Pilosebaceous Unit and Apocrine Disorders Flashcards
_____ is metabolized to _____ a more potent androgen, in the adrenal glands and sebaceous unit
testosterone to 5a-DHT
5a-DHT has what action at the sebaceous gland?
sebum production
What are the 4 general stages of pathogenesis of acne vulgaris?
microcomedone, come done, inflammatory papule and pustule and nodule/cyst
What is the underlying mechanism for the pathogenesis of acne vulgaris?
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
What are the common names for closed and open comedones? Which are more superficial?
whiteheads and black heads, blackheads are more superficial
Describe the symptoms of acne fulminans/ pyoderma faciale.
abrupt onset, deep lesions, complicated by scarring, fever, arthralgias, lymphadopathies and hepatosplenomegaly
Acne conglobata is different from acne fulminans how?
absence of systemic symptoms, still highly inflammatory with the presence of comedones nodules, abscesses and draining sinuses
What does acne excoriee mean?
pimples that have been scratched or manipulated and the inflammation that results
What is diagnostic characteristic of drug-induced acne?
uniform morphology, other symptoms include favors trunk and extremities 2-4 weeks aver starting drug
What are drugs that classically cause drug-induced acne?
glucocoritcoids, anabolic steroids, topical steroids, hormones, lithium, iodides and bromides, isoniazid (TB tx)
At what age does neonatal acne become infantile acne?
after about 3 months
Contrast the causes of neonatal and infantile acne
neonatal acne is a consequence of maternal hormones, infantile acne is under the hormonal influence of the child (generally resolves in 1-2 years)
What are the two general goals of acne treatment?
unplug obstructed follicular orifice and inhibit the growth of bacteria
What are the actions of topical retinoids (tretinoin or adapalene) v. benzoyl peroxide to treat acne?
keep follicular orifice unobstructed (apply to whole face) vs. inhibit the growth of bacteria (apply to inflammatory lesions)
Name 4 systemic treatments of acne.
oral antibiotics, [rest in females] oral contraceptives, oral spironolactone or oral isotretinoin (Acutain)
What side effects might you expect with minocycline.
blue/gary pigment, lupus like syndrome (mouth sores) in addition to nausea, pseudtumor cerebra and dizziness
Which acne medication stands out for its side effects, including: teratogenicity, and mood changes?
isotretinoin
How could you differentiate between rosacea and acne?
rosacea appears with the absence of comedones, it is also triggered by hot liquids, spicy foods, alcohol and environmental/emotional stressors
What is characteristic of perioral dermatitis
spares the vermillion border, worsens with topical steroids and mint or cinnamon flavoring (can be around eyes)
What treatments are available to treat the inflammation of rosacea? to treat the telangiectasias?
topical antibiotics as well as systemic antibiotics reduce erythema and inflammation, laser surgery treats telangiectasia
Hidradentitis suppurativa affects which skin structure?
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
Name the conditions included in follicular occlusion tetrad (acne inversa)
acne conglobata, dissecting cellulitis of the scalp, hidradenitis suppurativa and pilondial cyst (superior gluteal cleft)
What treatments are available for hidradenitis suppurativa?
medical therapy (systemic antibiotics, isotretinoin/retenoid, biologics/TNFa inhibitors) or surgical therapy (intralesional steroid injections, excision, CO2 laser ablation and liposection)
What treatments are available for hyperhidrosis?
aluminum chloride (plugs apocrine duct), oral anticholinergics, botulinum toxin injection, surgical sympathectomy (only in hands) and liposuction (only at axillae)
