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MSK/Derm > SM 264: Acne, Rosacea and Related Disorders > Flashcards

SM 264: Acne, Rosacea and Related Disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

What is a Pilosebaceous Unit?

A

Hair follicle + Sebaceous glands

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2
Q

When does Acne Vulgaris present, and after what physiologic event?

A

Presents early in puberty after Adrenarche

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3
Q

How is Acne tied to the hormonal system?

A

Acne is partially driven by Sebocyte maturation and Holocrine secretion of Sebum in response to rising Adrenal hormones

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4
Q

What causes follicular epidermal hyperproliferation in Acne Vulgaris?

A

Abnormal Keratinocyte development, which has a genetic basis

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5
Q

What are the 4 pillars of Acne Vulgaris pathogenesis?

A

Follicular Epidermal Hyperproliferation, Excess Sebum Production, IL-1 inflammation and C. acnes infection

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6
Q

Describe the broad overview of Acne Vulgaris pathogenesis?

A

Abnormal Keratinocye proliferation + excess Adrenal hormone induced sebum production causes Sebum to build up n the hair follicles, allowing for C. acnes to proliferate and produce inflammatory molecules that trigger IL-1

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7
Q

What bacterium is responsible for Acne Vulgaris development?

A

C. acnes

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8
Q

What’s happening in this Acne representation?

A

Abnormal Keratinocyte proliferation blocks the follicle duct, leading to excess Sebum to buildup after Adrenal hormones induce Sebocyte secretion, causing inflammation and infection by C. acnes

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9
Q

How do Sebaceous glands respond to hormones?

A

Sebaceous glands respond to Androgens by maturing their Sebocytes and producing Holocrine secretions of Sebum into a follicle duct

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10
Q

What class of hormones regulates Sebum production and how?

A

Androgens regulate Sebum production by binding to receptors on Sebaceous glands

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11
Q

What components are unique to Sebum?

A

Wax Esters and Squalene

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12
Q

How does C. acnes effect Sebum?

A

C. acnes catabolizes Sebum into Free Fatty Acids, which causes inflammation and redness in Acne Vulgaris

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13
Q

How do Free Fatty Acids cause inflammation?

A

FFA’s are generated after C. acnes catabolizes Sebum, and bind to TLR2 to increase production of pro-inflammatory cytokes like IL-1 and IL-8

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14
Q

What is this, is it inflammatory, and is it painful?

A

Closed Comedone, non-inflammatory, not painful

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15
Q

What is this, is it inflammatory, and is it painful?

A

Open Comedone, non-inflammatory, not painful

AKA blackheads, top of Comedone is open allowing Sebum to be oxidized and turn black

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16
Q

What is this, is it inflammatory, and is it painful?

A

Acne Papule, inflammed and raised/elevated, painful/tender

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17
Q

What is this, is it inflammatory, and is it painful?

A

Acne Pustule, inflammatory and raised, painful/tender

Filled with Dead Leukocytes

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18
Q

What is this, is it inflammatory, and is it painful? Also, what causes it?

A

Acne Nodule, inflammatory and raised and diffuse, painful/tender

As pus builds up, can’t expand upwards so it expands laterally and forms a wide Cyst/Nodule

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19
Q

How does Acne Vulgaris resolve?

A

Post-inflammatory hyper/hypopigmentation as well as scarring

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20
Q

What can happen in women to increase Acne Vulgaris suspectibility?

A

Increased Androgen sensitivity like PCOS can lead to worse Acne Vulgaris

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21
Q

What i sAcne Fulminans?

A

An explosive onset severe form of acne with lots of blood crust, malaise, and lower back pain

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22
Q

How does Acne Fulminans present?

A

Explosiv enoset severe Acne

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23
Q

What is this?

A

Acne Fulminans, as seen by the lots of bloody crust

24
Q

What is the standard Acne maintenance therapy?

A

Topical Retinoids

25
Q

What is the treatment for this?

A

Comedonal Acne is due to abnormal Keratinocytes without much involvement of bacteria or excess Sebum, so treat with Retinoids

26
Q

How do Retinoids work?

A

Vit. A derivatives that normalize abnormal Keratinocyte development, the first step in Acne development

Ex: Tretinoin

27
Q

What is the treatment for this?

A

Inflammatory Acne has abnormal Keratinocytes + bacteria/inflammation, so should be treated with Retinoids, as well as Tetracycline antibiotics (Clindamycin) and Benzyl Peroxide

28
Q

How does Benzoyl Peroxide work?

