne
takes 2-3 months to work
ex. topical retinoids or antikeratizning agents such as azaleic acid.

Question 10

Antibacterial topicals:

Answer 10

inflammatory and comedonal acne. SYNERGYSTIC when used with antibacterials.

ex. benzoyl peroxides.
se: irriative, can bleach textiles

Question 11

Topical Antibiotics:

Answer 11

effective in decreased P. acne population often used in combo with keratolytics and benzoyl peroxide.

ex. erythromycin, clindamycin, sulfacetamindes.

Question 12

System antibitoics:

Answer 12

effective for controlling moderate papular or nodular inflammatory acne.

ex. tetracycline, minocycline, doxycycline for 6 weeks
se: GI upset, photosensitivity and candidad vaginosis

Question 13

Systemic retinoids:

Answer 13

useful in severe nodular acne that is unresponsive to other treatment regimens.

ex. Accutane
se: TERATOGENIC!!! must use 2 BC forms
requires period lab monitoring
length of treatment is usually 5-6 months

Question 14

Hormonal therapies

Answer 14

useful for hormonal acne (cystic jawline)

ex. oral contraceptives

Question 15

Grade 1:

Answer 15

superficial: noninflammatory, comedones

topical keratolytics

Question 16

Grade 2:

Answer 16

superficial: inflammatory papules, pusutles

- treat with topical antibiotics, topical retinoids, benzoyl peroxide.

Question 17

Grade 3:

Answer 17

palpable deep inflammatory lesions

• patients with large cysts
• oral antibiotics

Question 18

Grade 4:

Answer 18

nodular, cystic acne
-oral antibiotics, accutane, OCPs
Intralesional corticosteroids

Question 19

Rosacea:

Answer 19

History of flushing
Presence of telangiectasias
Affects skin mainly of the central face, nose, cheeks, and chin

Occurs mostly in adults
Women more frequently than men
May lead to rhinophyma
TRIGGERS = alochol, sun, spicy and hot foods
DOES NOT SPARE THE NASOLABIAL FOLD!!!

Question 20

SLE:

Answer 20

Some systemic conditions may mimic acne
“butterfly rash” SPARES THE NASOLABIAL FOLD
-malar rash
tx: metronidazole, sulfa based lotions, azelex, vasoconstrictor creams, sunscreen, anti-inflammatory, antibiotics, lasers targeting the telangesctasias

Question 21

Follculitis

Answer 21

inflammation of the hair follicle

-psuedomonas follicultiis : pruitic and tender. usually self limited and will resolve in 2-3 days.

Question 22

Pityrosporum follicutlis

Answer 22

yeast follicultis

Question 23

hiradenitis suppurativa:

Answer 23

chronic skin condition also called acne inverse. usually in the armpits, groin, buttocks, under breasts. Painful with drainage. Double comedones, red tender nodules with tract between. Areas of open sore with drainage. Mild, moderate to severe cases.
-tx with antibiotics.