week 2- Acne Flashcards
which gland for acne vulgaris
pilosebaceous gland
key features of acne vulgaris
follicular hyperkeratinization, microbial colonization with Cutibacterium acnes, sebum production, and complex inflammatory mechanisms involving both innate and acquired immunity
which bacteria for acne
cutibacterium acnes
how many people ages 12-24 affected by acne
85%
prevalence and severity of acne
higher prevalence in females
higher severity in males
association with acne
-education level
-parental history
-skin sebum levels
-geopgraphy, diet, ethnicity
higher prevalence for race in acne
- African American and Latin American populations have a slightly higher prevalence of acne compared to Asian American and Caucasian populations
- However, geographically, many populations outside of Canada and the United States see less prevalence of acne which has implicated a standard American diet as an influencing factor in acne pathogenesis
papule
nodule
pustule
- Papule – a small, raised, solid, circumscribed lesion less than 1 cm in diameter
- Nodule – a palpable, raised, solid, circumscribed lesion greater than 1 cm in diameter
- Pustule – a small, circumscribed, inflamed, pus-filled lesion
comedo
closed comedo
open comedo
- Comedo – dilated hair follicle filled with keratin, bacteria, and sebum. Plural = comedones.
- Closed comedo – opening is obstructed and accompanied by an inflammatory response. Commonly called a whitehead
- Open comedo – opening is not obstructed and capped with a pigmented mass of skin debris. Commonly called a blackhead
blackhead and whitehead aka
blackhead- open comedo
whitehead- closed comedo
diagnose acne based on
presence of comedones, papules, pustules and nodules on the face, chest, or upper back.
-hyperpigmentation (fair skin)
when to do workup for hyperandrogenism if acne present
if signs of PCOS, virilization, atypical presentation
4 point severity scale for acne
1 (mild): open and close comedones with few inflammatory papule and pustules
2 (moderate): papule and pustule mainly on face
3 (moderately severe): numerous papule and pustules, occasional inflamed nodules, also on chest and back
4 (severe): many large, painful nodules and pustules
AKA
1. comedonal
2. mild papulopustular
3. moderate papulopustular
4. severe papulopustular/nodular
mild vs severe acne
mild- uninflamed comedones
severe- nodules
classfiy acne
drug induced acne
occupational acne
chemical acne
mechanical acne
drug induced acne from
topical and systemic corticosteroids
Antibiotics like penicillins and macrolides
–>Can also be caused by cotrimoxazole, doxycycline, ofloxacin, and chloramphenicol
anticonvulsants (phenytoin)
antipsychotics (olanzapine, lithium)
antifungals
chemotherapy drugs
antidepressants
antituberculosis drugs
naproxen
hydroxycloroquine
steroid acne (from corticosteroids) presents as
monomorphous papulopustules located mainly on the trunk and extremities, with less involvement of the face, and typically occurs after systemic administration of corticosteroids
antibiotics (penicillin and macrocodes) cause what type of acne and associated with what
acute generalized pustular eruptions without comedones.
associated with fever and leukocytosis
occupational acne from
halogenated aromatic hydrocarbons AKA chloracnegens
((dioxin exposure))
chemical acne AKA acne cosmetics from
heavy oil-based hair products and cosmetics and resolves with discontinuation of these products
mechanical acne (Acne mechanica) from
pressure and friction that induce acneiform eruptions
areas of restrictive clothing, prolonged contact with synthetic clothing fibers, use of sports equipment, etc.
neonatal acne in how many newborns
20%
when does neonatal acne devleop
usually 2 weeks old (before 6 weeks)
neonatal acne caused by
exposure to hormones in utero or via breastmilk
milia is
small (1 – 2 mm) white or yellow papules under the surface of the skin caused by keratin retention
milia and miliria in how many newborns
40-50% milia
40% miliaria
milia in which areas
forehead, cheeks, nose, and chin, but they may also occur on the upper trunk, limbs, penis, or mucous membranes
milia in adults usually from
cosmetic products
(looks like comedones but its not acne; misdiagnose)
miliaria is from
sweat retention caused by partial closure of eccrine structures
2 types of miliaria
- miliaria crystallina
- miliaria rubra
miliaria crystallina
Caused by superficial eccrine duct closure
- Consists of 1 – 2 mm vesicles without surrounding erythema most commonly on the head, neck, and trunk
miliaria rubra is AKA
heat rash
miliaria rubra
- Caused by deeper level of sweat gland obstruction
- Lesions are small erythematous papules and vesicles usually occurring on covered portions of the skin
infantile acne occurs
after 6 weeks old
common at 3-6 months
can last 2 years
childhood acne based on age
neonatal acne- 2 to 6 weeks
infantile ance- > 6 weeks ( up to 2 years)
mid-childhood acne- 1 to 7 yrs old
preadolescent acne -7-12 years old
cause of infantile acne
physiologic imbalances in androgen products
- Immature adrenals can produce elevated DHEAS which typically normalizes by 6 months of age
- LH levels surge between 6 and 12 months of age resulting in increased gonadal testosterone production in males
sometimes cosmetic
when to be worried about infantile acne
when Tanner stages are not consistent with age, increased height velocity, hirsutism,
refer to pediatric endocrinologist
mid-childhood acnes
1-7 yrs
comedones and inflammatory lesions on forehead, cheeks nose
rare
since androgens should be low at this age –> pediatric endocrinologist referral
preadolescent acne
1st sign of puberty
7-12 yrs old
comedones in T-zone
via rise of androgens in puberty
DDX for acne if secondary
hyperandrogenism: PCOS, adrenal hyperplasia, insulin resistance, hyperprolactinemia, Cushing’s disease, and certain cancers.
