Follicular Disorders Flashcards
Acne age
Usually between 11-30 years old, typical onset in adolescence
Acne long term effects
Permanent scarring, psychosocial withdrawals, decreased quality of life
Acne pathogenesis
Pilosebaceous unit obstruction, increased sebum production (hormonal influence), bacterial proliferation, inflammation
Acne triggers
Stres, hormonal fluctuation/menses, mechanical/occlusion, medications, pathologic androgen excess, diet
Acne stages - mild
Normal, open comedo (blackhead)
Acne stages - moderate
Closed comedo (whitehead), papule
Acne stages - severe
Pustule
Acne lesion types - active
Microcomedone, open comedone (blackhead), closed comedone (whitehead), papule, pustule, nodule/cyst/sinus tract
Acne lesion types - sequelae
Dypigmentation (post inflammatory hyperpigmentation), scarring (hypertrophic/keloidal, atrophic/pitting/ice pick)
Acne categorizing
Mild, moderate, severe, comedonal, inflammatory, nodulocystic, hormonal, with or without scarring, truncal involvement, impact on quality of life
Acne conglobata and acne fulminans morphology
Severe presentation, multiple connecting sinuses/tract, scarring
Acne conglobata and acne fulminans age
Usually teen males
Acne conglobata and acne fulminans associated diseases
May have systemic symptoms/body pain, associated auto inflammatory syndromes - pyogenic arthritis, pyoderma gangrenosum, cystic acne, hidradenitis suppuritiva
Acne conglobata and acne fulminans treatment
Very aggressive and needs referral
Acne excoriee definition
“Factitial dermatitis”, exogenous manipulation
Acne excoriee associated disease
Anxiety, OCD, body dysmorphic issues
Acne excoriee treatment
Topicals, recognize behavior and refer to behavioral health
Acne treatment - mild comedonal
Topical retinoid, salicylic acid, maybe benzoyl peroxide
Acne treatment - mild inflammatory or mixed
Combo topical therapy: benzoyl peroxide, antibiotic, retinoid
Acne treatment - moderate inflammatory or mixed
Benzoyl peroxide, antibiotic, retinoid, oral antibiotic, maybe hormonal treatment
Acne treatment - severe inflammatory or mixed
Benzoyl peroxide, antibiotic, retinoid, oral antibiotic, hormonal or isotretinoin treatment
Acne treatment - hormonal
OCP/spironolactone with or without topicals
Acne treatment - nodulocystic
Isotrentinoin or other
Postinflammatory dyspigmentation definition
Increased melanin deposition within epidermis, possibly worsened by sun exposure
Postinflammatory dyspigmentation treatment
Salicylic acid gel/cleanser, retinoids, azelaic acid, non-comedogenic sunscreen, cosmetic treatments if persistent
Acne scarring types
Atrophic (ice pick/box car), hypertrophic (keloidal)
Acne scarring treatments
Retinoids, IL steroid injections for hypertrophic, cosmetic procedures if persistent
Neonatal acne morphology
Papule, pustules, no comedones
Neonatal acne age
First weeks-months of life
Neonatal acne causes
Possibly maternal hormonal influence or hypersensitivity to Malessezia species
Neonatal acne treatment
No treatment required
Infantile acne morphology
Comedones, papules, pustules, maybe nodulocysts
Infantile acne age
3-6 months old
Infantile acne causes
Possibly transient adrenal/gonadal androgen production
Infantile acne treatment
Like teen acne, start with topicals, refer for further treatment
Childhood acne morphology
More persistant/severe than infantile, comedones, papule, pustules, maybe nodulocysts
Childhood acne age
6 months or older
Childhood acne treatment
Like teen acne, start with topicals, usually need oral medications
Childhood acne 2-7 years old
Endocrine referral necessary if severe, X-ray for bone age, look at DHEAS, testosterone, 17OH progesterone, LH, FSH, prolactin
Hidradenitis suppuritiva definition
Chronic acneiform inflammatory condition
Hidradenitis suppuritiva morphology
Painful, draining sinuses on body folds
Hidradenitis suppuritiva age
Pubertal or adults
Hidradenitis suppuritiva treatment
Similar to severe inflammatory acne
Folliculitis definition
Inflamed hair follicles where they are most dense (scalp, neck, chest, back, groin) with or without infection
Folliculitis morphology
Follicularly-centered papule or pustules, can be itchy or painful, can be exacerbated in areas of occlusion or friction
Folliculitis causes
Pseudomonas, pseudofolliculitis barba (razor bumps), tinea (barber’s itch)
Hair growth steps
Anagen, catagen, telogen, return to anagen
Alopecia definition
Hair loss, disruption in normal hair cycle
Alopecia subtypes - loss or decreased development
Areata, androgenetic, trichotillomania, inflammatory/scarring, genetic
Alopecia subtypes - shedding
Telogen effluvium, anagen effluvium
Alopecia areata definition
Localized (scalp) autoimmune phenomenon that may be associated with other autoimmune conditions
Alopecia areata morphology
Geometric, clean patterning, totalis (whole scalp) or universalis (whole body)
Androgenic alopecia - male pattern
Distinct patterning, higher 5-alpha reductase level, lower testosterone, higher free androgens, hair follicle diminishes and produces less
Androgenic alopecia - female pattern
Hair follicle diminishes and produces less, diffuse thinning or part thickening
Trichotillomania
Hair pulling behavior disorder, OCD spectrum, possible anxiety/depression
Anagen effluvium
Insult to hair follicle impairing mitotic activity, diffuse shedding of actively growing hairs
Telogen effluvium
Abrupt shift occurs so all telogens are in phase, postpartum, illness or stress induced, diffuse shedding all at once of resting hair, spontaneous regrowth
Acne histology
Dilated hair follicles with keratin debris, open for blackheads, closed for whiteheads, inflammatory cells may be present
Hidradenitis suppurativa histology
Increased inflammatory cells in the follicle, hyperkeratosis, no/few/small sebaceous glands, inflammation, draining sinuses leave tracts of excess secretion
Folliculitis histology
Increased inflammation, increased neutrophils, disruption or breaking of hair follicle
Alopecia areata histology
Increased inflammation centered on the hair bulb, increased lymphocytes attacking hair bulb
Androgenetic alopecia histology
Hair follicles decrease in size until they disappear, hair bulbs now in the dermis layer, sebaceous glands still present