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Acne myself Flashcards

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1
Q

Occurs first in ________ (early onset)

A

Girls

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2
Q

During _____, is more severe in males.

A

Puberty

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3
Q

During _____, is more severe in females .

A

Adulthood

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4
Q

When is the highest incidence of acne?

A

Adolescents

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5
Q

What are some causes acne?

A

Genetics
Hormones
Bacteria
Stress
Environmental Factors
Diet
Insulin Resistance
Body Mass Index

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6
Q

What are some environment factors?

A

Heat/Humidity
Hairstyles (bangs/low on neck)
Excessive Sweating
Occlusive/Irritating fabrics (wool, rough textures, unbreathable factors)
Pressure (hats/helmets)
Friction (excessive scrubbing)

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7
Q

What are some diet factors?

A

Milk- hormones/bioactive compound in milk. positive correlation between amount consumed and acne.
Lipids- saturated fatty acids increase sebum.
Protein- Whey protein
Glycemic control- high glycemic load increases sebum.

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8
Q

What are the four major factors involved in development of acne?

A

Oil
Follicular Hyperkeratinization
Bacteria
Inflammation

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9
Q

How does OIL cause acne?

A

Increased sebum production by sebaceous glands.

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10
Q

How does Follicular Hyperkeratinization cause acne?

A

Altered keratinization and ductal epidermis hyperproliferation

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11
Q

What is Hyperkeratinization?

A

Disorder of the cell lining inside of the hair follicle. A build up of keratin inside the follicle causing it to clog, obstructing the opening of the hair follicle.

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12
Q

How does Bacteria cause acne?

A

Colonization of Cutibacterium acnes bacteria.Gram-positive anaerobic diphtheroid, releases enzymes that results in inflammation and creation of inflammatory mediators.

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13
Q

What does Cutibacterium acnes result in?

A

Inflamed/raised clogged follicles.
Papules
Postules
Nodules

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14
Q

Which bacteria plays a central role in triggering inflammation in acne?

A

Cutibacterium acnes

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15
Q

What do Cutibacterium acnes bacteria release that contribute to inflammation?

A

Lipases and proteases

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16
Q

What causes the comedone to rupture during acne pathogenesis?

A

Neutrophil migration and enzymatic degradation

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17
Q

What type of lesion is a closed comedone (white head)?

A

Non-inflammatory, dome-shaped, whitish or greyish (1-2mm)

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18
Q

What type of lesion is a open comedone (black head)?

A

Non-inflammatory, dilated, follicular orifice, grey/brown/black keratotic material. (2-5mm)

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19
Q

What is a papule in the context of acne?

A

Raised/inflamed bump without pus (WBC is in follicle)

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20
Q

What is a pustule in the context of acne?

A

Raised/inflamed bump with pus (WBC reach surface)

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21
Q

What type of acne involves inflamed deep-seated, often tender lesions that are ≥5mm?

A

Nodular acne

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22
Q

Conglobate acne is characterized by?

A

Grouped comedones, papule, and nodules

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23
Q

What hormone group increases sebum production during puberty?

A

Androgens (convert to testosterone and dihydrotestosterone)

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24
Q

What drugs are associated with Drug Induced acne?

A

TBD how I want to set this up. Way too many drugs.

