Acne Vulgaris/Common Acne

Question 1

Clinical Feature

Answer 1

a common inflammatory pilosebaceous disease categorized with respect to severity

Question 2

Type I:

Answer 2

comedonal, sparse, no scarring

Question 3

Type II:

Answer 3

comedonal, papular, moderate ± little scarring

Question 4

Type III

Answer 4

comedonal, papular, and pustular, with scarring

Question 5

Type IV:

Answer 5

nodulocystic acne, risk of severe scarring

Question 6

sites of predilection

Answer 6

face, neck, upper chest, and back

Question 7

Pathophysiology of the lesion

Answer 7

hyperkeratinization at the follicular ostia (opening) blocks the secretion of sebum leading to the
formation of microcomedones

Question 8

Hormones Pathophysiology

Answer 8

androgens promote excess sebum production

Question 9

Pathophysiology Bacteria

Answer 9

Cutibacterium acnes metabolize sebum to free fatty acids and produces pro-inammatory mediators

Question 10

Epidemiology Age of onset

Answer 10

in puberty (10-17 yr in females, 14-19 yr in males)

Question 11

in prepubertal children consider

Answer 11

underlying hormonal abnormality (e.g. late onset congenital adrenal
hyperplasia)

Question 12

incidence

Answer 12

decreases in adulthood

Question 13

genetic predisposition

Answer 13

majority of individuals with cystic acne have parent(s) with history of severe
acne

Question 14

Differential Diagnosis

Answer 14

folliculitis, keratosis pilaris (upper arms, face, thighs), perioral dermatitis, rosacea

Question 15

Management MILD ACNE:

Answer 15

Topical Therapies OTC.
Benzoyl peroxide (BPO)
Salicylic acid

Question 16

Salicylic acid

Answer 16

Used when patients cannot tolerate a topical retinoid

due to skin irritation

Question 17

Benzoyl peroxide (BPO)

Answer 17

Helps prevent C. acnes resistance, is a bactericidal

agent (targets P. acnes) and is comedolytic

Question 18

Management MILD ACNE

Answer 18

Prescription Topical Therapies
Antimicrobials
Retinoids
Combination products

Question 19

Antimicrobials

Answer 19

Clindamycin (Dalacin T), Erythromycin

High rate of resistance when used as monotherapy

Question 20

Retinoids

Answer 20

Vitamin A Acid (Tretinoin, Stieva-A,
Retin A), Adapalene (Differin)

Backbone of topical acne therapy
All regimens should include a retinoid unless patient
cannot tolerate

Question 21

Combination products

Answer 21

Clindoxyl (Clindamycin and BPO)
Benzaclin (Clindamycin and BPO)
TactuPump (Adapalene and BPO)
Biacna (Clindamycin and Tretinoin)
Benzamycine (BPO and Erythromycin

Question 22

Combination products Function

Answer 22

Allows for greater adherence and efficacy
Combines different mechanisms of action to increase
efficacy and maximize tolerability

Question 23

Management MODERATE ACNE

Answer 23

Tetracycline/Minocycline/Doxycycline
Cyproterone acetate-ethinyl estradiol
Spironolactone

Question 24

Tetracycline/Minocycline/

Doxycycline

Answer 24

Use caution with regard to drug interactions: do not use
with isotretinoin
Sun sensitivity
Antibiotics require 3 mo of use before assessing efficacy

Question 25

Cyproterone acetate-ethinyl | estradiol

Answer 25

Diane-35® After 35 yr of age, estrogen/progesterone should only be considered in exceptional circumstances, carefully weighing the risk/benefit ratio with physician guidance

Question 26

Spironolactone

Answer 26

May cause hyperkalemia if concurrent renal dx | Black box warning for breast cancer

Question 27

SEVERE ACNE management

Answer 27

Isotretinoin

Question 28

Isotretinoin. Side Effects, courses. Tests

Answer 28

Most adverse effects are temporary and will resolve when the drug is discontinued Baseline lipid profile (risk of hypertriglyceridemia), LFTs and β-hCG before treatment May transiently exacerbate acne before patient sees improvement Refractory cases may require multiple courses of isotretinoin

Question 29

Treatment of Acne Scars

Answer 29

``` Tretinoin creams • Glycolic acid • Chemical peels for superficial scars • Injectable fillers (collagen, hyaluronic acid) for pitted scars • Fraxel laser • CO2 laser resurfacing ```

Question 30

Blackheads (comedones) are black | because of

Answer 30

oxidized fatty acids, not dirt

Question 31

Acne Exacerbating Factors | • Systemic medications:

Answer 31

lithium, phenytoin, steroids, halogens, androgens, iodides, bromides, danazol

Question 32

Acne Exacerbating Factors Topical agents:

Answer 32

steroids, tars, ointments, | oily cosmetics