Disorders of Sebaceous and Apocrine Glands - Exam 1 Flashcards
What is the technical term for teenage acne? What unit is involved?
acne vulgaris
pilosebaceous unit
What are the 4 pathogenesis factors that lead to acne vulgaris?
(1) increased sebum production
(2) follicular hyperkeratinization
(3) proliferation of Cutibacterium acnes (C. acnes, formally known as Propionibacterium acnes)
(4) inflammation.
What are the 4 stages of acne?
normal -> blackhead -> whitehead -> papule -> pustule -> nodule/cyst
What is the difference between a blackhead and a whitehead.
blackhead is open comedo and whitehead is closed comedo
What are the 4 components of acne?
Follicular plugging = blocks sebum drainage
Stimulation of sebaceous glands
Overgrowth of C. acnes
Inflammatory response
T/F: Acne is typically worse in white and black when compared to those of Asain/Mediterran descent?
FALSE! There is no racial predilection.
What medication tend to make acne worse? In adult women, acne is commonly seen in what area? men?
systemic or topical corticosteroids
women: along the mandibular jaw
men: more severe on the trunk
Describe drug- induced acne eruptions.
Drug-induced acneiform eruptions are typically comprised of monomorphic inflammatory papules and pustules
NOT open and closed comedones
What are exacerbating acne factors in women? men?
women: touching, rubbing, over-cleansing the face with numerous products, and wearing cosmetics
men: grease from working in fast-food restaurants, occlusion from sports equipment or hats, and drugs.
How do you determine the severity of a pt’s acne? **what level did Alex tell us to know?
**know what moderate is
What should you be thinking if acne is itchy? Where is it commonly found? How do you dx it? What is the tx?
Pityrosporum folliculitis
upper back, shoulders, and scalp of adolescents
consider scraping a pustule for potassium hydroxide (KOH)
ketoconazole
What am I?
Pityrosporum folliculitis
**What are good pt education points regarding the tx of acne?
**requires consistent, regular care that may see months to improve
**correct application over the entire area, NOT just the specific spots of acne
What are the mild tx options for acne?
topical retinoids
benzoyl peroxide
topical abx
**What is the important pt education point regarding retinoids?
Start using topical retinoids gradually, such as every third NIGHT, then slowly increase to nightly as tolerated to avoid excessive irritation and dryness.
deactivated by light
What is the MOA of retinoids? What is the MC SE? Are they safe in pregnany?
decreases cohesion and increases turnover of epidermal cells
dryness- MC. Photosensitivity
NO! CI in pregnancy
What is the advantage of using benzoyl peroxide? What are the SE?
no bacterial resistance
Skin irritation (erythema, xerosis, scaling,
stinging, tightening, burning sensation)
Bleaching of hair/clothing
What is the MOA of topical abx? When are they indicated? What are the 2 first line medications? **What is important to note? What is a SE?
reduces number of C. acnes in pilosebaceous unit
Mild-moderate inflammatory acne
Clindamycin and Erythromycin
**NOT indicated for MONOtherapy
skin irritation
What is considered moderate acne? What would you consider adding on?
with inflammatory papules or deeper-seated lesions, consider adding an oral medication
Add on topical doxy or minocycline
so use retinoid, benzoyl peroxide and PO abx for 3 months then taper abx
What is the MOA for oral abx? Why is it better than topical? What are the MC SEs?
inhibits C.acnes
quicker results than using topcials
MC S/E upset stomach and photosensitivity
What are the 2 first line abx classes for oral abx?
Tetracyclines and macrolides
tetra: doxycycline, minocycline
macrolides: Erythromycin, azithromycin (Zithromax)
What are the CI for tetracyclines? What is the notable SE?
CI pregnancy and young children
photosensitivity
______ is prescribed for pregnant women who need oral abx
macrolides: Erythromycin, azithromycin (Zithromax)
What are second line oral abx options for acne? Which one is CI in pregnancy?
bactrim and keflex
bactrim: avoid in preg
keflex: relatively safe in preg
What are the major SE of bactrim? When is it used?
SJS and TEN
Severe acne unresponsive to other oral abx
______ is an oral retinoids that is indicated for severe resistant nodular/cystic acne. How does it work?
Isotretinoin
Inhibition of sebaceous glands
Decrease in C. acnes
exact MOA is not well known
How is isotretinoin dosed? What is the therapeutic goal?
0.5-1 mg/kg/day divided BID x 15-20 weeks (4-6 Months)
Therapeutic goal of 120-150 mg/kg
(Cummulative dose)
Patients typically need 2 months break before restarting
_____ is the MC SE of isotretinoin. Name 3 additional one. What do you need to monitor?
dryness of skin and mucous membranes
HA
Thoughts of suicide and depression
myalgia
need to monitor LFTs: may increase them and Hypertriglyceridemia
**What are the 2 SUPER important things to remember about isotretinoin?
**NEVER prescribe with oral tetracycline (side effect profile goes way up) Pseudotumor cerebri
**CI -PREGNANCY DUE TO BIRTH DEFECTS
_____ is the oral retinoid maintenance program. What are the requirements for enrollment for a female?
iPledge
2 forms of birth control
need to have 2 negative pregnancy tests before you can start
no blood donation during treatment
What are the lab monitoring requirements for iPledge?
Baseline CMP / Lipid Monthly and pregnancy test
If baseline lipids become ____ consider stopping or starting lipid lowering drugs
> 700-800mg/dl
What is the tx for noninflammatory comedonal acne?
topical retinoids
What is the tx for MILD papulopustular acne? MODERATE?
mild:
BPO + topical ABX + topical Retinoid
moderate:
topical retinoid + oral ABX + BPO
+/- hormonal therapy
What is the tx for severe nodular acne?
