Acne and Rosacea - Wright Flashcards Preview

Derm Rheum > Acne and Rosacea - Wright > Flashcards

Flashcards in Acne and Rosacea - Wright Deck (54):
1

Pathogenesis of acne (4 things)?

1) Sebaceous Gland hyperplasia
2) Abnormal follicular desquamation
3) P. acnes colonization
4) Inflammation

2

What is a comedone?

A clogged hair follicle in the skin, producing a small papule; keratin and sebum combine to clog the follicle

3

What are the 2 general types of comedo?

Non-inflammatory and inflammatory

4

What are the 2 subtypes of non-inflammatory comedones

Blackhead (open) and whiteheads (closed)

5

What is the primary physiologic basis for development of acne during puberty/adolescence?

Androgens increase sebum production

6

What is the "black" in the blackhead?

The central keratin plug

7

What are the 2 primary abx used in acne treatment?

Doxycycline and Minocycline

8

What treatment would you use for very mild acne?

Benzoyl peroxide and salicylic acid

9

What abx is used in patients that cannot tolerate tetracyclines? What is a problem with this abx?

Erythromycin; resistance develops rapidly

10

Benzyl peroxide mechanism of action?

Kills P.acne, mild comedolytic properties, and mild anti-inflammatory properties

11

What is the benefit of combining benzyl peroxide with abx?

Benzyl peroxide decreases the emergence of resistance

12

What is benzyl peroxide most commonly combined with (most common acne therapy used)?

Combined with retinoids, they work synergistically

13

Resistance to benzyl peroxide?

None reported

14

Primary goal of therapy when treating acne (I know this is a shitty question, but she specifically mentioned this)?

Need the therapy to be comedolytic

15

What abx is most associated with development of colitis (C.diff especially)?

Clindamycin

16

Should you use topical abx alone? Why/Why not?

No; they have a slow onset, resistance emerges quickly, and they're NOT comedolytic

17

Topical retinoid mechanism of action?

Normalize follicular desquamation (comedolytic), anti-inflammatory, and enhance penetration of other compounds (benzyl peroxide/topical abx)

18

What is the first line therapy for ALL types of acne?

Topical retinoids

19

Side effects seen with benzyl peroxide and topical retinoids?

Local cutaneous irritation (dryness, peeling, redness); bleaching (benzyl peroxide only)

20

Which topical retinoid is category X in pregnancy?

Tazarotene

21

What type of acne would you use systemic abx in?

Moderate to severe inflammatory acne

22

Which tetracycline would you start with first?

Doxycycline

23

Which patients can you not use tetracyclines in? Why?

Patients less than 8 yrs old
it negatively affects bone/cartilage, teeth development

24

Significant ADE of tetracycline?

Stains your teeth
also photosensitivity

25

Significant ADE(s) of minocycline (4)

Dyspigmentation, lupus-like reaction, pseudotumor cerebri, Steven Johnson

26

Which patients/type of acne would you consider oral contraceptives in?

Females with moderate to severe inflammatory/mixed acne

27

How do oral contraceptives help acne?

Anti-androgen effects suppress sebum production

28

Indication for oral retinoids (isotretinoin)

Severe, scarring, or refractory acne

29

Mechanism of oral retinoids

1) Decrease size/activity of sebaceous glands by 90%
2) Normalize follicular keratinization; prevents new comedones
3) Inhibits P. acnes
4) Anti-inflammatory

30

Common, not severe side effects of oral retinoids? (5)

Dry lips/skins/eyes, nosebleeds, mild HA, myalgias, backaches

31

Severe side effects of oral retinoids? (4)

SEVERE teratogen, depression/suicidal ideation, skeletal changes, and development of inflammatory bowel disease

32

Simple treatment algorithm for acne management?

1) Mild comedonal--> Topical retinoid

2) Mild inflammatory/mixed--> Topical retinoid + topical abx

3) Moderate inflammatory/mixed --> Topical retinoid + topical abx + oral abx

4a) Severe inflammatory (minimal scarring)--> Topical retinoid + topical abx + oral abx

4b) Severe inflammatory (scarring or multiple treatment failure)--> Isotretinoin

33

Common therapy for back acne?

Benzyl peroxide body wash

34

Is acne linked to poor hygiene, dirt, or poor diet?

No; the diet part is controversial

35

What food product can exacerbate acne in teenage boys?

Milk

36

Epidemiology of Rosacea?

Fair skin women, over the age of 30

37

What is rosacea?

chronic skin condition characterized by facial erythema, papules/pustules, and swelling

38

What are some common triggers of rosacea?

Sunlight, exercise, hot/cold. stress, food, alcohol

39

Where does rosacea most commonly occur?

On the central face; cheeks, across the bridge of the nose

40

What is the course of disease in rosacea?

Chronically relapsing and remitting

41

What are the 4 types of rosacea?

1) Erythematoltelangiectatic: redness with telangiectasias

2) Papulopustular: you have papules and pustules

3) Phymatous: permanent swelling of the nose

4) Ocular: eye involvement

42

Treatment for rosacea?

Topcial therapy (metronidazole, azelaic acid); Systemic tetracyclines; Laser/surgery

43

What is periorificial dermatitis?

A disease of multiple small papules developing around orifices, most commonly the mouth

44

2 common patients periorificial dermatitis is seen in?

Women ages 20-45 and prepubertal children

45

Treatment for periorificial dermatitis?

D/C all topical steroids; tx with either topical or systemic abx; maybe topical NSAIDs

46

What is folliculitis?

follicular based papules on hear-bearing areas (trunk, thigh, buttocks, etc)

47

Most common cause of folliculitis?

Bacterial; Staph aureus (most common), streptococcus, pseudomonas

48

Which patients do you see eosinophilic folliculitis in?

HIV and transplant patients

49

Tx for folliculitis?

Abx soaps, topical abx

50

What is hidradenitis suppurativa?

chronic condition with formation of painful abscesses involving the apocrine gland bearing areas

51

Common places for hidradenitis suppurativa to occur?

axillary, inguinal, inframammary folds

52

Risk factors for hidradenitis suppurativa?

Being female, obesity, cigarettes, family hx

53

Pathogenesis of hidradenitis suppurativa?

Follicular keratin plugs cause hair follicle rupture--> follicle contents spilled into dermis--> local inflammation and abscess formation

54

Age when hidradenitis suppurativa presents?

Early 20s