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Rheum/Musculoskeletal/Derm Week 3 > Acne and Rosacea > Flashcards

Acne and Rosacea Flashcards

1
Q

What are the four main factors in the development of acne?

A
  • Sebaceous gland hyperplasia (especially via androgen)
  • Abnormal follicular desquamation
  • Proprionobacterium acne colonization
  • Inflammation
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2
Q

What is a microcomedo?

A

Non-inflammatory comedones, which are small, below the surface clots below the surface of the skin which then progress into blackheads (open) or whiteheads (closed), which are non-inflammatory comedones

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3
Q

What happens to blackheads and whiteheads?

A

These trap debris and become inflammatory and turn into papules, nodules, cysts, etc.

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4
Q
A
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5
Q

What are some topical treatments of acne?

A

-OTC: Benzoyl peroxide or salicylic acid

Prescription: Antimicrobials, retinoids

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6
Q

Which is more effective, benzoyl peroxide or salicylic acid?

A

Benzoyl peroxide

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7
Q

How does Benzoyl peroxide work?

A

Multiple MOA: killes P. acnes and mildly comedolytic and anti-inflammatory

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8
Q

Benzoyl peroxide is typically used in combination with ______.

A

retinoids

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9
Q

T or F. Benzoyl peroxide limits development of P. acnes ABX resistance

A

T.

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10
Q

What are the AEs of Benzoyl peroxide?

A

well-tolerated, but can get irritation, bleaching of fabric, and rarely allergic contact dermatitis

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11
Q

What are some topical ABX for acne?

A

Clindamycin and erythromycin (these have some anti-inflammatory effects- primary reason for use)

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12
Q

T or F. Topical ABX are not recommended for monotherapy for acne

A

T. This tends to increase ABX-resistance and these are not comedolytic so not that effective

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13
Q

How should topical ABX be used in acne?

A

Add topical BP or use a combo product

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14
Q

How do topical retinoids work?

A

The 1st line therapy for acne lately (and preferred for maintenance), and work by normalizing follicular desquamation (Comedolytic), anti-inflammatory, and enhance penetration of other compounds by getting rid of dead layers of skin

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15
Q

What are some topical retinoid options?

A
  • Adapalene (milder and better tolerated)
  • Tretinoin
  • Tazarotene (more for severe, do not give in pregnancy)
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16
Q

What are systemic ABX given for acne?

A

These are more for cases of moderate to severe *inflammatory* acne (most are not FDA approved for acne except Solodyn (minocycline)

the goal is maintenance with a topical (want to work people off PO ABX in 3-6 months)

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17
Q

Preferred systemic ABX for acne? over 8 yo

A

Tetracycline, Doxy, Mino

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18
Q

What are some AEs of systemic tetracycline?

A

GI upset, tooth staining

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19
Q

What are some AEs of systemic Doxycycline?

A

photosensitivity, esophagitis

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20
Q

What are some AEs of systemic Minocycline?

A

dyspigmentation, lupus-like rxns, SJS, pseudotumor cerebri, DHS

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21
Q

When are oral contraceptives used for acne?

A

consider for females with moderate to severe acne with flares around menstration cycles

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22
Q

How do OCs help in acne?

A

they have an anti-androgen effect to suppress sebum production

23
Q

When are oral retinoids indicated (Isotretinoin)?

A

severe, scarring, and refractory acne

24
Q

How does Isotretinoin work?

A

*affects all four main factors of acne production* (decreases size/activity of sebaceous glands, normalizies follicular keratinization, inhibits P. acnes, anti-inflammatory)

25
Q

What are some common AEs of oral retinoids?

A
  • dry lips, skin, eyes
  • nosebleeds,
  • muscles aches
  • mild HA
26
Q

What are some rarer, more severe AEs of oral retinoids?

A
  • teratogenic
  • depression, suicidal ideation
  • increased risk of fractures, epiphyseal closure
  • IBD (UC over CD)
27
Q

How should MILD comedonal acne be treated (typically pre-adolescent acne)?

