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PA MS > PAS dermatology: Acne, Rosacea and Folliculitis > Flashcards

PAS dermatology: Acne, Rosacea and Folliculitis Flashcards

1
Q

What is the prevalence of adolescents with acne?

A

35%-90%

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2
Q

What is the gender predominance pattern in Acne ?

A

*Male predominance in adolescent acne
* Female predominance in post-adolescent acne

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3
Q

What is the Pathogenesis of acne ?

A

FICI
*Follicular hyperkeratinization
* Increased sebum production
* Cutibacterium acnes (C. acnes) withinthe follicle.
* Inflammation

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4
Q

What are the risk factors for Acne

A
  • Family Hx
  • Stress
  • smoking
  • Insulin resistance
    *Skin trauma
    *Diet
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5
Q

What is the difference between open vs closed comedon ( Both are non-inflammatory)

A

Opne comedon is a papule of <5mm with central orifice containing Keratotic material. Whereas, Closed comedon is a dome shaped papule.

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6
Q

What is a papulopustular acne ?

A

It is an inflammatory acne consist of relatively superficial papules and pustules.

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7
Q

What is a nodulocystic acne ?

A

It is a Deep-seated, inflamed, tender, large papules or nodules.

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8
Q

What are the differential diagnosis for acne ?

A
  • Rosacea
  • Perioral dermatitis
  • Sebaceous hyperplasia
  • Acneiform eruptions: acne cosmetica; pomade acne; drug
    induced acne
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9
Q

When to evaluate for hyperandrogenism in acne Dx work up ?

A

When a female patient presents with post adolescence acne.

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10
Q

What are the factors to consider in post adolescent acne related hypernadrogeneism evaluation ?

A
  • Irregular menses
  • Infertility
  • Abrupt onset of severe acne
  • Acne refractory to therapy
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11
Q

What is the approach to acne assessment ?

A
  • Type and severity of acne
  • Skin type
  • Scarring
  • Post-inflammatory hyperpigmentation
  • Menstrual cycle history
  • Current skin care regimen and acne treatment
  • Psychological impact of acne
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12
Q

What is the mild acne presentation ?

A

A few comedons , a few papules and or pustules

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13
Q

What is a moderate acne ?

A

Several comedons , several papules and pustules

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14
Q

What is the severe acne presentation?

A

It consist of several commedons, papules, pustules and > 5mm nodules and or cysts.

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15
Q

What is the key to acne treatment ?

A

It is to treat based on the pathogenesis. ( Pathogenesis: FICI )

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16
Q

What are the solo treatments for mild acne ?

A
  • Topical benzoyl peroxide or topical azelaic acid.
  • Topical retinoid
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17
Q

What are the combo treatments for mild acne ?

A

1) COMBO: Topical benzoyl peroxide or topical azelaic acid AND topical retinoid
2) COMBO: Topical benzoyl peroxide or topical azelaic acid AND topical antibiotic
3) COMBO: Topical retinoid AND topical antibiotic

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18
Q

What is the treatment for mild to moderate acne ?

A

Topical retinoids + topical antibiotic

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19
Q

What is the treatment for moderate to severe acne ?

A

Topical retinoid AND Topical antibiotic OR Oral antibiotic
+/- Oral hormonal therapy.

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20
Q

What is the treatment for severe acne

A

Oral Isotretinoin

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21
Q

What is the MOA of isotretinoin ?

A
  • Shrinkage of sebaceous glands
  • Decrease in sebum secretion
  • Inhibits C. acnes
  • Decrease inflammation
  • Increases keratinocyte differentiation
22
Q

What are the indications for oral isotretinoin ?

A

*Severe acne
* Treatment-resistant acne
* Scarring acne
* Acne that causes significant psychological distress

23
Q

What is the protocol of oral isotretinoin therpay ?

A
  • 0.5 mg/kg/day for the first month
  • 1 mg/kg/day for subsequent months
  • Treatment length is ~6 months
  • Should be taken with food
  • No other acne medications should be used while taking
    isotretinoin
  • Acne may worsen initially
24
Q

What are the mostcommon side effects of isotretinonin?

