Objective 2 Acne and Rosecea

Question 1

Acne Subtypes

Answer 1

• Cosmetic
• Excorriae
• Hormonal
• Mechanical
• Congoblate
• Fulminans
• Infantile
• Late onset
• Tropical
• Drug induced
• PCOS, CAH, Adrenal Tumors

Question 2

DDX

Answer 2

• Folliculitis
• Hidradinitis Suppurative
• Psedubarbe folliculitis
• Rosecea
• Cosmetic

Question 3

Pathogenesis

Answer 3

1. Sebum secretion may be increased by hormonal factors including high levels of androgens or high levels of DHT in the skin. There can also be a genetic component to the androgen secretion.
2. Genetic, Hormonal, and environmental factors lead to poral occlusion due to increased proliferation of keratinocytes and occlusion of the follicular opening
3. Occlusion of the follicular opening leads to retention of sebum which can encourage bacterial overgrowth and local inflammation. The retained sebum can ruptire leading to a drastic increase in local inflammation
4. P Acnes digests TG in sebum in occluded and ruptured follicles especially which elads to proliferation and activation of the immune response through TLR2 among others. This leads to a type IV immune reaction and local inflammation and generation of oxygen radicals. Inflammation and oxygen radicals lead to vasodilation, inflammatory cell infiltrate and the characteristic open and closed comedones of acne

Question 4

Topical Treatment

Answer 4

1. Proper cleansing can help remove excess sebum and bacteria
2. Use of benzoyl peroxide can reduce bacterial numbers and decrease inflammatin. It may also reduce comedone formation
3. Azaleic acid can also reduce baterial numbers, be comedolytic and reduce nflammation
4. Topical Retinoids normalize keratinocyte proliferation and reduce poral occlusion. Also regulate sebum productino, and reduce inflammation through TLR2 and other pathways
5. Topical Antibiotics can reduce baterial numbers and reduce inflammation. Topical clindamycin, eryhtrocmycin may be effective
6. Cosmetic camaflouge can be used to hide lesions, but ensure it does not cause occlusion

Question 5

Systemic Treatment

Answer 5

1. Systemic antibiotics mainly tetracyclin, minocyclin, and doxycycline are used to decreased bacterial numbers and reduce inflammation.
2. Hormonal regulation through the use of antiandrogens such as spironolactone and OCP can reduce sebum production in acne that has a large hormonal component
3. Systemic retinoids including isotretinoin can regulate sebum production and regulate keratinocyte proliferation leading to reduced poral occlusion and reduced sebum retentino. Also limits bacterial overgrwoth and minimizes inflammation

Question 6

Prevention

Answer 6

It is important to use proper cleansing and hygeine strategies especially in acne
Crucual to avoid triggers such as spicy foods, alcohol, and sun in rosecea
Crucial to avoid the use of comodeogenic facial products that cause poral occlusion

Question 7

Rosecea Subsets

Answer 7

Erythrotelangectatic
Papulopustular
Rhinophyma
Occular

Question 8

Tx

Answer 8

Erythrotelangectatic: Metro gel, azaleic acid, avoid triggers. Can also use oral doxycycline. Treatment with lasers to reduce erythema and telagectasia

Papulppustular: Similiar except more liberal use of topical and oral antibiotics. Can also consider systemic retinoids

Rhinophyma: Requires surgery to remove sebaceous hyperplasia

Occular: Artificial tears, oral doxy, lid cleansing.