Lecture 2: Disorders of Sebaceous and Apocrine Glands

Question 1

What are the factors associated with development of acne vulgaris?

Answer 1

1. Increased sebum production
2. Follicular hyperkeratinization
3. Proliferation of cutibacterium acnes
4. Inflammation

Question 2

What triggers acne in puberty?

Answer 2

• Androgen stimulation of pilosebaceous unit
• Changes in keratinization at follicular orifice

Hormones and keratinization

Question 3

Stages of acne image

Answer 3

Question 4

When does the follicular ostium dilate in acne?

Answer 4

Comedo formation

Question 5

When does rupture of the follicular wall occur in acne?

Answer 5

Nodule/cyst

Question 6

What is a blackhead?

Answer 6

An open comedo

Question 7

Which gender usually has more acne?

Answer 7

Women

Question 8

Specifically in adult women, what kind of acne papules are found and where?

Answer 8

Deep seated & tender red papules along the mandibular jaw.

Question 9

What are drug-induced acneiform eruptions usually composed of?

Answer 9

Monomorphic inflammatory papules and pustules

Question 10

How is acne diagnosed?

Answer 10

Clinically

Question 11

Image of acne severity scale

Answer 11

Question 12

What could itchy acne be and what do we do then?

Answer 12

• If itchy, could be papules that we can do KOH prep on.
• Check for pityrosporum folliculitis (tx with keto shampoo)

Question 13

MOA of a retinoid

Answer 13

Decreases cohesion and increases turnover of epidermal cells

Question 14

MC SE of retinoids and pt education

Answer 14

• Dryness
• CI in pregnancy
• Photosensitivity

Think accutane

Question 15

Advantage of BPO in acne tx

Answer 15

No bacterial resistance

Question 16

SEs of BPO

Answer 16

• Skin irritation
• Bleaching of hair/clothing

Question 17

In what type of acne is topical abx indicated?

Answer 17

Papulopustular

Question 18

1st line topical abx

Answer 18

Clindamycin or erythromycin

Often combined with BPO

Question 19

What is topical clindamycin used with for acne?

Answer 19

• with BPO
• with tretinoin

BID or foam QD

Question 20

What is topical erythromycin used with for acne?

Answer 20

with BPO

BID

Question 21

When are oral abx indicated for acne?

Answer 21

Moderate acne: inflammatory papules or deep-seated lesions

Question 22

What are the oral abx for acne?

Answer 22

• Doxycycline
• Minocycline

100 mg BID with BPO and ret

Usually 3 month course, tapered to QD for 1-2 months

Question 23

MOA of oral abx for acne and main SEs

Answer 23

• MOA: inhibition of C. acnes
• SEs: upset stomach and photosensitivity

GI and sun

Question 24

First-line oral ABX for acne

Answer 24

• Tetracyclines: (CI in pregnancy/youngins + photosensitivity)
• Macrolides: increased resistance

Question 25

Second-line oral abx for acne?

Answer 25

* Bactrim DS (SJS, TEN, mostly for severe, not for preggos) * **Keflex** (crappy, but **relatively safe in preggos)**

Question 26

When is isotretinoin used and what does it do?

Answer 26

* Used for **severe resistant** nodular/cystic acne * Inhibition/decrease in C. acnes | Usually **last resort, monotherapy**

Question 27

MC SE of isotretinoin

Answer 27

Dryness of skin/mucous membranes | HAs, SI, LFTs, myalgia

Question 28

When isotretinoin CI?

Answer 28

* DO NOT USE WITH AN ORAL TETRACYCLINE * PREGNANT

Question 29

What must be monitored for someone on accutane?

Answer 29

* Baseline **CMP/Lipid monthly**: if over 700-800, stop/statin * Females: **2x negative pregnancy tests + no blood donation**

Question 30

Acne tx image

Answer 30

Question 31

What age is rosacea MC in?

Answer 31

30-50

Question 32

Rosacea presentation

Answer 32

* Facial flushing * Localized erythema * Telangiectasias * Papules * Pustules * Nose, cheeks, brow, chin

Question 33

MC demographic for rosacea

Answer 33

* Lighter skinned (type 1-3) * Females at a younger age

Question 34

Subtypes of rosacea

Answer 34

* Erythematotelangiectatic * Papulopustular * Phymatous * Ocular rosacea

Question 35

Describe erythematotelangiectatic rosacea

Answer 35

* Persistent erythema of central face * Intermittent flushing * Telangiectasias * Stinging/burning * **MC SUBTYPE**

Question 36

Describe papulopustular rosacea

Answer 36

* Acneiform papules and pustules predominate * Erythema and edema of central with sparing of periocular areas * (**No open comedones, differentiates between acne**)

Question 37

Describe phymatous rosacea

Answer 37

* **Chronic inflammation** and edema + marked thickening with sebaceous hyperplasia * **cobblestone appearance on nose is MC** * MC in men | looks like a dwarf

Question 38

Describe ocular rosacea

Answer 38

* Conjunctivitis, blepharitis, and hyperemia * Dry, irritated, itchy eyes * Keratitis, scleritis, and iritis potentially * **Can occur without cutaneous findings!**

Question 39

What medication can trigger rosacea?

Answer 39

Niacin/vit B3

Question 40

Tx of rosacea

Answer 40

* Avoid triggers * Sunscreen * Camo makeup * Topical metronidazole, ivermectin, sodium sulfacetamide, azelaic acid gel, brimonidine gel, oxymetazoline * Systemic: tetracyclines, metro, azithromycin

Question 41

Tx of severe papulopustular rosacea

Answer 41

Isotretinoin

Question 42

What drugs/therapies can help with flushing in rosacea?

Answer 42

* Clonidine BID * Intense pulsed light * BBs (nadolol)

Question 43

Tx of rosacea fulminans

Answer 43

Prednisolone as isotretinoin is started

Question 44

What is perioral dermatitis and MC demographic?

Answer 44

* Discrete erythematous micropapules * MC in females

Question 45

RFs for perioral dermatitis

Answer 45

* Topical fluorinated glucocorticoids + inhalers * Fluroinated toothpaste * OCP | Fluorine

Question 46

Tx for perioral dermatitis

Answer 46

D/C Steroids