SM_264a: Acne, Rosacea, and Related Disorders Flashcards
Acne pathogenesis involves ____, ____, ____, and ____
Acne pathogenesis involves follicular epidermal hyperproliferation, excess sebum production, inflammation (IL-1), and Cutibacterium acnes
(cells become abnormally adherent, excess sebum, increased pro-inflammatory cytokines, bacteria)
Sebum production is regulated by ____ and involves ____
Sebum production is regulated by androgens and involves androgen receptors
(holocrine secretion as the sebaceous gland matures - contents go into sebaceous gland and then sebaceous duct)
Describe Cutibacterium acnes
Cutibacterium acnes
- Gram +, anaerobic, microaerobic
- Resident flora of follice
- Acne patients have more than controls
- Promotes inflammation: antibodies to cell wall activate complement, produces lipases / proteases / hyaluronidases, binds TLR2 increasing proinflammatory cytokines
(feeds off sebum)
This is a ____
This is a closed comedone
(non-inflammatory, palpable)
This is an _____
This is an open comedone
(clinically inflammed lesions - raised, elevated, red)
This is an ____
This is an acne papule
(dilation of follicle, extrustion of material in follice into dermis, nodules)
This is an ____
This is an acne pustule
This is an ____
This is an acne nodule (and cysts)
These are ____
These are acne sinus tracts
This is ____
This is post-inflammatory hyperpigmentation
This is ____
This is acne scarring
(boxcar scars, rolling scars, no medication can reduce scarring)
This is ____ acne
This is drug-induced acne
This is acne related to ____
This is acne related to polycystic ovary syndrome
(hyperandrogenism due to increased levels or increased sensitivity to androgen)
This is ___
This is acne fulminans
(sudden onset of very severe acne, can have systemic symptoms, acne + arthritic symptoms)
Describe acne treatment
Acne treatment
- Early
- Adequately aggressive for severity
- Algorithmic approach
- Target pathogenic factors: often involves combined topicals and orals
- Patient education is critical
___ are first line treatment for comedonal acne
Retinoids are first line treatment for comedonal acne
(tretinoin, adapalene, tazarotene)
Inflammatory acne topic treatment involves ____ and ____
Inflammatory acne topic treatment involves retinoids and benzoyl peroxide
(no resistance to benzoyl peroxide, also antibiotics such as clindamycin, dapsone, and sodium sulfacetamide and sulfur)
Describe systemic treatment of acne
Systemic treatment of acne
- Moderate to severe inflammatory
- Minocycline > doxycycline >> tetracycline
- Sarecycline: antimicrobial, anti-inflammatory, reduces free fatty acid levels
- Erythromycin (pregnancy, kids < 8 yo)
- TMP/SMX
- Isotretinoin: reduces sebum production, decreases androgen synthesis, induces cell cycle arrest and apoptosis in sebocytes
____ is used with antibiotics to minimize resistance
Benzoyl peroxide is used with antibiotics to minimize resistance
____ is first line treatment for acne fulminans
Isotretinoin is first line treatment for acne fulminans
Hormonal therapy of acne involves ____ and ____
Hormonal therapy of acne involves combination birth control pills and spironolactone
- Combination birth controls: decrease LH and androgen production, increase hepatic sex-hormone binding globulin levels which decreases free testosterone levels
- Spironolactone: androgen receptor blocker, 5alpha-reductase inhibitor
____ is the main indication for hormonal therapy of acne
Hyperandrogenemia is the main indication for hormonal therapy of acne
___ is used to generate reactive oxygen species to destroy acne
Photodynamic therapy is used to generate reactive oxygen species to destroy acne
Rosacea pathogenesis involves ____, ____, and ____
Rosacea pathogenesis involves neurovascular instability and increased reactivity, innate immunity abnormality, and inflammation of follicle and surrounding dermis
(inflammatory signaling, vascular signaling and response leading to hyperreactivity of vessels, sensory response, exogenous triggers, and endogenous risk factors)
