Acneiform Disorders

Question 1

3 types of pilosebaceous units

Answer 1

Terminal follicles (long hairs)
Vellus follicles (miniature hairs)
Sebaceous follicles (no visible hair shaft)

Question 2

Sebum

Answer 2

Fatty liquid produced by sebaceous follicles

No known physiological function in humans (possibly involved in hydration, antimicrobial, and anti-oxidant)

Question 3

How do
1. Androgens
2. Retinoids
regulate sebum production

Answer 3

1. Increase sebum production

2. Inhibit sebum production

Question 4

Acne vulgaris

Answer 4

Chronic inflammation of the pilsebaceous unit that is associated with comedones
Primarily affects adolescents
Can persist well into adulthood

Question 5

4 parts in the pathogenesis of acne

Answer 5

Abnormal follicular keratinization
Increased sebum production
Overgrowth of follicular bacterium (propionibacterium)
Inflammation

Question 6

Mild acne characteristics

Answer 6

Mostly comedones
Few inflammatory lesions (papules or pustules)
No nodules
Minimal or no scarring

Question 7

Mild acne therapy

Answer 7

1. Reducing comedones (topical retinoids, benzoyl peroxide)
2. Reducing sebum production (topical retinoids)
3. Reducing bacterial growth and inflammation (topical clinda or erythro, others)

Question 8

Topical retinoids

Answer 8

Reduces comedones by promoting keratinocyte desquamation
Reduces sebum production
For mild acne
Slow onset of action
Adverse effects: redness, desquamation, burning sensation

Question 9

Topical antibiotics

Answer 9

Reduction of P. acnes/anti-inflammatory
Often used with benzoyl peroxide to decrease antibiotic resistance
Used for inflammatory lesions

Question 10

Topical benzoyl peroxide

Answer 10

Gel and body wash
Unclear MOA but used for antimicrobial/anti inflam
Side effects: irritant or allergic contact dermatitis

Question 11

Topical azelaic acid

Answer 11

Gel or cream
MOA: antibacterial, promotes keratinocyte desquamation, decreases hyperpigmentation
Adverse effects: redness, desquamation, burning sensation

Question 12

Moderate acne therapies

Answer 12

Systemic antibiotics
Systemic hormonal therapies
Systemic isotretinoin
Intralesional steroid injection

Question 13

What ABx are used systemically for acne?

Answer 13

Tetracycline/Doxy/Minocycline

Question 14

Severe acne therapies

Answer 14

Systemic anti inflammatory antibiotics plus topical therapy
Systemic isotretinoin (most effective!)

Question 15

Isotretinoin

Answer 15

Inhibits sebum production
Causes atrophy of sebaceous glands
Most effective therapy for acne
Side effects are common but easily manageable (teratogen, dry skin/lips)

Question 16

3 indications for isotretinoin

Answer 16

Nodulo-cystic acne
Scarring acne
Refractory moderate acne

Question 17

Rosacea definition

Answer 17

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

Question 18

4 subtypes of rosacea

Answer 18

1. Erythematotetangiectatic rosacea
2. Papulopustular rosacea
3. Phymatous rosacea
4. Ocular rosacea

Question 19

Treatments for the 4 types of rosacea

Answer 19

1. Lasers
2. Topical (metronidazole) or oral (tetracyclines, isotretinoin)
3. Surgical reconstruction
4. Opthamologists - topical steroids or oral tetracyclines