Flashcards in Acneiform Disorders Deck (45)
What are the 3 types of pilosebaceous units?
1. Terminal follicles
2. Vellus follicles
3. Sebaceous follicles
What type of hair are terminal follicles associated with?
Associated with long hairs (ie scalp)
What type of hair are vellus follicles associated with?
with miniature hairs like arm hairs
What type of hair are sebaceous follicles associated with?
no visible hair shaft! mostly on the face
What are the 3 main "sebaceous" areas
face, upper chest, upper back
What is the composition of sebum?
- squalene (long chain FA precursors of cholesterol)
- Cholesterol and cholesterol esters
- wax esters
- some IgA secretion
What is the physiological function of sebum?
No precisely known function in humans!
Could potentially be hydration, antimicrobial or anti-oxidant
What are 2 regulators of sebum production? What are their effects?
1. Androgens: increase sebum production
2. Retinoids: inhibit sebum production and trigger sebocyte apoptosis
Define: Acne vulgaris
Chronic inflammation of the pilosebaceous unit that is associated with comedones
- primarily affects adolescents but can persist well into adulthood
What are comedones?
blocked folllicular ostium with dead keratinocytes and sebum
What are the 4 main steps in the pathogenesis of Acne?
1. Abnormal follicular keratinization
2. Increased sebum production
3. Overgrowth of follicular bacterium
- generally propionibacterium acnes
What are some medications that can exacerbate acne?
3. Barbituate anticonvulsants
4. EGFR inhibitors
What types of lesions are common in mild acne
mostly comedones with few inflammatory lesions
Minimal to no scarring
What are the 3 therapy approaches for mild acne?
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
How do topical retinoids work?
1. reduce comedones by promoting keratinocyte desquamation
2. Reduce sebum production
3. have anti-inflammatory properties
How long do you need to treat mild acne with retinoids ?
weeks to months to see an effect
What are 3 adverse effects from treatment with retinoids?
3. Burning sensation
How do topical antibiotics work to treat mild acne? What should be used as a combined treatment?
Overall reduction in p. acnes populations
Should use in combination with benzoyl peroxide to decrease resistance
What is the mechanism of action of topical azelaic acid?
2. promotes keratinocyte desquamation
3. Decreases hyperpigmentation
What are some adverse effects of treatment with Azelaic acid?
3. burning sensation
What are the 4 treatment categories for managing moderate acne?
1. Systemic antibiotics
2. Systemic hormonal therapies
3. Systemic isoretinoin
4. Intra-lesional steroid injections
What is the first choice for antibiotic therapy for moderate acne?
One of: tetracycline/doxycycline/Minocycline
What are some side effects to systemic antibiotic treatment for moderate acne?
- takes several months to achieve clinical results
- GI upset
- benign intracranial hypertension
What are 3 examples of oral hormonal therapies you could use for managing moderate acne?
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)
What is the most effective therapy for severe acne?
How does systemic isoretinoin work to treat severe acne?
Inhibits sebum production and causes atrophy of sebaceous glands
What are the remission rates for severe acne after a 6 month course of isoretinoin?
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
4. photosensitivity and decreased light vision
5. Elevated liver function tests and hyper-triglyceridemia
7. Depressive symptoms and suicidal risks
what are the indications for treatment with systemic isoretinoin therapy?
1. nodulo-cystic acne
2. scarring acne
3. refractory moderate acne