____ are found on the skin in increased amounts in rosacea due to increased amounts of ____
Cathelecidins are found on the skin in increased amounts in rosacea due to increased amounts of demadex mites
(cathelecidins are antimicrobial peptides)
This is ____ rosacea
This is erythematotelangiectatic rosacea
This is ____ rosacea
This is papulopustular rosacea
This is ____ rosacea
This is phymatous rosacea
(on nose, brow, and cheek)
This is ____ rosacea
This is ocular rosacea
Describe ocular rosacea
Ocular rosacea
- Most of all rosacea patients
- 1/3 have sight-treatening corneal disease
- Ocular disease may precede skin disease
- Skin may be subtle in almost all ocular rosacea cases
- No diagnostic test, nonspecific symptoms
Eyelid findings in ocular rosacea include ____ and ____
Eyelid findings in ocular rosacea include blepharitis and conjunctival hyperemia
Corneal findings in ocular rosacea include ____ and ____
Corneal findings in ocular rosacea include superficial punctate keratitis and epithelial erosions
(1/3 of rosacea patients have corneal involvement)
Describe treatment of erythematotelangiectatic rosacea
Erythematotelangiectatic rosacea treatment
- Avoidance of sun and other triggers
- Redness associated with papules / pustules: azelaic acid, metronidazole, sodium sulfacetamide and sulfur
- Diffuse (background) redness: brimonide tartrate gel, oxymetazoline HCl cream, vascular lasers, and intensed pulsed light
Brimonidine tatrate gel used to treat diffuse redness in erythematotelangiectatic rosacea is a ____
Brimonidine tatrate gel used to treat diffuse redness in erythematotelangiectatic rosacea is a selective alpha2-adrenergic receptor agonist
Oxymetazoline cream used to treat diffuse redness in erythematotelangiectatic rosacea is a ____ and ____
Oxymetazoline cream used to treat diffuse redness in erythematotelangiectatic rosacea is a selective alpha-1A-adrenergic receptor agonist and vasoconstrictor
Describe treatment of papulopustular rosacea
Papulopustular rosacea treatment
- Topical medications: azelaic acid, metronidazole, ivermectin, sodium sulfacetamide and sulfur
- Oral medications: doxycycline = minocycline > tetracycline, metronidazole, isotretinoin
- Avoidance of sun and other triggers
Ivermectin is used in topical treatment of papulopustular rosacea because it ____
Ivermectin is used in topical treatment of papulopustular rosacea because it acts against the demadex mite
Describe treatment of phymatous rosacea
Phymatous rosacea treatment
- Isotretinoin: decreases tissue volume, decreases sebaceous gland size / number
- Surgical excision, hot loop contouring
- Ablative laser: carbon dioxide, erbium (YAG)
This is ____
This is periorificial (perioral) dermatitis
Describe periorificial (perioral) dermatitis
Periorificial (perioral) dermatitis
- Spearing, vermillion border
- Young women, children
- Frequent history of potent topical steroid use with positive response but rebound flare
- Etiology unknown
Describe treatment of periorificial dermatitis
Periorificial dermatitis treatment
- Avoid topical corticosteroids
- Topical agents: metronidazole, erythromycin, clindamycin, sodium sulfacetamide / sulfur, azelaic acid, topical calcineurin inhibitors (tacrolimus)
- Oral antibiotics: doxycycline / minocycline / tetracycline, erythromycin
Avoid ____ in treatment of periorificial dermatitis
Avoid topical corticosteroids in treatment of periorificial dermatitis
This is ____
This is hidradenitis suppurative
Describe presentation of hidradenitis suppurativa
Hidradenitis suppurativa presentation
- Axillae, breasts, inguinal creases, buttocks, perineum
- Often bilateral
- Tender, red, draining nodules ± abscesses
- Open comedones -> double comedones
- Scarring
Describe treatment of hidradenitis suppurative
Hidradenitis suppurative
- Weight loss, smoking cessation
- Topical agents
- Systemic agents
- Adalimumab
- Intralesional injection of corticosteroids
- Incision and drainage of acute abscesses
- Surgical excision of diseased areas: primary closure, split-thickness skin grafting, and healing by secondary intent
