Disorders of Sebaceous and Apocrine Glands - Exam 1

Question 1

What is the technical term for teenage acne? What unit is involved?

Answer 1

acne vulgaris

pilosebaceous unit

Question 2

What are the 4 pathogenesis factors that lead to acne vulgaris?

Answer 2

(1) increased sebum production
(2) follicular hyperkeratinization
(3) proliferation of Cutibacterium acnes (C. acnes, formally known as Propionibacterium acnes)
(4) inflammation.

Question 3

What are the 4 stages of acne?

Answer 3

normal -> blackhead -> whitehead -> papule -> pustule -> nodule/cyst

Question 4

What is the difference between a blackhead and a whitehead.

Answer 4

blackhead is open comedo and whitehead is closed comedo

Question 5

What are the 4 components of acne?

Answer 5

Follicular plugging = blocks sebum drainage
Stimulation of sebaceous glands
Overgrowth of C. acnes
Inflammatory response

Question 6

T/F: Acne is typically worse in white and black when compared to those of Asain/Mediterran descent?

Answer 6

FALSE! There is no racial predilection.

Question 7

What medication tend to make acne worse? In adult women, acne is commonly seen in what area? men?

Answer 7

systemic or topical corticosteroids

women: along the mandibular jaw

men: more severe on the trunk

Question 8

Describe drug- induced acne eruptions.

Answer 8

Drug-induced acneiform eruptions are typically comprised of monomorphic inflammatory papules and pustules

NOT open and closed comedones

Question 9

What are exacerbating acne factors in women? men?

Answer 9

women: touching, rubbing, over-cleansing the face with numerous products, and wearing cosmetics

men: grease from working in fast-food restaurants, occlusion from sports equipment or hats, and drugs.

Question 10

How do you determine the severity of a pt’s acne? **what level did Alex tell us to know?

Answer 10

**know what moderate is

Question 11

What should you be thinking if acne is itchy? Where is it commonly found? How do you dx it? What is the tx?

Answer 11

Pityrosporum folliculitis

upper back, shoulders, and scalp of adolescents

consider scraping a pustule for potassium hydroxide (KOH)

ketoconazole

Question 12

What am I?

Answer 12

Pityrosporum folliculitis

Question 13

**What are good pt education points regarding the tx of acne?

Answer 13

**requires consistent, regular care that may see months to improve

**correct application over the entire area, NOT just the specific spots of acne

Question 14

What are the mild tx options for acne?

Answer 14

topical retinoids

benzoyl peroxide

topical abx

Question 15

**What is the important pt education point regarding retinoids?

Answer 15

Start using topical retinoids gradually, such as every third NIGHT, then slowly increase to nightly as tolerated to avoid excessive irritation and dryness.

deactivated by light

Question 16

What is the MOA of retinoids? What is the MC SE? Are they safe in pregnany?

Answer 16

decreases cohesion and increases turnover of epidermal cells

dryness- MC. Photosensitivity

NO! CI in pregnancy

Question 17

What is the advantage of using benzoyl peroxide? What are the SE?

Answer 17

no bacterial resistance

Skin irritation (erythema, xerosis, scaling,
stinging, tightening, burning sensation)
Bleaching of hair/clothing

Question 18

What is the MOA of topical abx? When are they indicated? What are the 2 first line medications? **What is important to note? What is a SE?

Answer 18

reduces number of C. acnes in pilosebaceous unit

Mild-moderate inflammatory acne

Clindamycin and Erythromycin

**NOT indicated for MONOtherapy

skin irritation

Question 19

What is considered moderate acne? What would you consider adding on?

Answer 19

with inflammatory papules or deeper-seated lesions, consider adding an oral medication

Add on topical doxy or minocycline

so use retinoid, benzoyl peroxide and PO abx for 3 months then taper abx

Question 20

What is the MOA for oral abx? Why is it better than topical? What are the MC SEs?

Answer 20

inhibits C.acnes

quicker results than using topcials

MC S/E upset stomach and photosensitivity

Question 21

What are the 2 first line abx classes for oral abx?

Answer 21

Tetracyclines and macrolides

tetra: doxycycline, minocycline

macrolides: Erythromycin, azithromycin (Zithromax)

Question 22

What are the CI for tetracyclines? What is the notable SE?

Answer 22

CI pregnancy and young children

photosensitivity

Question 23

______ is prescribed for pregnant women who need oral abx

Answer 23

macrolides: Erythromycin, azithromycin (Zithromax)

Question 24

What are second line oral abx options for acne? Which one is CI in pregnancy?

Answer 24

bactrim and keflex

bactrim: avoid in preg

keflex: relatively safe in preg

Question 25

What are the major SE of bactrim? When is it used?

Answer 25

SJS and TEN Severe acne unresponsive to other oral abx

Question 26

______ is an oral retinoids that is indicated for severe resistant nodular/cystic acne. How does it work?

Answer 26

Isotretinoin Inhibition of sebaceous glands Decrease in C. acnes exact MOA is not well known

Question 27

How is isotretinoin dosed? What is the therapeutic goal?

Answer 27

0.5-1 mg/kg/day divided BID x 15-20 weeks (4-6 Months) Therapeutic goal of 120-150 mg/kg (Cummulative dose) Patients typically need 2 months break before restarting

Question 28

_____ is the MC SE of isotretinoin. Name 3 additional one. What do you need to monitor?

Answer 28

dryness of skin and mucous membranes HA Thoughts of suicide and depression myalgia need to monitor LFTs: may increase them and Hypertriglyceridemia

Question 29

**What are the 2 SUPER important things to remember about isotretinoin?

Answer 29

**NEVER prescribe with oral tetracycline (side effect profile goes way up) Pseudotumor cerebri **CI -PREGNANCY DUE TO BIRTH DEFECTS

Question 30

_____ is the oral retinoid maintenance program. What are the requirements for enrollment for a female?

Answer 30

iPledge 2 forms of birth control need to have 2 negative pregnancy tests before you can start no blood donation during treatment

Question 31

What are the lab monitoring requirements for iPledge?

