Acne and Rosacea Flashcards Preview

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

Flashcards in Acne and Rosacea Deck (54):
1

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

-Sebaceous gland hyperplasia (especially via androgen)

-Abnormal follicular desquamation

-Proprionobacterium acne colonization

-Inflammation

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2

What is a microcomedo?

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

3

What happens to blackheads and whiteheads?

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

4

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5

What are some topical treatments of acne?

-OTC: Benzoyl peroxide or salicylic acid

Prescription: Antimicrobials, retinoids

6

Which is more effective, benzoyl peroxide or salicylic acid?

Benzoyl peroxide

7

How does Benzoyl peroxide work?

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

 

8

Benzoyl peroxide is typically used in combination with ______.

retinoids

9

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

T.

10

What are the AEs of Benzoyl peroxide?

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

11

What are some topical ABX for acne?

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

12

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

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

13

How should topical ABX be used in acne?

Add topical BP or use a combo product 

14

How do topical retinoids work?

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

15

What are some topical retinoid options?

-Adapalene (milder and better tolerated)

-Tretinoin

-Tazarotene (more for severe, do not give in pregnancy)

16

What are systemic ABX given for acne?

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)

17

Preferred systemic ABX for acne? over 8 yo

Tetracycline, Doxy, Mino

18

What are some AEs of systemic tetracycline?

GI upset, tooth staining

19

What are some AEs of systemic Doxycycline?

photosensitivity, esophagitis

20

What are some AEs of systemic Minocycline?

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

21

When are oral contraceptives used for acne?

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

22

How do OCs help in acne?

they have an anti-androgen effect to suppress sebum production

23

When are oral retinoids indicated (Isotretinoin)?

severe, scarring, and refractory acne 

24

How does Isotretinoin work?

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

25

What are some common AEs of oral retinoids?

-dry lips, skin, eyes

-nosebleeds,

-muscles aches

-mild HA

26

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

-teratogenic

-depression, suicidal ideation

-increased risk of fractures, epiphyseal closure

-IBD (UC over CD)

27

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

topical retinoid

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28

How should mild inflammatory acne be treated?

topical retinoid+ topical ABX

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29

How should moderate inflammatory acne be treated?

topical retinoid + topical ABX + oral ABX

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30

How should SEVERE inflammatory acne be treated?

Minimal scarring: topical retinoid + topical ABX + oral ABX

Scarring: Isotretinoin

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31

Basic skin care during acne treatment

-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

Myths of acne

-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

When to refer to a dermatologist?

-severe acne (cysts, nodules)

-no response to treatment after 12 weeks

-if systemic ABX needed over 1yr

-acne assoicated with a systemic disease

34

What is the patient pop for rosacea?

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

35

What things contribute to rosacea?

-Inflammation

-Demodex folliculorum

-genetics

-vascular abnormalities

-triggers

36

What are some triggers of rosacea?

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

37

What are the four types of rosacea?

-Erythematotelangiectatic

-Papulopustular

-Phymatous (swelling- can lead to a large nose)

-Ocular

 

38

Rosacea

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39

What are some topical treatments for rosacea?

-metronidazole (more anti-inflammatory)

-azelaic acid

-sodium sulfacetamide with sulfur

40

Other treatments for rosacea?

-PO tetracycline

-laser, surgery, IPL (intense pulse light)

41

What is perioral dermatits (aka periorificial)

 

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

42

Triggers for perioral dermatitis?

-Hx of topical steroid use in that area

-menstruation, pregnancy

-stress

-fluorinated toothpaste

-Candida, demodex mites

43

How does perioral dermatitis present?

rash or 'pimples' around mouth or nose, eyes, labia rarely

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44

How is perioral dermatitis treated?

-dincontinue topical steroids

Mild: Topical ABX (Metrocream)

Severe: PO ABX

and may need topical non-steroidal anti-inflammatory

45

What is folloculitis?

Common sequlae of Staph aureus, Strep, or Pseudomonas infection

46

What is a fungal cause of folliculitis?

Pityrosporum orbiculare

47

Other causes of folliculitis?

-Mites (demodex)

-Mechanical (areas of friction)

-eosinophilic folloculitis (common in HIV or transplant patients with immunosuppresstants)

48

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49

How is folliculitis treated?

-antibacterial soaps/washes

or topical ABX/antifungals

50

What is Hidradenitis suppurativa (HS)?

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

What are some risk factors for HS?

Obesity

Cigs

Fam Hx

52

HS

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53

How is mild HS treated?

topical and/or oral ABX to suppress inflammation

54

How is moderate to severe HS treated?

injected steroids, TNFa inhibitors, surgery