CHAPTER 13: ACNE Flashcards by Madilou Milca

What is the primary lesions of acne

Comedo

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are usually 1-mm yellowish papules that may require stretching of the skin to visualize.

Closed com- edones (whiteheads)

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Types of acne scars

Ice pick- temples and cheeks
Box car
Rolling
Anetoderma type (atrophic)
Hypertrophic

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Most neonatal acne remit by age ___

1 year

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Acne onset from what age is considered as preadolescent acne?

7-12y

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The combination of these 3 elements in acne formation leads to the release of proinflammatory mediators➡️ formation of inflammatory lesions

Keratin
Sebum
Microorganisms- propionibacterium acnes

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Screening tests to exclude a virilizing tumor for severe acne resistant to therapy, relapse quickly or sudden onset

Serum dehydroepiandrosterone (DHEAS)
Serum testosterone

2 weeks before onset of menses

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Most common cause of treatment failure in acne

Lack of adherence

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Treatment for mild comedonal acne

1st line: topical retinoid + physical extraction

2nd line: alternate retinoid, salicylic, azelaic acid

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Treatment for mild papular/pustular acne

Topical antimicrobial combination + topical retinoid, benzoyl peroxide wash if mild truncal lesions (first line)
Alternate antimicrobials + alternate topical retinoids, azelaic acid, sodium sulfacetamide–sulfur, salicylic acid (second line)

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Treatment for moderate papular/pustular acne

1st line: Oral antibiotics + topical retinoid + benzoyl peroxide
2nd line: alternate antibiotic, topical retinoid, benzoyl peroxide

Women: spironolactone + OCP + topical retinoid +/- topical antibiotic and/or benzoyl peroxide

Isotretinoin- relapse quickly off oral antibiotics, does not clear or scars

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Treatment for severe acne

Nodular/conglobate

Isotretinoin
Oral antibiotic + topical retinoid + benzoyl peroxide

Women: spironolactone + OCP + topical retinoid +/- topical or oral antibiotic and/or benzoyl peroxide

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Preferred agents in maintenance therapy of acne

retinoids

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Oral antibiotic for pregnant women with acne

Amoxicillin 500mg TID

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side effects of dapsone treatment for acne

Hemo- lytic anemia

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Oral antibiotic for pregnant women with acne

Amoxicillin 500mg TID

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Known side effect of clindamycin that limits its use

150mg TID

Pseudomembranous colitis

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Antiandrogen treatment prescribed in combination with OCP in the treatment of acne

Spironolactone 100mg ODHS

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Dose of isotretinoin for severe acne

0.5-1mg/kg/day OD or BID

Starting: 20-40mg/day

When taking isotretinoin, women should not become pregnant until stopping medication for at least _______

1 month

To ensure excellent absorption, isotretinoin should be taken with

high fat meal

Follicular occlusion triad

Hidradenitis sup- purativa
2.dissecting cellulitis of the scalp
with acne conglobata,

A second course of isotretinoin may be done in acne conglobata if resolution does not occur after a rest period of _______

2 months

Rare form of extremely severe cystic acne that occurs in teenage boys

Highly inflammatory nodules and plaques that undergo swift suppurative degeneration

Fever, arthralgia, myopathy

acne fulminans

Treatment of acne fulminans

Prednisone, 40–60 mg, is necessary during the initial 4–8 weeks to calm the dramatic inflammatory response of acne fulminans. After 4 weeks 10–20 mg of isotretinoin is added. This should be slowly increased to standard doses and contin- ued for a full 120–150 mg/kg cumulative course. Large cysts may be opened and the contents expressed. Intralesional cor- ticosteroids will aid their resolution. Infliximab and dapsone are alternatives if isotretinoin is contraindicated.

SAPHO syndrome meaning

Synovitis Acne Pustulosis, Hyperostosis, and Osteitis.

Most potent acneiform inducing agents

The most potent acneiform- inducing agents are the polyhalogenated hydrocarbons, notably dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin).

Occurs in px who have had long periods of moderate acne and have been treated with long term antobiotics (tetracycline)

gram negative folliculitis

Treatment of choice for gram negative folliculitis

isotretenoin 2nd line/ if isotret is contraindicated: amoxicillin TMP-SMX

Primarily a cicatricial alopecia variant Persistent folliculitis of the back and neck Fibrosis with coalescence of papules into plaques over time May have sinus tracts

acne keloidalis

Recurrent abscess formation within the folded areas of skin that contain terminal hairs and apocrine glands

hidradenitis suppurativa

Primary site of inflammation in hidradenitis suppurativa

terminal hair

Most frequently affected site in hidradenitis suppurativa

axilla

Treatment of hidradenitis suppurativa

1. intralesional steroid therapy, which may be used initially in combination with topical Cleocin or oral doxycycline or minocycline. 2. topical daily cleansing with chlorhexidine gluconate (Hibiclens) solu- tion or benzoyl peroxide wash is an important preventive measure. 3. laser hair removal, 4. Antibiotics : tetra- cyclines amoxicillin, TMP-SMX DS, or dapsone. etra- cyclines amoxicillin, TMP-SMX DS, or dapsone, IV ertapenem 5.Isotretinoin and acitretin 6. TNF antagonists: infliximab and adalimumab 7. Photodynamic therapy and Nd:YAG laser 8. Severe recalcitrant hidradenitis suppura- tiva responded to the approach reported by van Rappard: combination clindamycin and rifampin, each 300 mg twice daily for 2 to 4 months. 9. wide surgical excision once inflammation is controlled NOTE: INCISION AND DRAINAGE IS STRONGLY DISCOURAGED

Follicular inflammatory nodules in the scalp that progress to abscess Scarring and alopecia

DISSECTING CELLULITIS OF THE SCALP

Most favored sites in dissecting cellulitis of the scalp

vertex and occiput

Treatment of dissecting cellulitis of the scalp

1. oral antibiotics: tetracyclines, TMP-SMX, quinolones 2. if S. aureus is cultured: oral rifampin and clindamycin 3. intralesional steroids + isotretenoin 0.5-1 mkd for 6-12 mos. 4. anti- TNF: infliximab and adalimumab 5. retinoid alitretinoin 6. marsupialization 7. Nd:YAG laser

Persistent erythema of the convex surfaces of the face (cheeks and nose most common)

rosacea

Rhinophyma occurs in what subtype of rosacea

glandular subtype of rosacea

Topical and oral therapy for rosacea

Treatment is dis- continuance of the corticosteroid and institution of topical tacrolimus in combination with short-term minocycline.

Dramatically fulminant onset of superficial and deep abscess, cystic lesions, sinus tracts with purulent material

Pyoderma faciale

Pyoderma faciale is differentated from acne by

It is distinguished from acne by the absence of comedones, rapid onset, fulminating course, and absence of acne on the back and chest

Treatment of pyoderma faciale

1. oral steroids , ffd by addition of isotretinoin 10-20 mg, increasing to 0.5–1 mg/kg only after the acute inflammatory component is well under control. 2. for pregnant: amoxicillin, eryth- romycin, azithromycin, or clindamycin

the most frequently identified cause of perioral dermatitis

use of fluorinated topical corticosteroids

Treatment of perioral dermatitis

1. discontinuing topical corticosteroids or protecting the skin from the inhaled product. 2. doxycycline will lead to control. 3. Tacro- limus ointment 0.1% or pimecrolimus cream will prevent flaring after stopping steroid use. 4. In patients without steroid exposure, oral or topical antibiotics and topical adapalene, azelaic acid, and metronidazole