CM: Derm - Acne Vulgaris, Rosacea, Hidrandenitis suppurativa

Question 1

Acne (types)

Answer 1

1. Comedonal acne 2. Papular/pustular 3. Cystic/nodular

Question 2

Acne (cause)

Answer 2

Microorganisms such as propioni acnes (p. acnes) trigger the immune system to effect keratinization. The keratinocytes occlude the follicular opening causing the fatty acids tyrosine to react and triggers the inflammatory response.

Question 3

Comedone (other names)

Answer 3

microcomedone, blackhead, whitehead

Question 4

Acne (Cystic/nodular symptoms)

Answer 4

Very painful, can cause systemic fatigue and lethargy

Question 5

Acne (Associated lesions)

Answer 5

1. Microcomedone (Primary) 2. Ice pick scarring 3. Post-inflammatory hyperpigmentation

Question 6

Ice pick scarring (description)

Answer 6

Atrophy from damage done by inflammation

Question 7

Acne (location)

Answer 7

Nasolabial folds (most common), can be anywhere on the body

Question 8

Acne (treatments)

Answer 8

1. Topical retinols for primary lesions 2. Topical antibiotics 3. Oral antibiotics

Question 9

Rosacea (cause)

Answer 9

Genetic predisposition for an aberrant innate immune system which increases number of cytokines (cathelicidins and calcarine) and antimicrobial peptides

Question 10

Rosacea (Triggers)

Answer 10

UVR, vascular changes, epidermal barrier dysfunction, neurogenic inflammation, microbes (demodex mites)

Question 11

Rosacea (description)

Answer 11

A disorder of the pilosebaceous unit that does not involve comedone formation

Question 12

Rosacea (Types)

Answer 12

1. Erythematotelangiectatic 2. Papulopustular 3. Phymatous 4. Ocular

Question 13

Rosacea (Erythematotelangiectatic cause)

Answer 13

Barrier dysfunction and vascular based; vessel dilation caused by cytokine (cathelicidins and calcarine) release

Question 14

Rosacea (Papulopustular description)

Answer 14

May involve follicular plugging but does not advance to scarring; does NOT normally include nasal labia fold

Question 15

Rosacea (Phymatous description)

Answer 15

May cause rhinophyma (bulbous nose); uncontrolled sebaceous gland growth; frequently have deep dark coloring to nose

Question 16

Rosacea (Ocular description)

Answer 16

No obvious lesions, dry gritty eyes accompanied by flushing and redness or scattered erythematis papules and pustules

Question 17

Rosacea (Ocular treatment)

Answer 17

Treat facial rosacea, not the eye itself

Question 18

Hidradenitis suppurativa (disease process)

Answer 18

Follicular opening of the pilosebaceous units become plugged with sebum and an acute-chronic inflammatory response occurs with secondary inflammation of apocrine glands

Question 19

Hidradenitis suppurativa (location)

Answer 19

Axilla, anogential area, inguinal fossa, lower abdominal skin flaps, anywhere skin is rubbing

Question 20

Hidradenitis suppurativa (Symptoms)

Answer 20

Double comedones end up producing deep sinus tracts that form large cystic nodules that drain, and they drain foul purulent material. These abscesses leave deep scarring.

Question 21

Hidradenitis suppurative (Cause)

Answer 21

Believed to have a genetic component but in relation to the immune response rather than the gland response

Question 22

Hidradenitis suppurative (Treatment)

Answer 22

Reduce friction, topical antibiotic, wash with soap and water every day (twice if possible), surgical consult

Question 23

Answer 23

Acne

Question 24

Answer 24

Rosacea

Question 25

Answer 25

Hidradenitis suppurative