Derma - Acne

Question 1

Chronic inflammatory disease of the pilosebaceous follicles, characterized by comedones, papules, pustules, nodules, and often scars

Answer 1

Acne vulgaris

Question 2

Primary lesion of the acne

Answer 2

Comedo

Question 3

Seen as flat or slightly elevaed papule with dilated central opening filled with blackened keratin

Answer 3

Open comedo or blackhead

Question 4

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

Answer 4

Closed comedones (whiteheads)

Question 5

Uncommon comedo that can reach 3-4 mm in size

Answer 5

Macrocomedones

Question 6

For these type of patients, lesions often resolve with reddish purple macule that is short-lived

Answer 6

Light-skinned patients

Question 7

For these type of ptx, lesions may resolve to macular hyperpigmentation and may last several months

Answer 7

Dark-skinned individuals

Question 8

Acne primary sites

Answer 8

Face
Neck
Upper trunk
Upper arms

Question 9

On the face, acne primary site

Answer 9

Cheeks

Question 10

Acne bgins at

Answer 10

Puberty

Question 11

Neonatal acne has

A. Male
B. Female
Preponderance

Answer 11

A. Male

Question 12

Acne that develops days after birth characterized by transient facial papules or pustules that usually clear spontaneously in a few days or weeks

Answer 12

Neonatal acne

Question 13

Acne that persist beyond the neonatal period or that have an onset after the first 6 weeks of life

Answer 13

Infantile acne

Question 14

In prolonged cases of infantile acne, what management is found effective

Answer 14

Topical benzoyl peroxide, erythromycin, or retinoids

Question 15

For more inflammatory dse of prolonged infantile acne, this management is added to topical medications

Answer 15

Oral erythromycin, 125 mg twice daily, or

Trimethoprim, 100 mg twice daily

Question 16

Can oral isotretinoin be prescribed for infantile acne

Answer 16

Yes and it is effective

Question 17

Midchildhood acne may evolve from

Answer 17

Persistent infantile acne or begin after age 1 yr

Question 18

Midchildhood has preponderance for

A. Males
B. Females

Answer 18

A. Males

Question 19

Fh of acne

Answer 19

Strong family history of moderately severe acne

Question 20

This workup is indicated fo midchildhood acne and for earlier-onset ptx with physical findings suggestive of a hormonal disorder

Answer 20

Perdiatric endocrinology workup

Question 21

what physical findings in earlier-onset patients, are suggestive of a hormonal disorder

Answer 21

Sexual precocity
Virilization
Growth abnormality

Question 22

Acne onset from age _______ is categorized as preadolescent acne

Answer 22

7-12 yo

Question 23

Principal abnormality of acne vulgaris is

Answer 23

Comedo formation

Question 24

What hormone stimulates the sebaceous gland that is critical in acne formation

Answer 24

Androgens

Question 25

What other abnormalities appear in women with hyperandrogenic states, aside from acne

Answer 25

``` Hirsutism Menstrual abnormalities (irregular) Seborrhea Acanthosis nigricans Androgenic alopecia ```

Question 26

What tx can be used directed at reducing sebaceous secretion

Answer 26

Isotretinoin Estrogens Antiandrogens

Question 27

This microorganism is particular to cause acne

Answer 27

Propionibacterium acnes

Question 28

causes a red, itchy rash and white scales

Answer 28

Seborrhea

Question 29

May be indicated in women who have acne resistant to conventional therapy (relapse quickly after a course of isotretinoin or who experience sudden onset of severe acne)

Answer 29

Gynecologic endocrine evaluation

Question 30

Screening tests to exclude a virilizing tumor inclue

Answer 30

Serum dehydroepiandrosterone sulfate (DHEAS) and testosterone, 2 weeks before onset of menses

Question 31

DHEAS level in adrenal tumors

Answer 31

Very high | >800 ug/dL

Question 32

DHES level in congenital adrenal hyperplasia

Answer 32

400-800 ug/dL

Question 33

Ovarian tumor is suggested by

Answer 33

testosterone levels greater that 200 ng/dL

Question 34

DHEAS level | Late-onset congenital adrenal hyperplasia

Answer 34

Normal levels

Question 35

PCOS expected hormone profile

Answer 35

High Testosterone level (150-200 ng/dL) | Inc in LH/FSH ratio (>2-3)

Question 36

Diagnosis of PCOS may ba made clinically by

Answer 36

Presence of anovulation (<9 periods per year or periods >40 days apart) Signs of hyperandrogenism (acne, hirsutism)

Question 37

Acne neonatorum is explained by infantile production of androgens which wanes at

Answer 37

6-12 monthss

Question 38

Acne developing after age 1 and before age 7 (onset of adrenarche) may be a form of

Answer 38

Acne cosmetica Acne venenata Drug-induced acne Part of an endocrinologic disorder

Question 39

Form of acne triggered by use of cosmetic products

Answer 39

Acne cosmetica

Question 40

Acne induced by external contact with a variety of chemicals including pomades and comstemics, oils, chlorinated hydrocarbons, and coal tar

Answer 40

Acne venenata

Question 41

Drugs that may worsen acne

Answer 41

