Acneiform Disorders Flashcards Preview

Med 2 - Week 44 > Acneiform Disorders > Flashcards

Flashcards in Acneiform Disorders Deck (45)
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1
Q

What are the 3 types of pilosebaceous units?

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

What type of hair are terminal follicles associated with?

A

Associated with long hairs (ie scalp)

3
Q

What type of hair are vellus follicles associated with?

A

with miniature hairs like arm hairs

4
Q

What type of hair are sebaceous follicles associated with?

A

no visible hair shaft! mostly on the face

5
Q

What are the 3 main “sebaceous” areas

A

face, upper chest, upper back

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
7
Q

What is the physiological function of sebum?

A

No precisely known function in humans!

Could potentially be hydration, antimicrobial or anti-oxidant

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

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

10
Q

What are comedones?

A

blocked folllicular ostium with dead keratinocytes and sebum

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
12
Q

What are some medications that can exacerbate acne?

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

What types of lesions are common in mild acne

A

mostly comedones with few inflammatory lesions

No nodules

Minimal to no scarring

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
15
Q

How do topical retinoids work?

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

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

A

weeks to months to see an effect

17
Q

What are 3 adverse effects from treatment with retinoids?

A
  1. Redness
  2. Desquamation
  3. Burning sensation
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

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
Q

What is the most effective therapy for severe acne?

A

Systemic isoretinoin

26
Q

How does systemic isoretinoin work to treat severe acne?

A

Inhibits sebum production and causes atrophy of sebaceous glands

27
Q

What are the remission rates for severe acne after a 6 month course of isoretinoin?

A

about 60-80%

28
Q

What are the side effects of isoretinoin therapy?

A
  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
Q

what are the indications for treatment with systemic isoretinoin therapy?

A
  1. nodulo-cystic acne
  2. scarring acne
  3. refractory moderate acne
30
Q

What are contraindications to isotretinoin therapy?

A

Pregnancy/breastfeeding

not compliant with pregnancy prevention

Concominant tetracycline therapy
- risk of intracranial HTN

Depression if uncontrolled

31
Q

Define rosacea

A

a chronic inflammatory and vaso-dilatory skin disorder characterized by facial flushing and erythema

32
Q

What is the epidemiology of rosacea?

A

1.4 million Canadians are affected

more common in women than in men

More common in caucasians

33
Q

What are some known triggers of rosacea?

A
  1. UV light
  2. Temperature shifts
  3. Topical steroids
  4. Alcohol consumption
  5. Cosmetics/irritants
34
Q

What are two pathological findings common in rosacea?

A
  1. dilated capillaries

2. Perifollicular inflammation

35
Q

What are the 4 subtypes of rosacea?

A
  1. erythematotelangiectatic rosacea (ETR)
  2. Papulopustular rosacea (PPR)
  3. Phymatous rosacea (PR)
  4. Ocular rosacea (OR)
36
Q

What are defining features of erythematotelangiectatic rosacea (ETR)?

A
  1. dilated capilaries

2. fixed facial erythema

37
Q

What are defining features of papulopustular rosacea (PPR)?

A
  1. central facial erythema
  2. pustules
  3. papules
  4. fixed edema
    * 5. no comedones! (different from acne)
38
Q

What is the pathological feature of phymatous rosacea?

A

hypertrophic changes of protruding structures

39
Q

What are defining features of ocular rosacea ?

A
  1. foreign body sensation
  2. Burning or stinging/dryness/itching
  3. Photophobia
  4. Conjuctival telangiectasia
  5. Peri-ocular erythema
40
Q

What specific treatment options are available for the treatment of ETR

A
  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
Q

What therapies are available for papulo-pustular rosacea?

A
  1. Topical
    - topical metronidazole (0.75-1%)
    - topical azelaic acid
  2. Oral therapies
    - oral tetracyclines
    - oral isotretinoin (0.5mg/kg/day)
42
Q

What are the indications of use for topical metronidazole?

A

only moderately effective for inflammatory papules, minimally effective for erythema, and not effective for telangiectasia

43
Q

What is a significant side effect to topical metronidazole

A

skin peeling and erythema

44
Q

What are the available treatment options for phymatous rosacea?

A
  1. oral tetracyclines
  2. Oral isotretinoin
  3. Surgical reconstruction
    - co2 laser
    - reconstructive plastic surgery
45
Q

What are the available treatment options for ocular rosacea?

A
  1. topical steroid solutions

2. oral tetracyclines