Acne and Rosacea

Question 1

What is acne?

Answer 1

Multi factorial skin disease which usually begins during puberty

Question 2

Epidemiology of acne?

Answer 2

• Very common, around 80% experiences some form of acne during puberty
• Usually stops after puberty, but not rarely persists
• Man and women equally affected but severe acne more common in men

Question 3

Pathogenesis of acne?

Answer 3

1. Pilosebaceous duct hyperkeratosis
2. Increased sebum secretion
3. Colonization of the duct with Propionibacterium acnes
4. Release of inflammatory mediators

Question 4

What are comedones?

Answer 4

pores of hair follicles that have gotten blocked with bacteria, oil and dead skin cells to form a bump on your skin

Question 5

Describe an early comedone?

Answer 5

1. infundibulum
   - hyperkaratosis
   - corneocyte cohesiveness
2. androgen stimulation of sebum secretion

Question 6

Describe a later comedone?

Answer 6

1. accumulation of shed keratin and sebum
2. formation of whorled lamellar concretions

Question 7

What is a whitehead?

Answer 7

a skin lesion consisting of a hair follicle that is occluded with sebum and keratin, appearing white at the surface
- closed comedo with no disruption of the epidermis

Question 8

What is a blackhead?

Answer 8

skin lesion consisting of a hair follicle that is occluded with sebum and keratin darkened by oxidation
- open comedo with disruption of the epidermis

Question 9

Describe an inflammatory papule/pustule?

Answer 9

• Propionibacterium acnes proliferation
• sebaceous lobule regression
• mild inflammation

Question 10

What is a nodule/cyst?

Answer 10

• marked inflammation
• scarring

Question 11

What are the types of acne?

Answer 11

1. Acne vulgaris
2. Acne conglobata
3. Acne excoriée
4. Cosmetic / pommade
5. Acne keloidalis
6. Drug-induced
7. Infantile
8. Chloracne

Question 12

What is acne vulgaris?

Answer 12

• Most common one
• Usually onset in puberty and usually remission after

Question 13

Features of acne vulgaris?

Answer 13

1. Papules
2. pustules
3. nodules
4. comedones

Question 14

What is acne conglobata?

Answer 14

is a highly inflammatory disease presenting with comedones, nodules, abscesses and draining sinus tracts
- is a severe form of acne
- begins at the ages between 18 and 30

Question 15

What is acne excoriee?

Answer 15

aka pickers acne
- is a mild acne accompanied by extensive excoriations caused by the person picking at the pimples

Question 16

What is pommade acne?

Answer 16

aka hairline acne
- type of acne caused by the use of hair styling products such as hair pomades, oils and gels that contain pore-clogging ingredients linked to comedone formation

Question 17

What is peri-oral dermatitis?

Answer 17

• chronic facial dermatitis affecting the perioral region
• affecting primarily children and women 20-45 years
• Presumably caused by regular application of (glucocorticoid) creams and/or cosmetics

Question 18

Clinical features of perioral dermatitis?

Answer 18

1. Erythema with grouped papules and pustules
2. Dry skin with painful burning and a sensation of tightness
3. No residual scarring after resolution

Question 19

What is acne keloidales?

Answer 19

Keloid around the hair follicle due to acne or folliculitis

Question 20

Epidemiology of acne keloidales?

Answer 20

1. dark-skinned people
2. men

Question 21

Distribution of acne keloidalis?

Answer 21

1. Chest
2. back
3. Neck: acne keloidalis nuchae (also hair that grows in the skin)

Question 22

What is acne keloidales nuchae?

Answer 22

• A chronic inflammatory skin condition affecting the nuchal and occipital region of the scalp
• Typically affects postpubertal individuals: usually men

Question 23

Etiology of acne keloidales nuchae?

Answer 23

1. Unclear; male preponderance suggests an association with increased androgen levels.
2. Lesions are caused by an abnormal immune response to trauma.

