Lecture 2: Disorders of Sebaceous and Apocrine Glands Flashcards
What are the factors associated with development of acne vulgaris?
- Increased sebum production
- Follicular hyperkeratinization
- Proliferation of cutibacterium acnes
- Inflammation
What triggers acne in puberty?
- Androgen stimulation of pilosebaceous unit
- Changes in keratinization at follicular orifice
Hormones and keratinization
Stages of acne image
When does the follicular ostium dilate in acne?
Comedo formation
When does rupture of the follicular wall occur in acne?
Nodule/cyst
What is a blackhead?
An open comedo
Which gender usually has more acne?
Women
Specifically in adult women, what kind of acne papules are found and where?
Deep seated & tender red papules along the mandibular jaw.
What are drug-induced acneiform eruptions usually composed of?
Monomorphic inflammatory papules and pustules
How is acne diagnosed?
Clinically
Image of acne severity scale
What could itchy acne be and what do we do then?
- If itchy, could be papules that we can do KOH prep on.
- Check for pityrosporum folliculitis (tx with keto shampoo)
MOA of a retinoid
Decreases cohesion and increases turnover of epidermal cells
MC SE of retinoids and pt education
- Dryness
- CI in pregnancy
- Photosensitivity
Think accutane
Advantage of BPO in acne tx
No bacterial resistance
SEs of BPO
- Skin irritation
- Bleaching of hair/clothing
In what type of acne is topical abx indicated?
Papulopustular
1st line topical abx
Clindamycin or erythromycin
Often combined with BPO
What is topical clindamycin used with for acne?
- with BPO
- with tretinoin
BID or foam QD
What is topical erythromycin used with for acne?
with BPO
BID
When are oral abx indicated for acne?
Moderate acne: inflammatory papules or deep-seated lesions
What are the oral abx for acne?
- Doxycycline
- Minocycline
100 mg BID with BPO and ret
Usually 3 month course, tapered to QD for 1-2 months
MOA of oral abx for acne and main SEs
- MOA: inhibition of C. acnes
- SEs: upset stomach and photosensitivity
GI and sun
First-line oral ABX for acne
- Tetracyclines: (CI in pregnancy/youngins + photosensitivity)
- Macrolides: increased resistance
Second-line oral abx for acne?
- Bactrim DS (SJS, TEN, mostly for severe, not for preggos)
- Keflex (crappy, but relatively safe in preggos)
When is isotretinoin used and what does it do?
- Used for severe resistant nodular/cystic acne
- Inhibition/decrease in C. acnes
Usually last resort, monotherapy
MC SE of isotretinoin
Dryness of skin/mucous membranes
HAs, SI, LFTs, myalgia
When isotretinoin CI?
- DO NOT USE WITH AN ORAL TETRACYCLINE
- PREGNANT
What must be monitored for someone on accutane?
- Baseline CMP/Lipid monthly: if over 700-800, stop/statin
- Females: 2x negative pregnancy tests + no blood donation
Acne tx image
What age is rosacea MC in?
30-50
Rosacea presentation
- Facial flushing
- Localized erythema
- Telangiectasias
- Papules
- Pustules
- Nose, cheeks, brow, chin
MC demographic for rosacea
- Lighter skinned (type 1-3)
- Females at a younger age
Subtypes of rosacea
- Erythematotelangiectatic
- Papulopustular
- Phymatous
- Ocular rosacea
Describe erythematotelangiectatic rosacea
- Persistent erythema of central face
- Intermittent flushing
- Telangiectasias
- Stinging/burning
- MC SUBTYPE
Describe papulopustular rosacea
- Acneiform papules and pustules predominate
- Erythema and edema of central with sparing of periocular areas
- (No open comedones, differentiates between acne)
Describe phymatous rosacea
- Chronic inflammation and edema + marked thickening with sebaceous hyperplasia
- cobblestone appearance on nose is MC
- MC in men
looks like a dwarf
Describe ocular rosacea
- Conjunctivitis, blepharitis, and hyperemia
- Dry, irritated, itchy eyes
- Keratitis, scleritis, and iritis potentially
- Can occur without cutaneous findings!
What medication can trigger rosacea?
Niacin/vit B3
Tx of rosacea
- Avoid triggers
- Sunscreen
- Camo makeup
- Topical metronidazole, ivermectin, sodium sulfacetamide, azelaic acid gel, brimonidine gel, oxymetazoline
- Systemic: tetracyclines, metro, azithromycin
Tx of severe papulopustular rosacea
Isotretinoin
What drugs/therapies can help with flushing in rosacea?
- Clonidine BID
- Intense pulsed light
- BBs (nadolol)
Tx of rosacea fulminans
Prednisolone as isotretinoin is started
What is perioral dermatitis and MC demographic?
- Discrete erythematous micropapules
- MC in females
RFs for perioral dermatitis
- Topical fluorinated glucocorticoids + inhalers
- Fluroinated toothpaste
- OCP
Fluorine
Tx for perioral dermatitis
D/C Steroids
