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Clin Med III: Dermatology > Disorders of Sebaceous & Apocrine Glands > Flashcards

Disorders of Sebaceous & Apocrine Glands Flashcards

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Dermatology Board Prep flashcards
1
Q

an extremely common, usually self-limited chronic inflammatory condition of the pilosebaceous unit

A

acne vulgaris

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2
Q

pathogenesis of acne vulgaris involves multiple factors, including: (4)

A
  1. increased sebum
  2. follicular hyperkeratinization
  3. proliferation of Cutibacterium acnes
  4. inflammation
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3
Q

Acne Vulgaris typically begins at puberty as a result of ?

A

androgen stimulation of pilosebaceous unit and changes in keratinization at the follicular orifice

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4
Q

4 components of acne

A
  1. Follicular plugging = blocks sebum drainage
  2. Stimulation of sebaceous glands
  3. Overgrowth of C. acnes
  4. Inflammatory response
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5
Q

Acne vulgaris is MC found on areas of skin with greatest density of sebaceous follicles, such as ?

A

the face, back, and upper chest.

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6
Q

T/F: Men are more likely to have acne in adulthood, as it is thought to be hormonally driven

A

F: women not men

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7
Q

While a benign condition, acne can lead to ____ and _____. Therefore, initiation of tx in the earliest stages is preferable.

A

permanent scarringsignificant psychosocial distress

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8
Q

what medication is MC known to cause acne?

A

systemic or are using topical corticosteroids, or individuals using anabolic steroids

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9
Q

characteristic lesions of acne (4)

A
  1. open comedones (blackheads)
  2. closed comedones (whiteheads, noninflammatory base)
  3. erythematous inflammatory papules
  4. pustules
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10
Q

Nodules and cysts can result in scarring, including ____ or ____

A

pitted
hypertrophic scars

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11
Q

besides the MC areas for acne to appear, adult women in particular can have acne where else?

A

deeper-seated, tender red papules are common along the mandibular jaw

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12
Q

type of acne that is comprised of monomorphic inflammatory papules and pustules rather than open and closed comedones (blackheads and whiteheads).

A

Drug-induced acneiform eruptions

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13
Q

diagnostic pearls that causes acne in women

certain habits

A

touching, rubbing, over-cleansing the face with numerous products, and wearing cosmetics may exacerbate acne.

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14
Q

besides the MC areas for acne, in men acne tends to be more severe where?

A

trunk

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15
Q

diagnostic pearls that causes acne in men

certian habits/activites

A

Consider external agents such as grease from working in fast-food restaurants, occlusion from sports equipment or hats, and drugs.

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16
Q

An ____ of acne severity is necessary for choosing the appropriate therapy.

A

assessment

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17
Q

itchy acne/putsules esp on upper back, shoulders, and scalp of adolescents and young adults, consider doing ____ testing to assess for _____, which could be treated with an antifungal shampoo such as ketoconazole.

A
  • scraping a pustule for potassium hydroxide (KOH)
  • Pityrosporum folliculitis
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18
Q

management pearls for acne

A
  • Acne often resolves after the teenage years.
  • Severe cases of nodulocystic acne will require more aggressive treatment.
  • Acne typically requires consistent, regular care over months to see improvements.
  • Make sure pt has correct expectation and applies topical medication to entire area of potential acne involvement, not just to individual lesions as spot tx.
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19
Q

mild acne therapy

A
  • Topical retinoids
  • Benzoyl peroxide (BPO)
  • Topical antibiotics
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20
Q

medications that can be used for mild acne therapy

A
  • Benzoyl peroxide (BPO)
  • Topical retinoids
  • Topical abx
  • Oral abx
  • Oral retinoid (isotretinoin)
  • Azelaic acid
  • Salicylic acid
  • Hormonal therapy
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21
Q

how to apply retinoid to avoid excessive irritation and dryness?

A

Start using topical retinoids gradually, such as every third night, then slowly increase to nightly as tolerated to avoid excessive irritation and dryness.

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22
Q

MOA of retinoid?
MC SE?
CI?