A

topical retinoid

28
Q

How should mild inflammatory acne be treated?

A

topical retinoid+ topical ABX

29
Q

How should moderate inflammatory acne be treated?

A

topical retinoid + topical ABX + oral ABX

30
Q

How should SEVERE inflammatory acne be treated?

A

Minimal scarring: topical retinoid + topical ABX + oral ABX

Scarring: Isotretinoin

31
Q

Basic skin care during acne treatment

A
  • Gentle cleansing 1-2x day
  • Mild, fragrance-free cleanser
  • oil-free moisturizer with SPF 30+ bid
  • avoid OTC acne washes and topicals during treatment (too irritating)
32
Q

Myths of acne

A
  • Acne is NOT caused by poor hygiene or diet
  • diet controversial (high glycemic index may lead to hyperinsulinemia and stimulate androgen synthesis
  • milk may actually be problematic
33
Q

When to refer to a dermatologist?

A
  • severe acne (cysts, nodules)
  • no response to treatment after 12 weeks
  • if systemic ABX needed over 1yr
  • acne assoicated with a systemic disease
34
Q

What is the patient pop for rosacea?

A

This is a relapsing and remitting problem common in women over 30 with fair skin

35
Q

What things contribute to rosacea?

A
  • Inflammation
  • Demodex folliculorum
  • genetics
  • vascular abnormalities
  • triggers
36
Q

What are some triggers of rosacea?

A

sunlight, exercise, hot/cold, stress, foods, alcohol

37
Q

What are the four types of rosacea?

A
  • Erythematotelangiectatic
  • Papulopustular
  • Phymatous (swelling- can lead to a large nose)
  • Ocular
38
Q

Rosacea

A
39
Q

What are some topical treatments for rosacea?

A
  • metronidazole (more anti-inflammatory)
  • azelaic acid
  • sodium sulfacetamide with sulfur
40
Q

Other treatments for rosacea?

A
  • PO tetracycline
  • laser, surgery, IPL (intense pulse light)
41
Q

What is perioral dermatits (aka periorificial)

A

Variant of rosacea that affects primarily women 20-45 yrs (and some prepubertal children)

42
Q

Triggers for perioral dermatitis?

A
  • Hx of topical steroid use in that area
  • menstruation, pregnancy
  • stress
  • fluorinated toothpaste
  • Candida, demodex mites
43
Q

How does perioral dermatitis present?

A

rash or ‘pimples’ around mouth or nose, eyes, labia rarely

44
Q

How is perioral dermatitis treated?

A

-dincontinue topical steroids

Mild: Topical ABX (Metrocream)

Severe: PO ABX

and may need topical non-steroidal anti-inflammatory

45
Q

What is folloculitis?

A

Common sequlae of Staph aureus, Strep, or Pseudomonas infection

46
Q

What is a fungal cause of folliculitis?

A

Pityrosporum orbiculare

47
Q

Other causes of folliculitis?

A
  • Mites (demodex)
  • Mechanical (areas of friction)
  • eosinophilic folloculitis (common in HIV or transplant patients with immunosuppresstants)
48
Q
A
49
Q

How is folliculitis treated?

A

-antibacterial soaps/washes

or topical ABX/antifungals

50
Q

What is Hidradenitis suppurativa (HS)?

A

condiition affecting apocrine gland bearing areas (commonly in the axillary, inguinal, underneath the breasts, and other body folds) commonly affecting women more than men

51
Q

What are some risk factors for HS?

A

Obesity

Cigs

Fam Hx

52
Q

HS

A
53
Q

How is mild HS treated?

A

topical and/or oral ABX to suppress inflammation

54
Q

How is moderate to severe HS treated?

A

injected steroids, TNFa inhibitors, surgery

Rheum/Musculoskeletal/Derm Week 3 (27 decks)

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