Diseases of follicles and sweat glands

Question 1

acne vulgaris

Answer 1

chronic disorder of overactivity of sebaceous glands, abnormal desquamification of follicular epithelium, most common skin disorder, usually during puberty

Question 2

What are the four main pathogenetic factors in acne vulgaris?

Answer 2

follicular hyperkeratinization, increased sebum production, propionibacterium acnes in follicle, inflammation

Question 3

comedone acne treatment

Answer 3

: retinoids, tretinoin cream, benzoyl peroxide, adalene, topcial antibiotics (erythromycin/clindamycin)

Question 4

papular or cystic acne treatment (mild, moderate, severe)

Answer 4

mild: combo of erythromycin/clindamycin with benzyl peroxide gel or wash
moderate: doxycycline, minocylcline, Bactrim
severe: isotretinoin

Question 5

rosacea presentation/etiology

Answer 5

skin on central face, erythema, phymatous changes, papules and pustules, flush. Seen in those with Fitzpatrick 1 and II, older women.

Question 6

Diagnostic phenotype rosacea

Answer 6

no comedones present, central erythema with skin thickening. Also need to have papules/pustules, flushing, or ocular manifestations.

Question 7

rosacea treatment

Answer 7

metronidazole gel/lotion/cream, azelex gel/cream (anti-redness), anti-demodex mite treatments, topical ivermectin, oral antibiotics. avoid ETOH/alcohol.

Question 8

Hidradentitis suppurativa presentation

Answer 8

chronic, usually seen in axilla, groin, perianal, perineal, inframammary, cause is unknown. visuble nodulees .5-2 cm in size that progress to abscesses

Question 9

hidradentitis staging system

Answer 9

stage I: abscess formation without sinus tracts/scarring. Stage II: recurrent abscesses with sinus tracts and scarring, single or multiple. Stage III: diffuses involvement, multiple connected sinus tracts and abscesses

Question 10

hidradentitis treatment (by stages)

Answer 10

all stages: education, avoid skin trauma, quit smoking
stage I: topical clindamycin, triamcinolone, punch debridement, systemic antibiotics
stage II: tetracycline or doxycycline oral, clindamycina and rimfambiin, acitretin, spironolactone, surgery.
Stage III: TNF-alpha inhibitors like infliximab, surgery

Question 11

Sebhorrheic dermatitis presentation

Answer 11

acute/chronic, dry scales and erythema on scalp, central face, presternal, interscapular, umbilicus, and body folds, scaly plaques

Question 12

Ddx for Sebhorrheic dermatitis

Answer 12

Cirrhosis, imeptigo, dry skin, contact dermatitis

Question 13

Sebhorrheic dermatitis treatment

Answer 13

scalp: shampoo (head/shoulders, selsum), ketoconazole, tar shampoos.
non-scalp: topical corticosteroids, antifungals,

Question 14

perioral dermatitis: presentation, tx, etiology

Answer 14

papular, erythematous eruption around mouth, usually in women, can be caused by hormones, steroids, contact dermatitis,. Treat with antibacterials in mild cases or oral antibiotics for 6-8 weeks

Question 15

sebaceous hyperplasia: presentation, tx, etiology, Ddx

Answer 15

2-6 mm ubilicated, skin colored/yellow papules on face with central umbilication. Caused by enlargement of sebaceous glands. Ddx: nodular carcinoma, only treated if irritated or cosmetic with oral isotretinion or shave excision

Question 16

furunculosis

Answer 16

abscess, usually caused by staph aureus in diabetics, athletic teams, prisons, homeless. Involves entire hair follicle, painful. Check nares for staph carrier. Treat with Bactrim

Question 17

carbuncles

Answer 17

multiple furuncles.