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Skin-Muscoskeletal > Week 3 - Acne Vulgaris > Flashcards

Week 3 - Acne Vulgaris Flashcards

0
Q

What is the typical clinical expression of acne vulgaris?

A

Multifaceted, noninflammatory open (blackheads) and closed (whiteheads) to inflammatory papules, pustules and nodules (cysts). This may lead to pitted or hypertrophic scars.

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1
Q

What is common acne defined as?

A

A skin disorder of the pilosebaceous unit. (sebaceous glands and their associated small hairs)

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2
Q

How many adolescents get acne?

A

80%

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3
Q

What is the Hallmark of acne?

A

Comedones

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4
Q

What are acne macules?

A

Pseudo-scars that are flat, red spots that are the final stage of most inflamed acne lesions

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5
Q

What are common acne myths?

A

Diet, Lack of bathing/shampooing, hairstyles, and cosmetics can cause or make acne worse.

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6
Q

When can acne worsen?

A

After long term repeated and protracted application of cosmetics over years.
During the week before menses for women.

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7
Q

What is the epidemiology of acne?

A

Neonates - pilosebaceous units are active in response to maternal hormones - usually resolves on its own - within 2-6 weeks of birth
Puberty - Mostly comedones
Mid-late teens - largest number of cases

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8
Q

Where is the normal distribution of acne?

A

Face and chest, shoulders, upper back and neck

-There is the greatest density of pilosebaceous units (hair follicle + sebaceous gland)

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9
Q

What is the pathophysiology of acne?

A
  • Excessive sebum production
  • Follicular plugging
  • Colonization of sebaceous follicle with propionibacterium acnes
  • Immune response with inflammation
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10
Q

What causes follicular plugging?

A

Excessive keratinization in the follicular canal

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11
Q

What is the predominant organism associated with acne and how does it cause inflammation?

A

Propionibacterium acnes

It hydrolyzes sebum into free fatty acids which serve as the primary pro-inflammatory substances of acne

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12
Q

When the enzymes in acne bacteria are working, they cause chemotactic factors to be released. What does this do?

A

The chemotactic factors attract neutrophils and the host response causes follicular wall inflammation.

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13
Q

How does stress influence acne?

A

It increases the output of adrenal steroids, affecting the sebaceous gland.

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14
Q

What medications trigger acne?

A

Most common: anabolic steroids, corticosteroids

-Isoniazid, Lithium, Phenytoin

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15
Q

What is mild acne?

A

Few to several papules and pustules, no nodules

16
Q

What is moderate acne?

A

Several to many papules and pustules, plus many nodules

17
Q

What is severe acne?

A

Numerous or extensive papules and pustules, plus many nodules

18
Q

What is comedonal acne?

A

Open and closed comedones with few, if any inflammatory lesions
Treatment: topical keratolytics agents (which dec. adhesiveness of follicular cells)

19
Q

What is papulopustular/inflammatory acne?

A

Comedonal lesions plus inflammatory lesions - erythematous papules and pustules
Treatment: topical agents and systemic antibiotics

20
Q

What is nodulocystic acne?

A

Extensive comedonal lesions and inflammatory papules and pustules plus nodules an cysts or abscesses.
Treatment: topical is not effective - if nodulocystic does not respond in 8 weeks of oral antibiotics, then consider minocycline or isotertinoin (Accutane)

21
Q

What are we looking for during laboratory testing for acne?

A

Endocrine causes of acne - congenital adrenal hyperplasia, adrenal tumor, polycystic ovary disease
- Look at serum DHEAS, total testosterone, free testosterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) ratio

22
Q

What is Grade I acne?

A

Superficial Non-inflammatory , open and closed comedones, flesh colored papules, no inflammation, no pustules, no scars, no nodules

23
Q

What is grade II acne?

A

Superficial inflammatory, open and closed comedones, inflammation, papules/pustules - few to several, no nodules, no scars

24
Q

What is grade III acne?

A

It is deep inflammatory, moderate to severe, open and closed comedones, papules/pustules, few nodules, little to no scar present

25
Q

What is grade IV acne?

A

Severe nodulocystic, deep/inflammatory, open and closed comedones, papules/pustules, extensive nodules, variable degree scar

26
Q

What are the most common antibiotic given for acne?

A

Doxycycline and minocycline - long term antibiotics

27
Q

What is isotretinoin?

A

It is accutane, only medication to suppress acne over long term. Need to do iPLEDGE program - need to use two forms of birth control (tetragenic)

28
Q

What is acne rosacea and what is its cause?

A

Hallmark: telangiectasia - chronic, progressive dermatosis characterized by erythema, papules, pustules, telangiectasia and potential hyperplasia over central part of face, affects middle aged adults
-Cause unknown but may be associated with H. pylori

Skin-Muscoskeletal (50 decks)

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