Question 24

Clinical features of acne keloidales nuchae?

Answer 24

The following features are circumscribed to the region surrounding the posterior hairline.
1. Keloid-like papules, plaques, and/or pustules
2. Cicatricial alopecia
3. Can cause itching, pain, and bleeding

Question 25

What is pseudofollicultis barbae?

Answer 25

razor bumps - ingrown hairs - An inflammatory skin condition characterized by firm, hyperpigmented, tender, pruritic papules and pustules on hair-growing areas on the lower face - Often caused by an inflammatory skin reaction in response to short hair that becomes entrapped within the skin i.e ingrown hairs (e.g., after shaving) - More common in Black males.

Question 26

Treatment for Pseudofollicultis barbae?

Answer 26

1. Grow the beard 2. Long shave 3. Shave in direction of hairs 4. Topical retinoids, steroids 5. Antiinflammatory antibiotics 6. Laserepilation

Question 27

Drug induced causes of acne?

Answer 27

1. Hormones (androgens) 2. Isoniazid 3. Rifampicin 4. Antiepileptics 5. Steroids

Question 28

General advice in acne treatment?

Answer 28

1. Stop using very oily products! - No Vaseline, oils or cosmetics 2. Keep the skin clean, but don’t wash it to often or with very warm water, use a gentle face wash, no aggressive soaps peelings and so on 3. Don’t manipulate

Question 29

Acne treatment?

Answer 29

1. Topical – Comedolytic – Anti inflammatory 2. Oral antibiotics 3. Retinoids

Question 30

Comedolytic topical acne treatment?

Answer 30

1. Benzoylperoxide 2.5-5-(10)% gel (stains) 2. Tretinoin 0.02%- 0.1% cream / gel 3. Adapalene – Always be careful!!

Question 31

Anti inflammatory topical acne treatment?

Answer 31

1. Clindamycin 1% lotion 2. Erythromycin 1-2% lotion

Question 32

Postinflammatory hyperpigmentation topical treatment?

Answer 32

1. Hydroquinone 2 (or 5) % 2. Sun protection

Question 33

Antibiotic acne treatment?

Answer 33

1. Tetracycline 2. minocycline 3. doxycycline (3 months) – Usually well tolerated, be careful with phototoxicity

Question 34

Retinoid acne treatment?

Answer 34

Isotretinoin (on average 6-9 months up to cumulative dose (120-150 mg/kg) – Very teratogenic!

Question 35

Side effects of retinoids?

Answer 35

1. dry skin - mainly mucsal 2. headache 3. muscle ache 4. tiredness

Question 36

Lab test to do before beginning retinoid therapy?

Answer 36

1. cholesterol/triglycerides/liver function 2. pregnancy test in women

Question 37

What is rosacea?

Answer 37

- A chronic inflammatory skin condition of unclear etiology that presents with persistent central facial erythema, telangiectasia, roughness/scaling, and possibly papules/pustules - which may be triggered by sun exposure, alcohol, or stress - In severe cases, the nose develops a large, bulbous shape (rhinophyma)

Question 38

Features of roacea?

Answer 38

1. Erythematotelangiectatic – Diffuse erythema/telangiectasia 2. Papulopustular – Papules, Pustules – NO comedones 3. Phymatous – Rhinophyma 4. Ocular involvement as well as erythema

Question 39

General measures in treatment of rosacea?

Answer 39

1. Sun avoidance and photo protection 2. Gentle skin care 3. Avoiding triggers

Question 40

What triggers rosacea?

Answer 40

1. ultraviolet radiation exposure 2. spicy foods 3. hot or alcoholic beverages 4. stress 5. extreme temperatures (hot or cold)

Question 41

Anti inflammatory treatment of rosacea?

Answer 41

1. Metronidazole topical 2. Oral tetracycline (doxycycline, minocycline) 3. Oral isotretinoin

Question 42

Anti redness treatment of rosacea?

Answer 42

1. Laser 2. Brimonidine topical