Acne & Rosacea

Question 1

what is a pathognomic lesion of acne

Answer 1

micro-comedone or comedone

Question 2

where is acne vulgaris most commonly found

Answer 2

areas of skin with greatest density of sebaceous follicles

Question 3

pathogenesis of acne

Answer 3

1. increased sebum production
2. follicular hyperkeratinization
3. proliferation of bacterium
4. inflammation

1-3: formation of comedone

Question 4

bacteria that causes acne

Answer 4

propionibacterium acnes

Question 5

morphology of drug-induced acne

Answer 5

monomoprhic inflammatory papules and pustules rather than open and closed comedones (e.g. corticosteroids, anabolic steroids)

Question 6

what causes nodules and cysts in acne?

Answer 6

involvement of many pilosebaceous units together

happens at a deeper level of dermis and sub-cut tissue

(cysts have cavity, nodules are solid)

Question 7

describe keloid scars, a sequelae of acne

Answer 7

dense, fibrous tissue nodules, typically found at areas of previously traumatized skin

Question 8

Tx for comedonal acne (whiteheads and blackheads)

Answer 8

topical retinoid

with combination of benzoyl peroxide

Question 9

Tx for mild papular or pustular acne

Answer 9

topical antibiotic-benzoyl perioxide combination

topical retinoid

Question 10

Tx for moderae acne with inflammatory papules or deeper-seated lesions

Answer 10

PO doxycycline or minocycline

retinoid

benzoyl peroxide

tetracycline- sun sensitivity

Question 11

Tx for severe acne

Answer 11

irotretinoin

contraception

5-6mo

bloodwork before, during, after Tx

Question 12

acne control in women

Answer 12

estrogen-containing oral contraceptives

spironolactone for hormonal acne along jawline and hirsutism

Question 13

what subtype of rosacea is this?

Answer 13

Erythematotelangiectatic rosacea

stinging/burning sensation

Question 14

what subtype of rosacea is this?

Answer 14

papulopustular rosacea

erythema and edema

sparing of periocular areas

absence of comedones to differentiate from acne

Question 15

what subtype of rosacea is this?

Answer 15

phymatous rosacea

thickening of skin, sebaceous hyperplsia, enlarged, cobblestoned appearance

men

Question 16

what subtype of rosacea is this?

Answer 16

ocular rosacea

conjunctivities, blepharitis, hyperaemia

dry, irritated, itchy eyes

keratitis, scleritis, and iritis

Question 17

Tx of rosacea

Answer 17

avoid triggers that aggravate vasodilation

broad-spectrum sunscreen

topicals are more effective for papulopustular than erythematotelangiectatic

Question 18

topicals for rosacea

Answer 18

metronidazole

azelaic acid

sodium suldacetamide

erythromycin

clindamycin

calcineurin inhibitors

ivermectin

permethrin

brimonidine

Question 19

systemic therapy for rosacea

Answer 19

oral antibiotics (tetracycline, doxycline, erythromycin)

low dose PI isotretinoin

Question 20

what is this a presentation of?

Answer 20

perioral dermatitis

uncertain etology

erythematous papular and pustular eruption involving nasolabial folds, upper and lower cutaneous lip, and chin

exclusively F

fluorinated toothpaste, OCC

Question 21

Periorbital involvement can occur in perioral dermatitis

Answer 21

T

Question 22

Tx for perioral dermatitis

Answer 22

discontinue topical corticosteroids

topical pimecrolimus 1%

identical to Tx for rosacea