A

Anti Microbial + Anti Inflammatory, always give with antibiotics when treating Acne

29
Q

When are Tetracyclines contraindicated?

A

Pregnant women and children < 8 y/o

30
Q

Why is premature Acne worrisome?

A

Acne requires Androgen hormones, so Acne in a young child suggests Endocrinopathy

31
Q

What is Isotretinoin?

A

Last line for Acne, induces apoptosis in Sebocytes to reduce Sebum production

Used for Acne Fulminans and Phymatous Rosacea

32
Q

When should antibiotic monotherapy be used for Acne Vulgaris?

A

Never - always limit it ot less than 3 months and always give antibiotics with Benzoyl Peroxide

33
Q

What acne treatments are specifically available to women?

A

Combinatino birth control pills and Spironolactone

34
Q

How do combination birth control pills decrease Acne?

A

They decrease Androgen production

35
Q

How does Spironolactone treat Acne?

A

Androgen receptor blocker

36
Q

When should hormonal therapy for Acne vulgaris be considered?

A

Hyperandrogenemia (PCOS) based off of Hormone levels, serious lesions, perimenstrual flare and resistance to conventional therapies (use it before Isotretinoin)

37
Q

What is Photodynamic therapy for Acne Vulgaris and how does it work?

A

Uses UV light to target Porphyris made by C. acne and treat inflammatory acne where C. acne is prevalent

38
Q

What is Acne Roasacea?

A

Gradual late onset Acne > 30 y/o that occurs in the face

39
Q

What drives Acne Rosacea pathogenesis?

A

Neurovascular instability reacting to environmental stimuli + TLR2 inflammation + follicular inflammation

40
Q

What microbes and proteins drive Acne Rosacea and how?

A

Demadex mites bind to TLR2 receptors and cause inflammation as well as production of Cathelicidin proteins in Acne Rosacea

41
Q

How does Acne Rosacea present and what is never found?

A

Presents with redness due to neurovascular changes and Papules/Pustules, but never Commodores or Blackheads because there are no clogged follicles

42
Q

How might Acne Rosacea cause blindness?

A

Ocular Rosacea, due to neurovascular involvement, which effects the Cornea + Conjunctiva

43
Q

How is the background redness in Acne Rosacea treated?

A

Brimonidine Tartrate (a2) and Oxymetazoline HCl (a1) target the blood vessels and cause vasoconstriction

44
Q

What is Brimonidine Tartrate and how does it work?

A

Selective a2 agonist that causes vasoconstriction to treat redness in Acne Rosacea

45
Q

What is Oxymetazoline and how is it used?

A

Selective a1 agonist that constricts blood vessels to treat redness in Acne Rosacea

46
Q

How are papules and pustules treated in Acne Rosacea?

A

Doxycyclin and Ivermectin

47
Q

What is Doxycyclin?

A

A tetracyclin antibiotic used to treat Papules and Pustules in Acne

48
Q

What is Ivermectin?

A

An anti-parasitic used to kill Demedix mites in Acne Rosacea

49
Q

What is this and how is it treated?

A

Phymatous Rosacea - severe nose involvement and redness following Acne Rosacea

Treat with Isotretinoin to kill Sebocytes and reduce tissue volume; consider surgery w/ risk of scars

50
Q

What is this?

A

Periorificial Dermatitis; rash that surrounds the mouth or eye and spares the upper lip or upper eyelid

51
Q

Who gets Periorificial Dermatitis and why?

A

Young women and children who use a topical steroid, etiology unknown

52
Q

How do you treat this?

A

Avoid topical corticosteroids, which caused the Periorificial Dermatitis

Consider Clindamycin

53
Q

What is this and why?

A

Hidradentitis Suppurative; a serious rash that develops in the Axilla, Brests, Perianal regions in Obese patients and those with a history of HS/Cystic Acne

54
Q

What is this and what feature is it showing?

A

Hidradenitis Suppurative showing Double Comedones

55
Q

How is Hidradenitis Suppurative treated?

A

Weight loss to fix Obesity

Smoking cessation

Topical Agents to kill bacteria

Systemic Agents to lower Inflammation

Adalimumab

56
Q

What procedures can be performed on Hidradenitis Suppurative?

A

Inject steroids, drain abscesses, and surgical excision of diseased areas as a last resort

MSK/Derm (46 decks)

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