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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
Q

What are the signs of isotretinonin toxicity ?

A

*Hyperlipidemia
* Hepatotoxicity
* Inflammatory bowel disease
* Myalgia in physically active patients.
*Pseudotumor cerebri
* Psychiatric effects

26
Q

What is the treatment for acne related post inflammatory hyperpigmentation ?

A

hydroquinone

27
Q

What is the treatment for acne related Atrophic scars?

A

Laser resurfacing

28
Q

What is the treatment for acne related Hypertrophic or keloidal scars?

A

corticosteroid injections

29
Q

What is the clinical presentation of Rosacea ?

A

Fixed centrofacial erythema with inflammatory papulopustular lesions. They often flare and Telangectasias are seen in the lesion field.

30
Q

What is the difference between rosacea and Acne ?

A

There are no comedons in rosacea.

30
Q

What is the age group of patients presenting with rosacea ?

A

> 30

30
Q

What is the prevalence of roscacea?

A

1 to 10 % of the population

31
Q

What is the pathophysiology of Rosacea ?

A

It is Unknown.
* Immune dysfunction
* Microbial organisms
* UV radiation
* Vascular hyperreactivity
* Genetics

32
Q

What are the Rosacea Exacerbating Factors?

A
  • Exposure to extreme temperatures
  • Sun exposure
  • Hot beverages, spicy foods, alcohol
  • Exercise
  • Irritation from topical products
  • Feeling angry or embarrassed
33
Q

What are the differential diagnosis for Rosacea ?

A
  • Ruddy complexion
  • Acute cutaneous lupus erythematosus
  • Acne
  • Perioral dermatitis
  • Long term topical steroid application
34
Q

What are the non Rx treatment for Rosacea ?

A
  • Avoid triggers
  • Gentle cleansing
  • Frequent skin moisturization
  • Daily broad-spectrum sunscreen
35
Q

What is the firstline treatment for mild to moderate Rosacea ?

A

Ivermectin 10mg/gm or Azealic acid 15 gm gel. + Bromonidine PRN for erythema

36
Q

What is the second line treatment for mild to moderate Rosacea

A

Metronidazole 0.75 gm cream or gel + Bromonidine PRN for erythema

37
Q

What is the treatment for moderate to severe Rosacea ?

A

Ivermectin 10 mg + Doxycycline modified release or Lemycline instead of doxy. ( Bromonidine PRN for erythema)

38
Q

What is the treatment for Rhynophyma in Rosacea ?

A

Laser ablation

39
Q

What is the treatment for ocular rosacea ?

A

Artificial tears, Eyelid hygiene + evening administration of erythromycin ointment to eyelids.

40
Q

What is the definition of folliculitis?

A

It is the inflammation of the superficial epidermal portion of the hair follicles.

41
Q

What is the most common pathogen associated to bacterial folliculitis ?

A

Staphylococcus aureus.

42
Q

What are the pathogens linked to gram negative folliculitis?

A

▪ Pseudomonas aeruginosa- “Hot Tub Folliculitis”
▪ Klebsiella, Enterobacter, Proteus

43
Q

What are the characteristics of superficial folliculitis ?

A

They present with pustules and erythemetus papules in the scalp hair follicles or in the facial hair follicles.

44
Q

What are the characteristics of deep folliculitis ?

A

Furuncles consist of deep tender abscess and carbuncles that are connect through a channel in several continuous hair follicles.

45
Q

What is the presentation of psudeomonas indcued hot tub folliculitis ?

A
  • 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
Q

What is the approach to folliculitis dx ?

A

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
Q

What are the common elements of folliculitis Tx ?

A

Warm compression for intact lesions + analgesics and anti-inflammatories. For open lesions Hydrogen peroxide for clensing the lesion.

48
Q

What is the antibiotic therapy for mild Folliculitis?

A

topical antibiotics for 7 days such as Erythromycin, Clindamycin. etc.

49
Q

What is the therapy for MRSA induced folliculitis?

A

Mupirocin ointment or Fusidic acid ointment.

PA MS (44 decks)

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