``` Corticosteroids Anabolic steroids Neuroleptics Lithium Cycosporine ```

Question 42

Family history of acne | Important

Answer 42

FH of acne | Tendency to scarring

Question 43

Diet that can worsen acne

Answer 43

High-glycemic diet | Large quantities of skim milk

Question 44

Acne tx | Comedonal

Answer 44

Topical retinoid +/- physical extraction (first line) | Alternate retinoid, salicylic acid, azelaic acid (second line)

Question 45

Acne tx | Mild, papular/pustular

Answer 45

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)

Question 46

Moderate acne | Papular. Pustular tx

Answer 46

Oral antibiotic + topical retinoid + benzoyl peroxide (first line) Alternate antibiotic, alternate topical retinoid, alternate benzoyl peroxide (second line) In women: spironolactone + oral contraceptive + topical retinoids +/- topical antibiotic and or benzoyl peroxide Isotretinoin, if relapses quickly off oral antibiotics, does not clear or scars

Question 47

Severe acne | Nodular or conglobate tx

Answer 47

Isotretinoin | Oral antibiotic + topical retinoid + benzoyl peroxide

Question 48

A multifactorial disorder of the pilosebaceous unit characterized by comedones, papules, pustules, nodules, and cysts, with occasional scarring

Answer 48

Acne vulgaris (common acne)

Question 49

Predilection sites of acne vulgaris

Answer 49

Face, neck, chest, upper back

Question 50

Acne vulgaris more severe for this gender

Answer 50

Males

Question 51

acne severity grading | comedonal, few lesions , no scarring

Answer 51

I

Question 52

acne severity grading | Nodulocystic, severe scarring

Answer 52

IV

Question 53

acne severity grading | Papular, moderate number, +/- scarring

Answer 53

II

Question 54

Pustular, >25 lesions, moderate scarring

Answer 54

III

Question 55

Topical tx acne vulgaris

Answer 55

``` Benzoyl peroxide Clindamycin/ erythromycin Retinoic acid Adapalene Azelaic acid ```

Question 56

Oral tx acne | Antibiotics

Answer 56

Antibiotics | Tetracycline, minocycline, doxycycline, lymecycline, erythromycin

Question 57

Oral tx hormones

Answer 57

Antiandrogen: Cyproterone acetate High estrogen OCP

Question 58

Types of oral tx acne vulgaris

Answer 58

Antibiotics Anti-androgen hormones Isotretinoin

Question 59

Drug effect + follicular keratinization +++ P. Acnes + inflammation - sebum excretion

Answer 59

Benzoyl peroxide

Question 60

Drug effect + P. Acnes - sebum exretion - follicular keratinization - inflammation

Answer 60

Clindamycin | Erythromycin

Question 61

Drug effect ++ follicular keratinization + P. Acnes - inflammation - sebum excretion

Answer 61

Tretinoin | Adapalene

Question 62

Drug effect ++ follicular keratinization ++ P. Acnes + inflammation - sebum excretion

Answer 62

Azelaic acid

Question 63

Drug effect + sebum excretion - follicular keratinization - P. Acnes - inflammation

Answer 63

Antiandrogens

Question 64

``` Drug effect +++ sebum excretion ++ follicular keratinization + P. Acnes ++ inflammation ```

Answer 64

Isotretinoin

Question 65

Adjunctive procedures | Acne vulgaris

Answer 65

``` Intralesional steroids Acne surgery Chemical peeling Microdermabrasion Lasers and light ```

Question 66

Pathogenesis of acne vulgaris

Answer 66

Colonization of pilosebaceous follicles by P. Acnes Inflammation Hyperplasia of sebaceous glands -> inc sebum production Follicular hyperkeratinization