SAPHO syndrome (systemic disorder presenting with acne)
what is the acronym
A rare inflammatory disorder of bone, joints, and skin characterized by the presence of synovitis, acne, pustulosis, hyperostosis, and osteitis
PAPA, PASH, and PAPASH syndromes from
over activation of immune system; increase production of the IL-1 family and neutrophil-rich cutaneous inflammation
- PAPA syndrome
- A rare autosomal dominant disorder caused by mutations in the CD2-binding protein characterized by pyogenic sterile arthritis, pyoderma gangrenosum, and acne
- PASH syndrome
- A rare hereditary autoinflammatory disorder characterized by pyoderma gangrenosum, acne, and hidradenitis suppurativa
- PAPSH syndrome
- A rare autoinflammatory disorder characterized by pyogenic arthritis, acne, pyoderma gangrenosum, and hidradenitis suppurativa
acne conglobata
- tender, disfiguring, double or triple interconnecting comedones, cysts, inflammatory nodules, and deep burrowing abscesses on the face, shoulders, back, chest, upper arms, buttocks, and thighs
- Cysts often contain purulent, foul-smelling material that is discharged on the skin surface
acne conglobata from
diseases that are dysfunctional in follicular unit
acne conglobata can occur in
isolation or present with a systemic inflammatory condition, including SAPHO syndrome, PAPA syndrome, PASH syndrome, or PAPASH syndrome
also related to use of thyroid hormone, exposure to halogenated aromatic hydrocarbons (occupational acne), and the use of, or sudden discontinuation of, anabolic steroids
acne fulminans AKA acne maligna
*painful, ulcerating, and hemorrhagic clinical form of acne with a very sudden onset
* May or may not be associated with systemic symptoms such as fever and polyarthritis
* May cause bone lesions
causes of acne fulminant
high doses of isotretinoin when initiating treatment in patients with severe acne
- Also associated with anabolic steroid use
acne conglobata vs fulminans occurance
less than 200 cases of acne fulminates ever
conglobata uncommon but usually if use anabolic steroids in athelets
acne conglobata vs fulminans differentiate presentation
- Acne fulminans typically involves cysts and acutely inflamed lesions
- Acne conglobata involves polyporous comedones which are not present in acne fulminans
acne excoriee
excoriation disorder in which patients have a conscious, repetitive, and uncontrollable desire to pick, scratch, or rub acne lesions
skin picking –> lesions
excoriation disorders linked to
obsessive compulsive
diagnosis of acne excoriee
- Repeated attempts to decrease picking behavior
- Skin picking causes clinically significant distress or impairment in social, occupational, or other areas of functioning
- Skin picking is not attributable to the physiologic effect of a substance (e.g. cocaine) or another medical condition (e.g. scabies)
- Skin picking is not better explained by symptoms of another mental disorder (e.g. delusions or tactile hallucinations in a psychotic disorder)
solid facial edema is rare but associated with
longstanding acne vulgaris
clinical presentation of solid facial edema
localized, symmetric, non-pitting, non-painful edema over the glabellar region, midface, nasal saddle, and infraorbital regions
who mostly gets solid facial edema
males in their late teens or early twenties who present with a multi-year history of acne followed by a recent onset of persistent edema
rosacea (NOT ACNE)
long-term inflammatory skin condition that causes reddened skin and a rash, usually on the nose and cheeks
eye problem from rosacea
ocular rosacea
where does rosacea affect
center of the face,
but in rare cases, it can extend to other parts of the body, such as the sides of the face, the ears, neck, scalp, and chest
symptoms of rosacia
facial redness (flushing or blushing)
tingle and burn
rash and bumps
telangiectasia (dilated small blood vessels)
skin thickening on nose
eye irritation, swell, stye
perioral dermatitis typically effects
common acneiform eruption that usually affects women 20–45 years of age but can affect all adults and children
perioral dermatitis presentation
- Presents with discrete monomorphic papules and pustules on an erythematous base with or without scale distributed symmetrically around the mouth with a clear zone between the vermilion border and the affected skin
- It can extend to the nasolabial folds and skin around the lateral canthi (periorbital dermatitis)
what triggers perioral dermaitits
topical corticosteroids
folliculitis
hair follicle disorder
presents with follicular-based pustules and/or inflammatory papules on any hair-bearing area, but most commonly on the trunk, buttocks, thighs, axillae, face, and scalp
causes of folliculitis (infectious or non infectious)
- Bacteria are the most common cause (Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa)
- Fungal folliculitis caused by Malassezia is common and can become chronic if not treated
- Mechanical folliculitis can be caused by hair removal practices, tight clothing, and ingrown hairs
