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Dermatology 2 > Acne and Folliculitis > Flashcards

Acne and Folliculitis Flashcards

1
Q

Acne Pathogenesis

- 4 steps overview + 1

A
  1. Follicular plugging
  2. Excess sebum
  3. Presence/activity of P. acnes
  4. Inflammation
  5. Genetics
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2
Q

Follicular plugging

A

Microcomedone turns into comedone when corneocytes accumulate in the hair follicle, leading to hyperkareatosis

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3
Q

Excess sebum

A

Caused by androgens: DHT and DHEAS

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4
Q

Presence of p. acnes

A

Bacteria typically found deep in sebaceous follicle, proliferations inside pustule, causing more inflammation

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5
Q

Inflammation

A

Hyperkeratotic hair follicle expands and ruptures, leading to a pustule and inflammation

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6
Q

Clinical features of acne

A
  1. Comedones-open (blackhead) and closed (whitehead)
  2. Papules/Pustules: inflammatory
  3. Nodules/Cysts: can be scarring
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7
Q

4 Treatment options for acne

A
  1. Topicals
  2. Oral abx
  3. Oral retinoids
  4. Hormonal Therapy
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8
Q

Topicals medications for acne

A
  • Antibiotics

- Retinoids

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9
Q

Topical antibiotics

A
  • Action against p. acnes
  • Anti-inflammatory
  • Not comedolytic (won’t get rid of comedones)
  • Erythromycin, clindamycin, sulfur, benzoyl peroxide, dapsone
  • Bacterial resistance with erythromycin, benzoyl lessens resistance and gives comedolytic properties
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10
Q

Topical retinoids

A
  • Comedolytic
  • Anti-inflammatory
  • Can cause sensitivity
  • Tretinoin, adapalene, tazarotene
  • Used alone or in combo with topical antibiotic
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11
Q

oral antibiotics

A
  • Reduces p. acnes colonization of skin and follicles and decrease inflammation
  • Doxycycline, minocycline
  • Second line options: trimethoprim/sulfamethoxazole, sometimes azithromycin
  • Can cause GI upset, photosensitivity (doxy), vertigo, hyperpigmentation, SJS/TENS, ER options help
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12
Q

Oral retinoids

  • name
  • MoA
A
  • Isotretinoin (accutane)
  • Normalizes epidermal differentiation, suppressing sebum production, decreasing inflammation
  • Does not help with infection or inflammation
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13
Q

Oral retinoids

- Monitoring

A

Have to enroll in iPledge for contraceptive counseling

  • baseline LFTs, lipids, CBC, hCG
  • monitor blood-work monthly
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14
Q

Oral retinoids

- MC side effects

A
  • Dryness: decreased oil gland activity
  • Dry skin, lips, eyes, joints
  • HA
  • GI
  • Blurry vision (usu dry eyes)
  • Arthralgia (dry joints)
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15
Q

Oral retinoids

- when used with ____ family of drugs, risk for _____

A
  • tetracyclines

- pseudomotor cerebri

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16
Q

What two things do people worry about when using oral retinoids that are not supported by evidence

A
  • link to depression, anxiety, mood changes, suicidal ideation/suicide
  • link to ulcerative colitis
17
Q

Hormonal therapy

- Two main drugs used

A
  • spironolactone (MC)

- oral contraceptives

18
Q

Spironolactone in acne

A
  • binds to androgen receptors and reduced androgen production, suppresses sebum production
  • usu used in adult females
  • monitor bp and k+
19
Q

Oral contraceptive use for acne

A
  • used as adjunct therpay
  • reduce androgens by decreases SHBG which reduces testosterone
  • Yaz commonly used
  • not usually Rxed by terms, usually send to gyn.
20
Q

Folliculitis

- overview

A
  • inflammation and infection of hair follicle
  • MC staph, sometimes pseudomonas (hot tub)
  • damaged follicle caused by irritation (clothing rubbing on skin, trauma, shaving, sweat blockage, oil, makeup)
21
Q

Pseudofolliculitis barbae

A

(razor bumps)
- Growth of stiff hairs into the skin may cause chronic low-grade irritation or inflammation that may mimic infectious folliculitis

22
Q

Folliculitis clinical features

A
  • found all over body
  • chronically found in areas of shaving, waxing, hair plucking, friction
  • Superficial pustule surrounding a hair follicle with itching and burning
23
Q

Folliculitis treatment

A
  • avoid shaving area, change razor often, warm compress, anti-bacterial soap, non-occlusive moisturizer
  • avoid friction and rubbing
  • avoid lycra workout clothes and tight, rough fabric like jeans
  • benzoyl peroxide 5% wash (MC)
  • Clindamycin 1% lotion, gel, foam
  • Cephalexin, dicloxacillin, doxy, minocycline
24
Q

How to treat hot tub folliculitis

A

clears on its own without treatment

25
Q

Pityrosporum folliculitis

- etiology

A
  • Warm weather, occlusion and excessive sebum production
  • Can be confused with back acne. The pustules and papules will ALL be the same size unlike acne which will have a bunch of
26
Q

Pityrosporum folliculitis

- treatment

A

Topical antifungals or systemic fluconazole different sized lesions

Dermatology 2 (10 decks)

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