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SMS Week 3 > Acne Vulgaris and Acne Rosacea > Flashcards

Acne Vulgaris and Acne Rosacea Flashcards

1
Q

Acne is a disorder of what?

A

a skin disorder of the pilosebaceous unit

basically the presence of at least 5-10 comedones

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2
Q

What is the classic presentation you should think of when you think of acne?

A

comedones - black heads (open) and white heads (closed)

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3
Q

Besides the comedones, what can happen on the skin in acne?

A

papules, pustules, and nodules (cystic)

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4
Q

What are 4 myths about acne?

A
  1. diet
  2. lack of bathing
  3. haristyles (bangs)
  4. cosmetics

….cause acne

Nope - they don’t

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5
Q

WHat causes neonatal acne?

A

Neonates have pilosebaceous units that are active at birth and may react to maternal hormones

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6
Q

WHen does acne typically start?

A

in puberty - often precedes menarche in girls by one year

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7
Q

When do the highest number of cases of acne occur?

A

in the mid-late teens (affecting more boys than girls at this point, but girls are more likely to have persistence into 20s and 30s)

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8
Q

WHat are the 4 issues in the pathophysiology of acne?

A
  1. Excessive sebum production
  2. Follicular plugging
  3. colonization of sebaceous follicle with bacteria
  4. immune response with inflammation
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9
Q

What bacteria colonizes sebaceous follicles most often?

A

propionibacterium acnes

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10
Q

What hormones stimulate sebum secretion from sebaceous glands?

A

adrenal androgens

however, people who have acne proabably have sebaceous glands that are hyperresponsibe to androgens - not an overproduction of androgens

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11
Q

What causes a follicle to be plugged?

A

excessive keratinization in the follicular canal

the desquamating cells stick together in the canal rather than flowing to the surface with sebum.

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12
Q

What is the main cause of the inflammation seen in acne?

A

the colonization with P. acnes

It hydrolyzes the sebum into free fatty acids which serve as the primary pro-inflammatory substances of acne

also the lipases, proteases and hyaluronidases leading to inflammation

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13
Q

WHat is the relationship between stress and acne?

A

acne may flare during periods of stress because stress increases the outpur of adhrenal steroids which affects the sebaceous glands

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14
Q

What are the 5 main meds that can trigger acne?

A

anabolic steroids

corticosteroids

isoniazid

lithium

phenytoin

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15
Q

In the classificaiton of acne, what do the following mean?

mild

moderate

severe

A

mild = presence of few to several papules and pustules, no nodules

moderate = several to many papules and pustules, along with a few to severel nodules

severe = numerous or estensive papules an dpustules, plus many nodules

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16
Q

Besides mild, moderate and severe, what is antother way we can classify acne?

A

comedonal

papulopustular

nodulocystic

(each can be subdivided into mild, moderate and severe)

17
Q

How is acne graded?

A

grade 1: superficial non-inflammatory (comedones, flesh-colored papules, NO inflammation, NO pustules, NO nodules, NO scars)

grade 2: superficial inflammatory (open and closed comedones, inflammation, few to several papules/pustules, NO nodules, NO scars)

grade 3: deep inflammatory (moderate to severe, open and closed comedones, papules/pustules, few nodules, little to no scar present)

grade 4: severe nodulocystic (comdones, papeuls/pustules, extensive nodules, variable degree of scar)

18
Q

WHere on the body does acne occur?

A

usually face

lesser degree on back, chest, shoulders, neck and upper arms

this is the highest concentraiton of pilosebaceous glands on the body

19
Q

When should you do laboratory tests with a presentation of acne?

A

WHen you suspect hyperandrogenism

especially in women, check serume DHEAS, total testosterone, lutenizing hormone to follicle stimulating hormone ratio

20
Q

What should be in the differential diagnosis of acne?

A

acne rosacea

gram-negative folliculitis

perioral dermatitis

steroid-induced acne

21
Q

WHat are the 4 main arms of acne treatment?

A

local therapy

systemic therapy

hormonal therapy

physical therapy

22
Q

What would be the first line of treatment for grade 1, superficial noninflammatory acne?

A

topical benzoyl peroxie, ropical retinoides, alpha hydroxy acids, salicylic acid, physician directed extraction

23
Q

What additional treatment can be considered in grade 2, superficial inflammatory acne?

A

topical antibiotics

24
Q

What additional treatments can start to be considered in grade 3, deep inflamatory acne?

A

oral antibiotics

intralesional cotricosteroid injections

hormone therapy

oral retinoids like oral isotretinoin

25
Q

What additional therapy can be considered for grade 4, deep inflammatory with scarring acne?

A

incision and drainage

26
Q

WHat vehicle is better for dry skin? For oily skin? Over hair bearing skin?

A

dry: creams
oily: gels or solutions

hear-bearing: lotions (and pretty much an skin type)

27
Q

What are retinoids good for?

A

Best choise for anti-comedonal treatment

suppress inflammation

tretinin 9retin A) tazarotene (tazorac), adapalene (differing), isotretinoin gel

28
Q

What oral antibiotics are often used for acne?

A

tetracycline

erythromcin

DOXYCYCLINE

MINOCYCLINE

clindamycin

trimethorpime/sulfamethoxazole (bactrim)

29
Q

What are some hormonal therapies we can use to treat acne?

A

oral contraceptives - estrogens

glucocorticoids

anti-androgens like spironolactone and flutamide

30
Q

What is the only medication to suppress acne over the long term (works on all four factors)?

A

isotretinoin

accutane

31
Q

What is acne rosacea characterized by?

A

chronic and progressive dermatosis

erythema

papules/pustules

telengiectasis

potential hyperplasis over central portion of the face - esp nose

32
Q

Who does acne rosacea most often affect?

A

middle aged adults

33
Q

What are the causes of acne rosacea?

A

pretty unknown still

commonly thought to be vascular, but there seems to be a relationship with helicobacter pylori infection (maybe related to gastrin secretion which may stimulate flushing)

34
Q

WHere does rosacea occur on the face?

A

you get the papules, pustules and telangiectasis in the central third of the face, sparing the lateral aspects of the forehead and cheeks

35
Q

What is the treatment for acne rosacea?

A

antibiotics for the papular/pustular components - sually tetracycline or doxycycline

metronidazole (metrogel)

Azelaic acid gel (finacea)

corticosteroid lotion to reduce background erythema

36
Q

What are the 2 major complications of rosacea?

A

rhinophyma (hyperplasia of the sebaceous glands, CT and vascular bed of the nose)

Ocular complications (blepharitis, conjunctivitis or keratosis

37
Q
A

SMS Week 3 (11 decks)

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