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Flashcards in Acneiform Diseases Deck (26):
1

Best time period to manage acne

During early adolescent years (10-13)

2

How can estrogen and testosterone cause acne?

Increased levels of these hormones can cause increased activity of the sebaceous glands.  The high levels of sebum produced eventually blocks the hair follicle (comedo) causing an accumulation of sebum below the epidermal surface.  The sebum can be infected by bacteria and cause inflammation and pus formation leading to papule and pustule formation.

3

Difference between white heads and black heads.

White heads are comedones that are closed by skin.

Black heads are comedones that are open, exposing the accumulated melanin

4

Main infectious agent in acne.

Propionibacterium acnes

5

Describe the 4 grades of acne

Grade 1: comedones

Grade 2: comedones, papules, pustules (non-inflammatory)

Grade 3: comedones, papules, pustules (inflammatory)

Grade 4: grade 3 along with cysts/nodules

6

Treatment for Grade 1 acne

Retinoid cream applied at night.

Can also use benzoyl peroxide or topical antibiotics

7

Treatment for Grade 2 acne.

Combination medication: usually benzoyl peroxide with a topical antibiotic

Retinoid creams can also be used

8

Treatment for Grade 3 acne

Same as Grade 2 but with the addition of an oral antibiotic.

Tx: Benzoyl peroxide with retinoid cream and/or topical antibiotics.  Add tetracycline or doxycycline

9

Treatment for Grade 4 acne

Systemic AND topical antibiotics

10

Grade the acne

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Grade 3: starting to see inflammation

11

Grade the acne

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Grade 1: just closed comedones visible

12

Grade the acne

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Grade 2: comedones with papules and pustules but no inflammation

13

Grade the acne

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Grade 4: nodule is visible

14

What are 3 physical treatments that can be done for acne lesions?

1. Comedone Extraction

2. Intralesional Steroid Injection

3. Dermabrasion

15

Last resort drug treatment for severe scarring cystic acne

Isotretinoin: tertogenic and usually reserved for prescription by a dermatologist

MOA: unknown but it's thought to induce apoptosis in certian cells in the body
 (mainly sebaceous gland cells)

16

What should a PCP suspect if a 40 year old patient presents with a CC of acne?

Rosacea: often looks like acne, but rosacea commonly presents in middle aged patients

17

Etiology of rosacea

Not known, maybe immunologic inflammatory response (ex. response to cathelicidin which is an antimicrobial protein)

There is also correlation with increased amount of Demodex mites prompting an inflammatory response on the skin.

18

How is Rosacea diagnosed?

It's a clinical diagnosis.

At least one primary feature: flushing, nontransient erythema, papules and pustules, telangiectasia

At least one secondary feature: burning or stinging, plaque, dry appearance, edema, ocular manifestation, peripheral location, phymatous changes (swelling or mass)

19

Name the 4 subtypes of rosacea.

1. Erythematotelangiectatic

2. Papulopustular

3. Phymatous

4. Ocular

20

Most frequent sign of ocular rosacea.

Blepharitis: inflamed eyelid (usually the margins)

21

4 medications that can aggravate rosacea.

Corticosteroids

vasodilators

ACE-Is

Simvastatin

22

Major factor differentiating rosacea from acne

Rosacea doesn't have comedones

Acne has comedones

23

Major factor differentiating Rosacea from SLE.

Rosacea does not have sickness or fever

24

What is the management strategy for rosacea?

1st line: lifestyle changes, avoid food, drinks, and environmental triggers

Step 1: oral antibiotic to alleviate symptoms AND daily use of topical medicine

Step 2: maintain remission with topical agents

25

What are the 5 topical agents that can be used in rosacea therapy?

Metronidazole

Azelaic Acid

Clindamycin

Erythromycin

Sulfacetamide/Sulfur

26

What are the 4 first line oral antibiotics used to treat rosacea?

Tetracycline

Minocycline

Doxycycline

Erythromycin