Pilosebaceous Unit and Apocrine Disorders

Question 1

_____ is metabolized to _____ a more potent androgen, in the adrenal glands and sebaceous unit

Answer 1

testosterone to 5a-DHT

Question 2

5a-DHT has what action at the sebaceous gland?

Answer 2

sebum production

Question 3

What are the 4 general stages of pathogenesis of acne vulgaris?

Answer 3

microcomedone, come done, inflammatory papule and pustule and nodule/cyst

Question 4

What is the underlying mechanism for the pathogenesis of acne vulgaris?

Answer 4

infundibular hyperkaratosis and stimulation of sebum secretion by 5a-DHT, the accumulation of keratin and sebum plug form a come done which can burst and become inflamed

Question 5

What are the common names for closed and open comedones? Which are more superficial?

Answer 5

whiteheads and black heads, blackheads are more superficial

Question 6

Describe the symptoms of acne fulminans/ pyoderma faciale.

Answer 6

abrupt onset, deep lesions, complicated by scarring, fever, arthralgias, lymphadopathies and hepatosplenomegaly

Question 7

Acne conglobata is different from acne fulminans how?

Answer 7

absence of systemic symptoms, still highly inflammatory with the presence of comedones nodules, abscesses and draining sinuses

Question 8

What does acne excoriee mean?

Answer 8

pimples that have been scratched or manipulated and the inflammation that results

Question 9

What is diagnostic characteristic of drug-induced acne?

Answer 9

uniform morphology, other symptoms include favors trunk and extremities 2-4 weeks aver starting drug

Question 10

What are drugs that classically cause drug-induced acne?

Answer 10

glucocoritcoids, anabolic steroids, topical steroids, hormones, lithium, iodides and bromides, isoniazid (TB tx)

Question 11

At what age does neonatal acne become infantile acne?

Answer 11

after about 3 months

Question 12

Contrast the causes of neonatal and infantile acne

Answer 12

neonatal acne is a consequence of maternal hormones, infantile acne is under the hormonal influence of the child (generally resolves in 1-2 years)

Question 13

What are the two general goals of acne treatment?

Answer 13

unplug obstructed follicular orifice and inhibit the growth of bacteria

Question 14

What are the actions of topical retinoids (tretinoin or adapalene) v. benzoyl peroxide to treat acne?

Answer 14

keep follicular orifice unobstructed (apply to whole face) vs. inhibit the growth of bacteria (apply to inflammatory lesions)

Question 15

Name 4 systemic treatments of acne.

Answer 15

oral antibiotics, [rest in females] oral contraceptives, oral spironolactone or oral isotretinoin (Acutain)

Question 16

What side effects might you expect with minocycline.

Answer 16

blue/gary pigment, lupus like syndrome (mouth sores) in addition to nausea, pseudtumor cerebra and dizziness

Question 17

Which acne medication stands out for its side effects, including: teratogenicity, and mood changes?

Answer 17

isotretinoin

Question 18

How could you differentiate between rosacea and acne?

Answer 18

rosacea appears with the absence of comedones, it is also triggered by hot liquids, spicy foods, alcohol and environmental/emotional stressors

Question 19

What is characteristic of perioral dermatitis

Answer 19

spares the vermillion border, worsens with topical steroids and mint or cinnamon flavoring (can be around eyes)

Question 20

What treatments are available to treat the inflammation of rosacea? to treat the telangiectasias?

Answer 20

topical antibiotics as well as systemic antibiotics reduce erythema and inflammation, laser surgery treats telangiectasia

Question 21

Hidradentitis suppurativa affects which skin structure?

Answer 21

apocrine sweat glands, it is a painful conditions where apocrine follicles are ruptured and create an inflammatory response leaving recurrent nodules with draining sinus tracts

Question 22

Name the conditions included in follicular occlusion tetrad (acne inversa)

Answer 22

acne conglobata, dissecting cellulitis of the scalp, hidradenitis suppurativa and pilondial cyst (superior gluteal cleft)

Question 23

What treatments are available for hidradenitis suppurativa?

Answer 23

medical therapy (systemic antibiotics, isotretinoin/retenoid, biologics/TNFa inhibitors) or surgical therapy (intralesional steroid injections, excision, CO2 laser ablation and liposection)

Question 24

What treatments are available for hyperhidrosis?

Answer 24

aluminum chloride (plugs apocrine duct), oral anticholinergics, botulinum toxin injection, surgical sympathectomy (only in hands) and liposuction (only at axillae)