Topical retinoid + oral ABX + BPO
OR
Oral Isotretinoin (monotherapy)
**What are the 6 pt education points for acne?
How does rosacea present? What age range?
It presents with relapsing-remitting course of facial flushing and localized erythema, telangiectasia, papules, and pustules on the nose, cheeks, brow, and chin.
common between 30 and 50
etiology of rosacea is poorly understood but _____ may play a pathogenic role in some patients
demodex mites
What skin types does rosacea tend to effect more? What age does it present in when comparing males and females?
Rosacea primarily affects individuals with lighter skin phototypes
females tend to present at a younger age than males
Why does rosacea effect darker skin types less?
darker skin types are less prone to photodamage, and flushing and telangiectasias are harder to visualize
What are the 4 main rosacea subtypes?
Erythematotelangiectatic
Papulopustular
Phymatous
Ocular rosacea
What am I? Describe it
Papulopustular rosacea
Acneiform papules and pustules predominate.
Erythema and edema of the central face with relative sparing of the periocular areas
What am I? Describe it. What will the pt complain of?
Erythematotelangiectatic rosacea
persistent erythema of the central portion of the face with intermittent flushing and telangiectasias
Patients often complain of stinging or burning sensations on the skin
What am I? Describe it? MC in men or women?
Phymatous rosacea
Chronic inflammation and edema marked thickening of the skin with sebaceous hyperplasia, resulting in an enlarged, cobblestoned appearance of affected skin
MC in men
What am I? What does it often present with? What will the pt complain of? Does there always need to be a cutaneous finding?
ocular rosacea
conjunctivitis, blepharitis, and hyperemia
dry, irritated, itchy eyes
aka sometimes it feels like a foreign body sensation in the eyes
NO! can just be isolated to the eyes
**How can you tell rosacea and acne apart?
rosacea lacks open comadones and acne will have comadones!!
What is the MC form of rosacea?
Erythematotelangiectatic rosacea
What are some common rosacea triggers that you should warn pts about?
Weather
Food and drink
Exercise
Emotions
Topical products
Hormonal imbalances
Medications (Niacin)
What is the conservative therapy options for rosacea?
avoidance of known triggers
extremes of temperature
appropriate use of broad-spectrum sunscreens and avoiding sun exposure
camouflage makeup with green/yellow tint are also helpful
What are the topical first line tx options for rosacea? ______ is used if concerned about demadex overcolonization
Metronidazole preparations
ivermectin cream
Give 3 additional topical therapy options for rosacea
Sodium sulfacetamide with 5% sulfur
15% azelaic acid gel
Brimonidine gel and oxymetazoline topical
_________ is preferred for rosacea and is applied twice daily for patients with oily skin types
______ is cream or lotion twice daily for patients with normal to dry skin types.
Metronidazole 0.75% GEL: oily skin
metronidazole 0.75% cream or lotion: normal to DRY
_______ has been shown to be equally as effective as topical metronidazole for rosacea and is safe to use while pregnant
Azelaic acid 15% gel
______ are a mainstay of therapy in rosacea.
Tetracycline antibiotics:
doxy 40mg qd
metronidazole 200 mg twice daily
Azithromycin 250-500 mg daily 3 times weekly
aka low dose doxy rosacea pts can live on
______ is also effective in treating severe papulopustular rosacea
Isotretinoin
What are some additional tx options for Telangiectasias / erythematotelangiectatic rosacea specifically?
Camouflage cosmetics, brimonidine 0.33% topical gel, vascular lasers, intense pulsed light therapy
What are some additional tx options for flushing rosacea specifically?
lonidine 0.05 mg twice daily, intense pulsed light, pulsed dye laser, beta blockers (nadolol 40 mg daily)
What are some additional tx options for rhinophyma rosacea specifically?
Surgical paring / sculpting, electrosurgery, and laser
What are some additional tx options for Rosacea fulminans specifically?
Prednisolone 1 mg/kg daily is usually required while isotretinoin is being initiated and then tapered over several weeks. Isotretinoin therapy is continued for several months.
What am I? What sex? What 3 factors influence it? What is the tx?
perioral dermatitis
predominantly in females
factors:
topical fluorinated glucocorticoids (including inhalers)
fluorinated toothpaste
OCP
tx:
D/C steroid use. Topical and
oral antibiotics
What are the 4 different stages of acne?
microcomedone
comedone
inflammatory papule/ pustule
nodule
What stage of acne?
-hyperkeratotic infundibulum
-cohesive corneocytes
-sebum secretion
microcomedone
What stage of acne?
-accumulation of shed corneocytes and sebum
-dilation of fillicular ostium
comedone
What stage of acne?
-further expansion of follicular unit
-proliferation of P. acnes
-perifollicular inflammation
inflammatory papule/pustule
What stage of acne?
-rupture of follicular wall
-marked perifollicular inflammation
-scarring
nodule
When is acne the most common for men and women?
Acne is more common in men during the teenage years
more common in women in adulthood
What is the OTC retinoid tx option?
Adapalene (Differin gel)
Retinoid creams should be used every ______ night starting out
3rd night
Rosacea develops between the ages of _____ and _____. What is the MC side effects of topical retinoids?
30 and 50
dryness
What is the recommended frequency of serum pregnancy testing for females pts during treatment?
two tests prior to starting and one test monthly
consider looking at the answers from the acne case studies to really make sure you know the pt education they are looking for for every severity of acne
if they release the answer key?? not sure yet
