Acneiform Lesions

Question 1

Inflammation of the pilosebaceous units of certain body areas

Face, chest, back

Manifests itself as comedones, papulopustules, or nodules/cysts

Age of onset- puberty

Answer 1

Acne Vulgaris

Question 2

What are the key factors for the development of acne vulgaris?

Answer 2

Key factors are follicular keratinization, androgens, and
Propionibacterium acnes

Question 3

What are some contributary factors for the development of acne vulgaris?

Answer 3

Contributary factors are acnegenic mineral oils, drugs, emotional
stress, occlusion and pressure on the skin

Question 4

excess skin cells or build up on the skin

Answer 4

Follicular keratinization

Question 5

this bacteria lies deep within the pore and is anaerobic; over time it breaks down the heavy oil in the sebaceous gland, which causes inflammation which results in pimples and cysts

Answer 5

Propionibacterium acnes:

Question 6

Comedones: Open (blackheads), Closed (whiteheads)

Papules and papulopustules

Nodules or cysts: 1-4 cm in diameter, “Undergrounders”

Answer 6

Acne Vulgaris

Question 7

What is the treatment for mild acne vulgaris?

Answer 7

OTC:

Topical antibiotics (Clindamycin and Erythromycin

Benzoyl peroxide gels (2%, 5%, or 10%)

Topical retinoids

Question 8

What is the treatment for moderate acne vulgaris?

Answer 8

Add “cyclines” 🡪 Minocycline is good for acne
Tetracycline an option

Women – add high dose estrogens + progesterone + antiandrogens

Question 9

What is the treatment for severe acne vulgaris?

Answer 9

Accutane (Isotretinoin) is an option – most effective for cystic acne (Managed by a dermatologist, someone who is accredited)

Question 10

Common chronic inflammatory acneiform disorder of the facial
pilosebaceous units, increased reactivity of capillaries leading to flushing and telangiectasia

Age of onset - 30-50 years with a peak incident between 40 and 50 years

Predominately in females

Answer 10

Rosacea

Question 11

Rosacea is also called what?

Answer 11

adult acne

Question 12

What stage of Rosacea is described below?

Persistent erythema with telangiectases

Answer 12

Stage I

Question 13

What stage of Rosacea is described below?

Persistent erythema, telangiectases, papules, tiny pustules

Answer 13

Stage II

Question 14

What stage of Rosacea is described below?

Persistent deep erythema, dense telangiectases, papules, pustules, nodules

Rarely persistent “solid” edema of the central part of the face

Answer 14

Stage III

Question 15

Describe the early presentation of Rosacea

Answer 15

Capillaries undergo continual inflammation and dilation

Pathognomonic flushing (red face)

Tiny papules and papulopustules - Pustule often small (<1mm) and
on the apex of the papule

No comedones

Question 16

Describe the late presentation of Rosacea

Answer 16

Red facies and dusky-red papules and nodules

Scattered, discrete lesions

Telangiectases

Marked sebaceous hyperplasia and lymphedema in chronic rosacea, causing disfigurement of the nose, forehead, eyelids, ears, and chin

Question 17

What is the treatment for Rosacea?

Answer 17

Topical - Metronidazole gel or cream

Systemic - Minocycline or Doxycycline; Metronidazole

Question 18

Chronic, suppurative, often cicatrical disease of apocrine gland-bearing skin in the axillae, anogenital region, and the scalp (rare)

Inflammatory changes to apocrine glands

Unique double comedones

Age of onset: puberty to climacteric

More common in females than males

More common in obesity and diabetes

Etiology is unknown

Answer 18

Hidradenitis Suppurativa

Question 19

Intermittent pain and marked point tenderness related to abscess formation in axillae and/or anogenital area

Inflammatory nodules/abscesses of axillae, buttocks, inguinal region

Answer 19

Hidradenitis Suppurativa

Question 20

Initial lesion - Very tender, Red, inflammatory nodule/abscess that may resolve or drain purulent/seropurulent material

Unique double comedones – double blackheads

Later lesions - pus drains from opening of abscess and sinus tracts

Answer 20

Hidradenitis Suppurativa

Question 21

What are the treatment options for Hidradenitis Suppurativa?

Answer 21

Supportive/Watchful Waiting - some can resolve on their own

Intralesional glucocorticoids

Surgery

Oral antibiotics - Tetracycline, Erythromycin, Minocycline

isotretinoin