Week 3 - Acne Vulgaris Flashcards
What is the typical clinical expression of acne vulgaris?
Multifaceted, noninflammatory open (blackheads) and closed (whiteheads) to inflammatory papules, pustules and nodules (cysts). This may lead to pitted or hypertrophic scars.
What is common acne defined as?
A skin disorder of the pilosebaceous unit. (sebaceous glands and their associated small hairs)
How many adolescents get acne?
80%
What is the Hallmark of acne?
Comedones
What are acne macules?
Pseudo-scars that are flat, red spots that are the final stage of most inflamed acne lesions
What are common acne myths?
Diet, Lack of bathing/shampooing, hairstyles, and cosmetics can cause or make acne worse.
When can acne worsen?
After long term repeated and protracted application of cosmetics over years.
During the week before menses for women.
What is the epidemiology of acne?
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
Where is the normal distribution of acne?
Face and chest, shoulders, upper back and neck
-There is the greatest density of pilosebaceous units (hair follicle + sebaceous gland)
What is the pathophysiology of acne?
- Excessive sebum production
- Follicular plugging
- Colonization of sebaceous follicle with propionibacterium acnes
- Immune response with inflammation
What causes follicular plugging?
Excessive keratinization in the follicular canal
What is the predominant organism associated with acne and how does it cause inflammation?
Propionibacterium acnes
It hydrolyzes sebum into free fatty acids which serve as the primary pro-inflammatory substances of acne
When the enzymes in acne bacteria are working, they cause chemotactic factors to be released. What does this do?
The chemotactic factors attract neutrophils and the host response causes follicular wall inflammation.
How does stress influence acne?
It increases the output of adrenal steroids, affecting the sebaceous gland.
What medications trigger acne?
Most common: anabolic steroids, corticosteroids
-Isoniazid, Lithium, Phenytoin
What is mild acne?
Few to several papules and pustules, no nodules
What is moderate acne?
Several to many papules and pustules, plus many nodules
What is severe acne?
Numerous or extensive papules and pustules, plus many nodules
What is comedonal acne?
Open and closed comedones with few, if any inflammatory lesions
Treatment: topical keratolytics agents (which dec. adhesiveness of follicular cells)
What is papulopustular/inflammatory acne?
Comedonal lesions plus inflammatory lesions - erythematous papules and pustules
Treatment: topical agents and systemic antibiotics
What is nodulocystic acne?
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)
What are we looking for during laboratory testing for acne?
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
What is Grade I acne?
Superficial Non-inflammatory , open and closed comedones, flesh colored papules, no inflammation, no pustules, no scars, no nodules
What is grade II acne?
Superficial inflammatory, open and closed comedones, inflammation, papules/pustules - few to several, no nodules, no scars
What is grade III acne?
It is deep inflammatory, moderate to severe, open and closed comedones, papules/pustules, few nodules, little to no scar present
What is grade IV acne?
Severe nodulocystic, deep/inflammatory, open and closed comedones, papules/pustules, extensive nodules, variable degree scar
What are the most common antibiotic given for acne?
Doxycycline and minocycline - long term antibiotics
What is isotretinoin?
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)
What is acne rosacea and what is its cause?
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