A
  • decreases cohesion and increases turnover of epidermal cells
  • dryness (MC); photosensivity
  • CI: Pregnancy
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23
Q

types of retinoids (6)

A
  • Tretinoin (0.025%-0.1% q 24 h at PM)
  • Tazarotene (0.05%-0.1% cream or gel applied q24hrs)
  • Adapalene (0.1%-0.3% every 24 hours at bedtime; the 0.1% gel now OTC)
  • Trifarotene (Aklief) Newest retinoid
  • Tretinoin combo (tretinoin + clinda phosphate)
  • Adapalene combo (adapalene + BPO)
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24
Q

which acne medication has the advantage of having no bacterial resistance?
Multiple fixed-combinations with retinoids and topical abx

A

BPO

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25
Q

SE of BPO

A
  • Skin irritation (erythema, xerosis, scaling,
  • stinging, tightening, burning sensation)
  • Bleaching of hair/clothing
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26
Q

1st line for Mild-moderate inflammatory acne (papulopustular)

A

Clindamycin and Erythromycin
however NOT indicated for monotherapy

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27
Q

what is added to clinda/erythromycin for mild-moderate inflammatory acne?

A

BPO to reduce bacterial resistance
Patients often experience skin irritation

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28
Q

For moderate acne -with inflammatory papules or deeper-seated lesions, consider adding what tx?
options?

A

oral medication

  • Doxycycline or minocycline
  • Add 100 mg q12h to topical regimen (retinoid + BPO)
  • oral abx x 3 mo, after which the dose can be tapered to 100 mg once daily for a month or two before stopping.
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29
Q

MOA of general oral ABX?
SE?

A
  • inhibits C. acnes; Quicker results than the use of topicals
  • MC S/E upset stomach and photosensitivity
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30
Q

SE and CI of tetracyclines

A
  • CI: pregnancy and young children
  • SE: photosensitivity
31
Q

macrolides have what preg category?

A

B

Increased resistance

32
Q

first line orab abx for acne vulgaris

A

tetracyclines
macrolides

33
Q

second line oral abx?

A
  • Bactrim
  • cephalexin
34
Q

what oral abx has a risk for SJS, TEN?

A

bactrim

35
Q

which second line oral abx for acne is less effective but have a preg cat B (relatively safe)?

A

cephalexin

(avoid bactrim in preg)

36
Q

what medication is resevered for severe resistant nodular/cystic acne?

A

oral retinoids - isotretinoin

37
Q

dosing for isotretinoin

A
  1. 0.5-1 mg/kg/day divided BID x 15-20 weeks (4-6 Months)
  2. Therapeutic goal of 120-150 mg/kg
    - typically need 2 months break before restarting
38
Q

MC SE of oral retinoids?
Other SE?

A

Dryness of skin and mucous membranes (eyes sometimes)

  • HA
  • Thoughts of suicide and depression
  • Possible increased LFTs and Hypertriglyceridemia
  • myalgia
39
Q

NEVER prescribe oral retinoids with ____ (side effect profile goes way up - Pseudotumor cerebri)

A

oral tetracycline

40
Q

an absolute CI in oral retinoids

A

pregnancy!!

41
Q

what is iPLEDGE? Difference between male vs female in iPLEDGE?

A

a program by the U.S. FDA intended to manage the risk of birth defects caused by isotretinoin

  1. Instruction brochure; Enroll patient
  2. Males are easy!!!
  3. Female - 2 forms of birth control
    - Negative preg test before start x 2
    - No blood donation during tx
42
Q

labs needed during iPLEDGE

A
  1. Baseline CMP / Lipid Monthly and preg test
    - Lipids >700-800mg/dl consider stopping or starting lipid lowering drug
43
Q

regimen for noninflammatory comedonal acne?

A

Topical retinoids

44
Q

regimen for mild papulopustular acne?

A

Topical Antimicrobial (BPO + ABX)
AND Retinoid

45
Q

regimen for Moderate papulopustular

A

Topical retinoid + oral ABX + BPO
Hormonal Therapy

46
Q

regimen for Severe nodular

A
  • Topical retinoid + oral ABX + BPO
  • Oral Isotretinoin (monotherapy)
  • Hormonal therapy
46
Q

pt ed about acne

A
  1. PROVIDE REALISTIC EXPECTATIONS
    - 6-8 weeks before improvement
    - Can get worse before it gets better
  2. Washing BID
  3. Detergent/softener/dryer sheets
  4. Diet (link with dairy)
  5. Avoid hand contact
  6. Avoid products full of perfumes/fragrances
47
Q

facial flushing and localized erythema, telangiectasia, papules, and pustules on the nose, cheeks, brow, and chin. It commonly develops in individuals between the ages of 30 and 50

A

Rosacea

48
Q

possible cause of Rosacea

A

Demodex mites may play a pathogenic role in some patients.

49
Q

rosacea primarily affects who?

A

lighter skin phototypes, and females tend to present at a younger age than males.

