Acneiform Disorders Flashcards
Describe the different pathophysiology of acne
- Excessive oil
- Disruption in shedding of skin cells on the surface
- Cutibacterium acnes grows and causes inflammation which results in the acneiform lesions
Differentiate the classifications of acne
- Mild: few papules/ pustules/ comedones. combination of lesions small in number and size, limited in location, no nodules or scarring
- Moderate: many papules / postures / comedones. possible scarring, more than one location
- Severe: extensive papules / pustules / nodules. scarring is present, can be many locations or just one severely affected region
Describe the types of acne
- Papulopustular: papules and/or pustules
- Comedonal: open or closed comedones
- Nodulocystic: nodules, deep cysts
Identify topical and systemic treatment for acne
- Benzoyl Peroxide
- Topical antibiotics
- Aczone Gel
- Retinoids
- Oral antibiotics
- Combination birth control pills
- Spironolactone
- Isotretinoin
Identify patient education points for acne
- There is no cure for acne
- Treatment response can take at least 6 weeks
- It may get worse before it gets better
- No picking
- Treatment can be trial and error
- Healthy diet (fruits and veggies), lots of water
- Cleansing should be twice a day with warm water and hands
- Make up and moisturizer should be oil free
- Avoid toners, scrubs and masks
Describe treatment considerations for isotretinoin
- For severe nodulocystic acne or as a last resort treatment or for severe emotional impact from acne
- Not a cure but can cause long term remission
- Side effects include dry lips and skin, sun sensitivity, muscle / joint pain, alopecia, nose bleeds
- More serious side effects: risk of depression and pseudocerebri tumor (severe headache with n/v blurred vision)
- Category X: teratogenic (CANNOT be pregnant - IPLEDGE)
- Lab testing requirements: serum HCG, urine HCG, LFT, cholesterol, and triglycerides
Identify signs and symptoms of rosacea
- Primarily affects the face and eyes
- “Flushing and blushing”: centrofacial erythema
- Flares and remissions
- Acneiform lesions (papules, pustules or nodules)
- Telangiectasia (broken blood vessels)
- Burning or fire sensation
- Tenderness
- Ocular symptoms: blepharitis (eyelid margin inflammation), keratitis (conjunctive inflammation), c/o dry eye or feeling of sand in eye
List topical and systemic treatments for rosacea
Topical
- Topical Abx (Metronidazole most common)
- Topical Retinoid (Azaleic Acid)
- Topical Vasoconstrictor (Mirvaso and Rhofade) **warn about rebound flaring
- Soolantra (topical Ivermectin)
Oral
- Doxycycline (low anti inflammatory dose for long term use)
Identify trigger factors of rosacea
- Temperature extremes
- Stress
- Spicy food
- Alcohol, especially red wine
- Sun exposure
Define folliculitis and causative organisms
Folliculitis is the inflammation of the hair follicle. It can be infectious (caused by bacteria S. aureus) or non infectious (inflammatory)
Identify the clinical manifestations of folliculitis
Follicular pustules, follicular erythematous papules or nodules. Occurs on hair bearing skin, pain and pruritic may be present
What is the treatment for folliculitis
May resolve spontaneously
- Can use topical Abx for most cases (Mupirocin or clindamycin)
- Extensive involvement is treated with oral Abx (cephalexin, or Bactrim or Clindamycin for MRSA)
What are the risks/ contraindictations for antibiotic acne treatments
- Antibiotic resistance
- Clindamycin causes C. diff if orally ingested
- Side effects of oral antibiotics: nausea, vomiting, diarrhea, skin rash, vertigo, minocycline staining
- Warn about sun exposure, avoiding pregnancy
What are side effects of combination birth control pills?
Nausea, headaches, risk of stroke, heart attack, blood clots *ask about smoking hx!
What is a complication of Rosacea?
Rhinophyma: hyperplasia of soft tissues of the nose. Usually a result of delay/non treatment
Isotretinoin for early disease, surgical correction for late disease.
