Flashcards in Acne Deck (93)
What is acne?
A skin condition that occurs where there's a hair follicle
Teenagers are prone to acne but so are adults (there is also neonatal acne)
90-100% of people experience acne at some point in their life
What are the peak ages for acne?
Does acne resolve?
Most of the time it will resolve before the age of 25 but it can persist
Where do lesions appear?
Face, neck, check, back (upper back and upper chest)
What are aggravating factors of acne?
Stress/emotions (range of extreme emotions)
Diet (possibly - low glycemic index, low levels of processed sugar, more protein may lead to less acne)
Medications (occlusive agents)
How does acne affect people?
It can have significant psychological morbidity
It's a visible condition so people are often self-concious about it
Describe the pathology of acne?
There are 4 major stages:
1. Increased follicular keratinization (sticky plug that forms at the top of the follicle and blocks it)
2. Increased sebum production (due to hormone changes)
3. Bacterial (Propionibacterium acnes) lipolysis of sebum triglycerides to free fatty acids
4. Inflammation (redness and swelling)
What are the non-inflammatory lesions?
Closed comedones (whitehead)
Open comedones (blackhead)
Describe a blackhead
Open comedone - the sebum is exposed to oxygen and light, which turns it dark
The follicle is still open
Describe a whitehead
There's a layer of tissue or epithelial cells cover the trapped sebum underneath
How long does it take before a close comedone appears?
What are the inflammatory lesions?
What is a papule?
It involves the epidermis and the dermis
This lesions extends deep within the layers of the skin
It is often a small, pink/reddish bump that is tender to the thouch (they've gone nerve deep)
The opening is still closed
What is a pustule?
A pus-filled papule
Often red and inflamed at the base
What are the 3 types of acne scars?
Depressed (classic icepick, boxed, rolling)
Hypertropic (aka keloidal; it's a raised scar due to hyperproliferation)
There can also be pigmentary alteration
What are the different types of acne?
Describe drug-induced acne
It can be a side effect (ask patients if they've been on any new medications recently)
It often has a very consistent presentation (there isn't a variety of close and open comedones, there isn't a variety in size)
Describe neonatal acne
Presents usually in the first 2-3 months of life
Affects more boys than girls
Might be due to the transfer of maternal androgens
We do not treat this (self-limiting)
Infants who have neonatal acne may have more severe form of acne when they're in their teens
Describe acne conglobata
A very serious form of acne
Can be extremely painful
Describe acne fulminans
Very serious form of acne
The nodules and cysts ulcerate
There are often systemic symptoms (joint pain, fever, muscle pains)
Describe contact acne
Can occur when you come into contact with an occlusive agent (e.g., oil-based cosmetic, hair bangs, industrial agents such as aerosolized oils)
Describe endocrine acne
Related to a syndrome in which there's androgen production or an off balance of hormone production
Sometimes occurs in females with polycystic ovarian syndrome
Describe acne mechanica
Localized acne from physical stress (e.g., bangs, bike helmet, etc.)
Describe acne excoriee
The patient will pick at the comedones that it actually ends up in chronic erosions
Describe acne rosacea
Generally appears later in life (over 30 years)
Capillaries are close to the surface (spider veins)
Sometimes the patient also has eye symptoms (red, gritty eyes)
Certain things can cause a flare (sun, extreme temperatures, spicy foods, alcohol)
It is important that the patient seeks treatment for the condition because there's a potential for negative side effects (the tissue can become so inflamed that the patient's nose will enlarge and appear red; it's very difficult to return it back to normal)
What is perioral dermatitis?
Treated very similarly to acne
More of an inflammatory condition
Specifically around the chin and nose area
What is gram negative folliculitis?
Lesions have a sudden onset
Often mistaken for flares of acne
Treated slightly different
How is acne classified?
Describe mild acne
Few to several papules and pustules
No noodles or scarring
Under 50% of affected area is involved