50
Q

rosacea is reported less commonly in skin types IV-VI why?

A

darker skin types are less prone to photodamage, and flushing and telangiectasias are harder to visualize

51
Q

4 main subtypes of rosacea

A
  1. Erythematotelangiectatic
  2. Papulopustular
  3. Phymatous
  4. Ocular rosacea.
52
Q
  • Presents with persistent erythema of the central portion of the face with intermittent flushing.
  • Telangiectasias
  • Patients often complain of stinging or burning sensations on the skin. MC subtype.

dx?

A

Erythematotelangiectatic rosacea

53
Q

Acneiform papules and pustules predominate

  • Erythema and edema of the central face with relative sparing of the periocular areas.
  • (lacks open comedones, Differentiate between acne)

dx?

A

Papulopustular rosacea

54
Q
  • Chronic inflammation and edema marked thickening of the skin with sebaceous hyperplasia, resulting in an enlarged, cobblestoned appearance of affected skin. MC on the nose (rhinophyma).
  • MC Men

dx?

A

Phymatous rosacea

55
Q

Presents with conjunctivitis, blepharitis, and hyperemia.

  • Patients complain of dry, irritated, itchy eyes.
  • Keratitis, scleritis, and iritis are potential but infrequent complications
  • Ocular rosacea can occur in patients with or without cutaneous findings.

dx?

A

Ocular rosacea

56
Q

rosacea features

A
  • Flushing - Erythema; Telangiectasia (Cheeks/forehead)
  • Papules/pustules/nodules - Nose/cheeks/forehead
  • Hyperplasia and fibrosis of the sebaceous glands: -phyma
57
Q

roscaea sx

A
  • Burning
  • Stinging
  • Edema
  • Plaques
  • Flushing
58
Q

rosacea triggers

A
  • Weather
  • Food and drink
  • Exercise
  • Emotions
  • Topical products
  • Hormonal imbalances
  • Medications (Niacin)
59
Q

conservative therapy for rosacea

A
  • avoidance of known triggers, including spicy foods, alcohol, emotional stress, hot beverages (eg, hot soup, coffee, tea), extremes of temperature, etc.
  • Appropriate SPF and sun avoidance
  • Camouflage makeups with green- or yellow-tinted preparations are helpful in masking underlying redness.
60
Q

topicals for rosacea

A
  • Metronidazole preparations
  • Ivermectin cream
  • Sodium sulfacetamide with 5% sulfur
  • 15% azelaic acid gel
  • Brimonidine gel and oxymetazoline topical
61
Q

systemic therapies for rosacea

A
  1. Tetracyclines: mainstay
    - Doxy OR minocycline
  2. Oral metronidazole
  3. Azithromycin
  4. Isotretinoin also effective in treating severe papulopustular rosacea
62
Q

management for Telangiectasias / erythematotelangiectatic rosacea

A
  1. Camouflage cosmetics
  2. brimonidine 0.33% topical gel
  3. vascular lasers
  4. intense pulsed light therapy
63
Q

rosacea: management for Flushing

A
  1. Clonidine
  2. intense pulsed light
  3. pulsed dye laser
  4. nadolol
64
Q

rosacea: management for Rhinophyma

A

Surgical paring / sculpting, electrosurgery, and laser

65
Q

management for Rosacea fulminans

A
  1. Prednisolone while isotretinoin is being initiated and then tapered over several weeks.
  2. Isotretinoin continued for several months.
66
Q
  • Discrete erythematous micropapules and microvesicles
  • Often confluent in perioral and periorbital skin
  • Occurs mainly in females predominantly

dx?

A

Perioral Dermatitis

67
Q

RF for Perioral Dermatitis

A
  1. topical fluorinated glucocorticoids (including inhalers)
  2. fluorinated toothpaste
  3. OCP
68
Q

tx perioral dermatitis

A

D/C steroid use. Topical and
oral antibiotics

69
Q
  • hyperkeratotic infundibulum
  • cohesive corneocytes
  • sebum secretion

which stage of acne?

A

microcomedone

70
Q
  • accumulation of shed corneocytes and sebum
  • dilation of fillicular ostium

which stage of acne?

A

comedone

71
Q
  • further expansion of fillicular unit
  • proliferation of proprionibacterium acnes
  • perifollicular inflammation

which stage of acne?

A

inflammatory papule/pustule

72
Q
  • rupture of follicular wall
  • marked perifollicular inflammation
  • scarring

which stage of acne?

A

nodule

Clin Med III: Dermatology (13 decks)

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