deck_5402862 Flashcards

(52 cards)

1
Q

What are the four main factors in the development of acne?

A

-Sebaceous gland hyperplasia (especially via androgen)-Abnormal follicular desquamation-Proprionobacteriumacne colonization-Inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a microcomedo?

A

Non-inflammatory comedones, which are small, below the surface clots below the surface of the skin which then progress into blackheads (open) or whiteheads (closed), which are non-inflammatory comedones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens to blackheads and whiteheads?

A

These trap debris and become inflammatory and turn into papules, nodules, cysts, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some topical treatments of acne?

A

-OTC: Benzoyl peroxide or salicylic acidPrescription: Antimicrobials, retinoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which is more effective, benzoyl peroxide or salicylic acid?

A

Benzoyl peroxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does Benzoyl peroxide work?

A

Multiple MOA: killes P. acnes and mildly comedolytic and anti-inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Benzoyl peroxide is typically used in combination with ______.

A

retinoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T or F. Benzoyl peroxide limits development of P. acnes ABX resistance

A

T.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the AEs of Benzoyl peroxide?

A

well-tolerated, but can get irritation, bleaching of fabric, and rarely allergic contact dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some topical ABX for acne?

A

Clindamycin and erythromycin (these have some anti-inflammatory effects- primary reason for use)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T or F. Topical ABX are not recommended for monotherapy for acne

A

T. This tends to increase ABX-resistance and these are not comedolytic so not that effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should topical ABX be used in acne?

A

Add topical BP or use a combo product

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do topical retinoids work?

A

The 1st line therapy for acnelately (and preferred for maintenance), and work by normalizing follicular desquamation (Comedolytic), anti-inflammatory, and enhance penetration of other compounds by getting rid of dead layers of skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some topical retinoid options?

A

-Adapalene (milder and better tolerated)-Tretinoin-Tazarotene (more for severe, do not give in pregnancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are systemic ABX given for acne?

A

These are more for cases of moderate to severe inflammatory acne (most are not FDA approved for acne except Solodyn (minocycline)the goal is maintenance with a topical (want to work people off PO ABX in 3-6 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Preferred systemic ABX for acne? over 8 yo

A

Tetracycline, Doxy, Mino

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some AEs of systemic tetracycline?

A

GI upset, tooth staining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some AEs of systemic Doxycycline?

A

photosensitivity, esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some AEs of systemic Minocycline?

A

dyspigmentation, lupus-like rxns, SJS, pseudotumor cerebri, DHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When are oral contraceptives used for acne?

A

consider for females with moderate to severe acne with flares aroundmenstration cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do OCs help in acne?

A

they have an anti-androgen effect to suppress sebum production

22
Q

When are oral retinoids indicated (Isotretinoin)?

A

severe, scarring, and refractory acne

23
Q

How does Isotretinoin work?

A

affects all four main factors of acne production (decreases size/activity of sebaceous glands, normalizies follicular keratinization, inhibits P. acnes, anti-inflammatory)

24
Q

What are some commonAEs of oral retinoids?

A

-dry lips, skin, eyes-nosebleeds,-muscles aches-mild HA

25
What are some rarer, more severe AEs of oral retinoids?
-teratogenic-depression, suicidal ideation-increased risk of fractures, epiphyseal closure-IBD (UC over CD)
26
How should MILD comedonal acne be treated (typically pre-adolescent acne)?
topical retinoid
27
How should mild inflammatory acne be treated?
topical retinoid+ topical ABX
28
How should moderate inflammatory acne be treated?
topical retinoid + topical ABX + oral ABX
29
How should SEVERE inflammatory acne be treated?
Minimal scarring: topical retinoid + topical ABX + oral ABXScarring: Isotretinoin
30
Basic skin care during acne treatment
-Gentle cleansing 1-2x day-Mild, fragrance-free cleanser-oil-free moisturizer with SPF 30+ bid-avoid OTC acne washes and topicals during treatment (too irritating) 
31
Myths of acne
-Acne is NOT caused by poor hygiene or diet-diet controversial (high glycemic index may lead to hyperinsulinemia and stimulate androgen synthesis-milk may actually be problematic
32
When to refer to a dermatologist?
-severe acne (cysts, nodules)-no response to treatment after 12 weeks-if systemic ABX needed over 1yr-acne assoicated with a systemic disease
33
What is the patient pop for rosacea?
This is a relapsing and remitting problem common in women over 30 with fair skin
34
What things contribute to rosacea?
-Inflammation-Demodex folliculorum-genetics-vascular abnormalities-triggers
35
What are some triggers of rosacea?
sunlight, exercise, hot/cold, stress, foods, alcohol
36
What are the four types of rosacea?
-Erythematotelangiectatic-Papulopustular-Phymatous (swelling- can lead to a large nose)-Ocular 
37
Rosacea
38
What are some topical treatments for rosacea?
-metronidazole (more anti-inflammatory)-azelaic acid-sodium sulfacetamide with sulfur
39
Other treatments for rosacea?
-PO tetracycline-laser, surgery, IPL (intense pulse light)
40
What is perioral dermatits (aka periorificial) 
Variant of rosacea that affects primarily women 20-45 yrs (and some prepubertal children)
41
Triggers for perioral dermatitis?
-Hx of topical steroid use in that area-menstruation, pregnancy-stress-fluorinated toothpaste-Candida, demodex mites
42
How does perioral dermatitis present?
rash or 'pimples' around mouth or nose, eyes, labia rarely
43
How is perioral dermatitis treated?
-dincontinue topical steroidsMild: Topical ABX (Metrocream)Severe: PO ABXand may need topical non-steroidal anti-inflammatory
44
What is folloculitis?
Common sequlae of Staph aureus, Strep, or Pseudomonas infection
45
What is a fungal cause of folliculitis?
Pityrosporum orbiculare
46
Other causes of folliculitis?
-Mites (demodex)-Mechanical (areas of friction)-eosinophilic folloculitis (common in HIV or transplant patients with immunosuppresstants)
47
How is folliculitis treated?
-antibacterial soaps/washesor topical ABX/antifungals
48
What is Hidradenitis suppurativa (HS)?
condiition affecting apocrine gland bearing areas (commonly in the axillary, inguinal, underneath the breasts, and other body folds) commonly affecting women more than men
49
What are some risk factors for HS?
ObesityCigsFam Hx
50
HS
51
How is mild HS treated?
topical and/or oral ABX to suppress inflammation
52
How is moderate to severe HS treated?
injected steroids, TNFa inhibitors, surgery