A

Most Common
* Dry skin and lips
* Dry eyes
* Photosensitivity
*Teratogenicity –spontaneous abortions and
severe life-threating
congenital malformations
* Pregnancy Prevention
Program

25
What are the signs of isotretinonin toxicity ?
*Hyperlipidemia * Hepatotoxicity * Inflammatory bowel disease * Myalgia in physically active patients. *Pseudotumor cerebri * Psychiatric effects
26
What is the treatment for acne related post inflammatory hyperpigmentation ?
hydroquinone
27
What is the treatment for acne related Atrophic scars?
Laser resurfacing
28
What is the treatment for acne related Hypertrophic or keloidal scars?
corticosteroid injections
29
What is the clinical presentation of Rosacea ?
Fixed centrofacial erythema with inflammatory papulopustular lesions. They often flare and Telangectasias are seen in the lesion field.
30
What is the difference between rosacea and Acne ?
There are no comedons in rosacea.
30
What is the age group of patients presenting with rosacea ?
> 30
30
What is the prevalence of roscacea?
1 to 10 % of the population
31
What is the pathophysiology of Rosacea ?
It is Unknown. * Immune dysfunction * Microbial organisms * UV radiation * Vascular hyperreactivity * Genetics
32
What are the Rosacea Exacerbating Factors?
* Exposure to extreme temperatures * Sun exposure * Hot beverages, spicy foods, alcohol * Exercise * Irritation from topical products * Feeling angry or embarrassed
33
What are the differential diagnosis for Rosacea ?
* Ruddy complexion * Acute cutaneous lupus erythematosus * Acne * Perioral dermatitis * Long term topical steroid application
34
What are the non Rx treatment for Rosacea ?
* Avoid triggers * Gentle cleansing * Frequent skin moisturization * Daily broad-spectrum sunscreen
35
What is the firstline treatment for mild to moderate Rosacea ?
Ivermectin 10mg/gm or Azealic acid 15 gm gel. + Bromonidine PRN for erythema
36
What is the second line treatment for mild to moderate Rosacea
Metronidazole 0.75 gm cream or gel + Bromonidine PRN for erythema
37
What is the treatment for moderate to severe Rosacea ?
Ivermectin 10 mg + Doxycycline modified release or Lemycline instead of doxy. ( Bromonidine PRN for erythema)
38
What is the treatment for Rhynophyma in Rosacea ?
Laser ablation
39
What is the treatment for ocular rosacea ?
Artificial tears, Eyelid hygiene + evening administration of erythromycin ointment to eyelids.
40
What is the definition of folliculitis?
It is the inflammation of the superficial epidermal portion of the hair follicles.
41
What is the most common pathogen associated to bacterial folliculitis ?
Staphylococcus aureus.
42
What are the pathogens linked to gram negative folliculitis?
▪ Pseudomonas aeruginosa- “Hot Tub Folliculitis” ▪ Klebsiella, Enterobacter, Proteus
43
What are the characteristics of superficial folliculitis ?
They present with pustules and erythemetus papules in the scalp hair follicles or in the facial hair follicles.
44
What are the characteristics of deep folliculitis ?
Furuncles consist of deep tender abscess and carbuncles that are connect through a channel in several continuous hair follicles.
45
What is the presentation of psudeomonas indcued hot tub folliculitis ?
* Red, edematous perifollicular papules and pustules occurring 8-48 hours after exposure * Lesions in areas covered by bathing suits; face & neck usually spared * Usually resolve 7-14 days * May be associated with pain, pruritus
46
What is the approach to folliculitis dx ?
The Dx is based on History and physical examination. However, gram stain and culture of puss should be considered + Skin biopsy to differentiate folliculitis from other conditions should be considered.
47
What are the common elements of folliculitis Tx ?
Warm compression for intact lesions + analgesics and anti-inflammatories. For open lesions Hydrogen peroxide for clensing the lesion.
48
What is the antibiotic therapy for mild Folliculitis?
topical antibiotics for 7 days such as Erythromycin, Clindamycin. etc.
49
What is the therapy for MRSA induced folliculitis?
Mupirocin ointment or Fusidic acid ointment.

PA MS (44 decks)

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