Acne

Question 1

What is the pathogenesis of acne?

Answer 1

Genetic predisposition to build up of keratinocytes that block the pores on the face. Sebaceous glands produce too much sebum that cant escape from the pore. This leads to a build up of keratinocytes and sebum that causes inflammation and eventual scarring.

Question 2

What happens in severe acne?

Answer 2

Get five plus pseudocysts plus comedones and pustules. Over 100 comedones and inflammations. Will eventually scar and lead to post inflammatory pigmentation.

Question 3

What is acne fulminans?

Answer 3

Most severe form of cystic acne. Characterized by the abrupt onset of nodular and suppurative acne with systemic manifestations (fever, artralgias, myalgias, hepatosplenomegaly )

Question 4

What drugs can cause drug induced acne?

Answer 4

Anabolic steroids, corticosteroids, phenytoin, lithium

Question 5

What is acne excoriee?

Answer 5

Papules and comedones are neurotically excoriated leaving crusted lesions that may scar.

Question 6

What are treatments for acne?

Answer 6

Topical retinoids
Benzoyl Peroxide
topicalantibiotics (Clindamycin/Erythromycin)
Azelaic acid
Antibiotic tablets ( Lymecycline, Tetracyclin)
In women, thecombined oral contraceptive pill
Isotretinoin tablets

Question 7

What is the pathophysiology for rosacea?

Answer 7

Damage to dermal connective tissue (radiation)? Abnormal vascular reactivity?
Sensitivity to noxious stimuli is increased
Increased number of demodex folliculorum (mites)

Question 8

What are the clinical features of rosacea?

Answer 8

Affects central convex areas of the face (nose, forehead, cheeks, chin)
Onset marked by vascular changes, notably episodic flushing with no sweating.
Erythema with burning sensation is easily triggered by minor irritants. (stress, hot drinks, alcohol,spices)
Papules and pustules in more advanced cases, WITHOUT COMEDONES
Persistent tissue thickening due to oedema, fibrosis and glandular hyperplasia.

Question 9

What is phymatous rosacea?

Answer 9

Overgrowth of sebaceous glands
Skin becomes swollen and smoother. Pores become more apparent
Gradually, a lumpy surface develops.
(tends to be on the noses of old men)

Question 10

What are possible treatments for rosacea?

Answer 10

Avoidance of obvious vasodilators and irritants
Metronidazole cream or gel is a major topical therapy
azelaic acid cream or gel
ivermectin cream
Tetracyclines are the most prescribed oral medications
Surgery for rhinophymas