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25
What is Drug Induced Acne?
Inflames lesions with no evidence of comedones.
26
How to diagnose Drug Induced Acne?
Lesion type Lesion distribution Scarring and Hyperpigmentation Signs of Hyperandrogenism
27
What are signs of Hyperandrogenism?
hirusitism, male pattern hair loss, voice deepening, irregular menses PCOS, congenital adrenal hyperplasia, adrenal and ovarian tumors
28
What are the grades for acne using the Severity Grading Taxonomies
Type 1 Type 2 Type 3 Type 4
29
What is Type 1 acne?
Almost clear: rare noninflammatory lesions (NIL) with no more than 1 papule.
30
What is Type 2 acne?
Mild, some NIL but no more than a few papule/pustules.
31
What is Type 3 acne?
Moderate, many NIL, some ILs, no more than 1 nodule.
32
What is Type 4 acne?
Severe: up to many NIL and IL, but no more than a few nodular lesions.
33
What is the treatment approach for acne?
Reverse clogged pours Taper regimens over time Simplify regimen once acne controlled Use fewest agents and lowest doses Continue therapy >8weeks
34
What are the exclusions for self care for acne?
Moderate to Severe acen (Types 3 and 4) Exacerbating factors present that cannot be resolved (comedogenic drugs, mechanical irritation) Pregnancy Rosacea (visible blood vessel with redness and small bumps)
35
What are some non pharm treatments?
Eliminate aggravating factors (hat, hairstyles, fabric) Maintain balanced diet, low glycemic intake Control stress Cleanse 2x a day with mild soap or soapless cleanser (no cream based cleansers and no scrubbers) Use only oil free cosmetics (avoid multi step cosmetics) Shave infrequently using sharp blades or electric razors (soften beard before shaving and shave in direction of hair growth) Use device to extract keratin from comedones.
36
Which drugs work by targeting the abnormal keratinization (Hyperkeratinization) ?
BP Topical retinoids Salicylic Acid Azelaic Acid Isotretinoin
37
Which drugs work by targeting the increased sebum production (Oil)?
Topical Retinoids Hormonal Agents Isotretinoin
38
Which drugs work by targeting the Bacteria (P. acnes)?
BP Topical/Oral antibiotics Azelaic Acid
39
Which drugs work by targeting the release of inflammatory mediators (Inflammation)?
Topical/Oral Antibiotics Topical/Oral Retinoids Azelaic Acid Dapsone COCs Oral Corticosteroids
40
What is the treatment mainstay for mild acne?
Topical therapy for initial and maintenance.
41
What are the first line agents for Mild acne?
Topical Retinoids BP Topical Antibiotics Topical Antibiotics + BP Topical Retinoid + BP Topical Retinoid + Antibiotic
42
Which first line agent should NOT be used as monotherapy?
Topical Antibiotics (should be in combo with another agent)
43
_______ and ______ have condition recommendation against use?
Physical modalities and the use of pneumatic broad band light with adapalene.
44
What is the treatment mainstay for moderate to severe acne?
Systemic Antibiotics Hormonal Agents Isotretinoin
45
Systemic Antibiotics should be limited to __________ due to risk of resistance?
3-4 months of max use
46
Systemic Antibiotics should be combined with ______ or ______?
BP or other topical treatment
47
What is the first line systemic antibiotic for moderate to severe acne?
Doxycycline
48
_____ and ____ are the 2nd line systemic antibiotic options?
Minocycline and Saracycline
49
Adjuvent Intralesional Corticosteroids injections are indicated for what?
Larger acne papules/nodules at risk of scarring Rapid improvement of inflammation and pain
50
PO Isotretinoin can be FIRST line for severe acne if?
There is a psychosocial burden or risk of scarring If standard oral or topical treatment fails.
51
These are Vitamin A derivatives that target retinoic acid receptors (RAR) and retinoic x receptors (RXR) on keratinocytes?
Retinoids
52
What effects does Retinoids have?
Comedolytic Anti-inflammatory Improves dyspigementation Maintains clear skin
53
What Adverse Effects does Retinoids have?
Photosensitivity, redness, drying, burning, peeling Darker skin more prone to Retinoid dermititis
54
What are some Counseling Points when using Retinoids?
Some are degraded by the sun (use with sunscreen or at night) Apply 30 minutes after cleansing face (retinoids aren't stable in water) Start with lowest concentration, every other night to reduce irritation Gels/Creams less irritating than solutions Tolerance develops so best results in 3 months Avoid in Pregnancy and Breastfeeding
55
What are some Retinoids?
Retinoic Acid (Vitamin A acid, Tretinoin, Atralin, Retin-A) Adapalene (Differen, Epiduo + BP) Tazarotene (Tazorac, Fabior, Avage, Arazlo) Trifarotene (Aklief)
56
What are the most irritating Retinoids?
Retinoic Acid and Tazarotene
57
What is the only Retinoid available OTC?
Differin Gel .1%
58
What formulations are stable to light and BP?
Micronized or Microsphere
59
Which Retinoid should you be cautious in fish allergies?
Micronized Tretinoin Gel (.05%)
60
All Retinoids should be avoided in pregnancy but what Retinoid has a contraindication for Pregnancy?
Tarazotene
61
Which Retinoid is selective for RAR-gamma receptor?
Trifarotene
62
This is an antimicrobial agent that releases free oxygen radicals and is mildly comedolytic? Also is Bactericidal to P.acnes.
Benzoyl Peroxide (BP)
63

Acne Treatment (2 decks)

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