Acneiform Disorders Flashcards

(45 cards)

1
Q

What are the 3 types of pilosebaceous units?

A
  1. Terminal follicles
  2. Vellus follicles
  3. Sebaceous follicles
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2
Q

What type of hair are terminal follicles associated with?

A

Associated with long hairs (ie scalp)

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3
Q

What type of hair are vellus follicles associated with?

A

with miniature hairs like arm hairs

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4
Q

What type of hair are sebaceous follicles associated with?

A

no visible hair shaft! mostly on the face

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5
Q

What are the 3 main “sebaceous” areas

A

face, upper chest, upper back

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6
Q

What is the composition of sebum?

A
  • triglycerides
  • squalene (long chain FA precursors of cholesterol)
  • Cholesterol and cholesterol esters
  • wax esters
  • some IgA secretion
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7
Q

What is the physiological function of sebum?

A

No precisely known function in humans!

Could potentially be hydration, antimicrobial or anti-oxidant

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8
Q

What are 2 regulators of sebum production? What are their effects?

A
  1. Androgens: increase sebum production

2. Retinoids: inhibit sebum production and trigger sebocyte apoptosis

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9
Q

Define: Acne vulgaris

A

Chronic inflammation of the pilosebaceous unit that is associated with comedones
- primarily affects adolescents but can persist well into adulthood

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10
Q

What are comedones?

A

blocked folllicular ostium with dead keratinocytes and sebum

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11
Q

What are the 4 main steps in the pathogenesis of Acne?

A
  1. Abnormal follicular keratinization
  2. Increased sebum production
  3. Overgrowth of follicular bacterium
    - generally propionibacterium acnes
  4. Inflammation
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12
Q

What are some medications that can exacerbate acne?

A
  1. corticosteroids
  2. Lithium
  3. Barbituate anticonvulsants
  4. EGFR inhibitors
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13
Q

What types of lesions are common in mild acne

A

mostly comedones with few inflammatory lesions

No nodules

Minimal to no scarring

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14
Q

What are the 3 therapy approaches for mild acne?

A
  1. Reduction in comedones: topical retinoids or benzoyl peroxide
  2. Reducing sebum production: topical retinoids
  3. Reducing bacterial growth and inflammation: topical clindamycin or erythromycin combined with benzoyl peroxide, topical azelaic acid, topical retinoids + benzoyl peroxide, topical dapsone
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15
Q

How do topical retinoids work?

A
  1. reduce comedones by promoting keratinocyte desquamation
  2. Reduce sebum production
  3. have anti-inflammatory properties
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16
Q

How long do you need to treat mild acne with retinoids ?

A

weeks to months to see an effect

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17
Q

What are 3 adverse effects from treatment with retinoids?

A
  1. Redness
  2. Desquamation
  3. Burning sensation
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18
Q

How do topical antibiotics work to treat mild acne? What should be used as a combined treatment?

A

Overall reduction in p. acnes populations

Should use in combination with benzoyl peroxide to decrease resistance

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19
Q

What is the mechanism of action of topical azelaic acid?

A
  1. antibacterial
  2. promotes keratinocyte desquamation
  3. Decreases hyperpigmentation
20
Q

What are some adverse effects of treatment with Azelaic acid?

A
  1. redness
  2. desquamation
  3. burning sensation
21
Q

What are the 4 treatment categories for managing moderate acne?

A
  1. Systemic antibiotics
  2. Systemic hormonal therapies
  3. Systemic isoretinoin
  4. Intra-lesional steroid injections
22
Q

What is the first choice for antibiotic therapy for moderate acne?

A

One of: tetracycline/doxycycline/Minocycline

23
Q

What are some side effects to systemic antibiotic treatment for moderate acne?

A
  • takes several months to achieve clinical results
  • GI upset
  • rash/hepatitis
  • phototoxicity
  • hyperpigmentation
  • benign intracranial hypertension
24
Q

What are 3 examples of oral hormonal therapies you could use for managing moderate acne?

A
  1. Diane 35: low dose estrogen + cyproterone acetate
  2. Ortho tricyclen/Alesse: low dose estrogen + a 3rd gen progestin (has minimal androgenic activity)
  3. Spironolactone 50-100 mg
    - anti-androgen (but also a diuretic)
25
What is the most effective therapy for severe acne?
Systemic isoretinoin
26
How does systemic isoretinoin work to treat severe acne?
Inhibits sebum production and causes atrophy of sebaceous glands
27
What are the remission rates for severe acne after a 6 month course of isoretinoin?
about 60-80%
28
What are the side effects of isoretinoin therapy?
1. severe teratogen: pregnancy prevention essential from 1 month prior to therapy, during therapy, and 1 month following 2. dry skin/nasal mucosa/lips 3. Dermatitis 4. photosensitivity and decreased light vision 5. Elevated liver function tests and hyper-triglyceridemia 6. Alopecia 7. Depressive symptoms and suicidal risks
29
what are the indications for treatment with systemic isoretinoin therapy?
1. nodulo-cystic acne 2. scarring acne 3. refractory moderate acne
30
What are contraindications to isotretinoin therapy?
Pregnancy/breastfeeding not compliant with pregnancy prevention Concominant tetracycline therapy - risk of intracranial HTN Depression if uncontrolled
31
Define rosacea
a chronic inflammatory and vaso-dilatory skin disorder characterized by facial flushing and erythema
32
What is the epidemiology of rosacea?
1.4 million Canadians are affected more common in women than in men More common in caucasians
33
What are some known triggers of rosacea?
1. UV light 2. Temperature shifts 3. Topical steroids 4. Alcohol consumption 5. Cosmetics/irritants
34
What are two pathological findings common in rosacea?
1. dilated capillaries | 2. Perifollicular inflammation
35
What are the 4 subtypes of rosacea?
1. erythematotelangiectatic rosacea (ETR) 2. Papulopustular rosacea (PPR) 3. Phymatous rosacea (PR) 4. Ocular rosacea (OR)
36
What are defining features of erythematotelangiectatic rosacea (ETR)?
1. dilated capilaries | 2. fixed facial erythema
37
What are defining features of papulopustular rosacea (PPR)?
1. central facial erythema 2. pustules 3. papules 4. fixed edema * 5. no comedones! (different from acne)
38
What is the pathological feature of phymatous rosacea?
hypertrophic changes of protruding structures
39
What are defining features of ocular rosacea ?
1. foreign body sensation 2. Burning or stinging/dryness/itching 3. Photophobia 4. Conjuctival telangiectasia 5. Peri-ocular erythema
40
What specific treatment options are available for the treatment of ETR
1. erythema - laser or intense pulsed light therapies work OK - topical brominidine 0.33% gel acts as an alpha 2 agonist 2. Telangiectasia - vascular laser surgery is #1 or alternative is intense pulsed light
41
What therapies are available for papulo-pustular rosacea?
1. Topical - topical metronidazole (0.75-1%) - topical azelaic acid 2. Oral therapies - oral tetracyclines - oral isotretinoin (0.5mg/kg/day)
42
What are the indications of use for topical metronidazole?
only moderately effective for inflammatory papules, minimally effective for erythema, and not effective for telangiectasia
43
What is a significant side effect to topical metronidazole
skin peeling and erythema
44
What are the available treatment options for phymatous rosacea?
1. oral tetracyclines 2. Oral isotretinoin 3. Surgical reconstruction - co2 laser - reconstructive plastic surgery
45
What are the available treatment options for ocular rosacea?
1. topical steroid solutions | 2. oral tetracyclines