Answer 31

Baseline CMP / Lipid Monthly and pregnancy test

Question 32

If baseline lipids become ____ consider stopping or starting lipid lowering drugs

Answer 32

>700-800mg/dl

Question 33

What is the tx for noninflammatory comedonal acne?

Answer 33

topical retinoids

Question 34

What is the tx for MILD papulopustular acne? MODERATE?

Answer 34

mild: BPO + topical ABX + topical Retinoid moderate: topical retinoid + oral ABX + BPO +/- hormonal therapy

Question 35

What is the tx for severe nodular acne?

Answer 35

Topical retinoid + oral ABX + BPO OR Oral Isotretinoin (monotherapy)

Question 36

**What are the 6 pt education points for acne?

Answer 36

Question 37

How does rosacea present? What age range?

Answer 37

It presents with relapsing-remitting course of facial flushing and localized erythema, telangiectasia, papules, and pustules on the nose, cheeks, brow, and chin. common between 30 and 50

Question 38

etiology of rosacea is poorly understood but _____ may play a pathogenic role in some patients

Answer 38

demodex mites

Question 39

What skin types does rosacea tend to effect more? What age does it present in when comparing males and females?

Answer 39

Rosacea primarily affects individuals with lighter skin phototypes females tend to present at a younger age than males

Question 40

Why does rosacea effect darker skin types less?

Answer 40

darker skin types are less prone to photodamage, and flushing and telangiectasias are harder to visualize

Question 41

What are the 4 main rosacea subtypes?

Answer 41

Erythematotelangiectatic Papulopustular Phymatous Ocular rosacea

Question 42

What am I? Describe it

Answer 42

Papulopustular rosacea Acneiform papules and pustules predominate. Erythema and edema of the central face with relative sparing of the periocular areas

Question 43

What am I? Describe it. What will the pt complain of?

Answer 43

Erythematotelangiectatic rosacea persistent erythema of the central portion of the face with intermittent flushing and telangiectasias Patients often complain of stinging or burning sensations on the skin

Question 44

What am I? Describe it? MC in men or women?

Answer 44

Phymatous rosacea Chronic inflammation and edema marked thickening of the skin with sebaceous hyperplasia, resulting in an enlarged, cobblestoned appearance of affected skin MC in men

Question 45

What am I? What does it often present with? What will the pt complain of? Does there always need to be a cutaneous finding?

Answer 45

ocular rosacea conjunctivitis, blepharitis, and hyperemia dry, irritated, itchy eyes aka sometimes it feels like a foreign body sensation in the eyes NO! can just be isolated to the eyes

Question 46

**How can you tell rosacea and acne apart?

Answer 46

rosacea lacks open comadones and acne will have comadones!!

Question 47

What is the MC form of rosacea?

Answer 47

Erythematotelangiectatic rosacea

Question 48

What are some common rosacea triggers that you should warn pts about?

Answer 48

Weather Food and drink Exercise Emotions Topical products Hormonal imbalances Medications (Niacin)

Question 49

What is the conservative therapy options for rosacea?

Answer 49

avoidance of known triggers extremes of temperature appropriate use of broad-spectrum sunscreens and avoiding sun exposure camouflage makeup with green/yellow tint are also helpful

Question 50

What are the topical first line tx options for rosacea? ______ is used if concerned about demadex overcolonization

Answer 50

Metronidazole preparations ivermectin cream

Question 51

Give 3 additional topical therapy options for rosacea

Answer 51

Sodium sulfacetamide with 5% sulfur 15% azelaic acid gel Brimonidine gel and oxymetazoline topical

Question 52

_________ is preferred for rosacea and is applied twice daily for patients with oily skin types ______ is cream or lotion twice daily for patients with normal to dry skin types.

Answer 52

Metronidazole 0.75% GEL: oily skin metronidazole 0.75% cream or lotion: normal to DRY

Question 53

_______ has been shown to be equally as effective as topical metronidazole for rosacea and is safe to use while pregnant

Answer 53

Azelaic acid 15% gel

Question 54

______ are a mainstay of therapy in rosacea.

Answer 54

Tetracycline antibiotics: doxy 40mg qd metronidazole 200 mg twice daily Azithromycin 250-500 mg daily 3 times weekly aka low dose doxy rosacea pts can live on

Question 55

______ is also effective in treating severe papulopustular rosacea

Answer 55

Isotretinoin

Question 56

What are some additional tx options for Telangiectasias / erythematotelangiectatic rosacea specifically?

Answer 56

Camouflage cosmetics, brimonidine 0.33% topical gel, vascular lasers, intense pulsed light therapy

Question 57

What are some additional tx options for flushing rosacea specifically?

Answer 57

lonidine 0.05 mg twice daily, intense pulsed light, pulsed dye laser, beta blockers (nadolol 40 mg daily)

Question 58

What are some additional tx options for rhinophyma rosacea specifically?

Answer 58

Surgical paring / sculpting, electrosurgery, and laser

Question 59

What are some additional tx options for Rosacea fulminans specifically?

Answer 59

Prednisolone 1 mg/kg daily is usually required while isotretinoin is being initiated and then tapered over several weeks. Isotretinoin therapy is continued for several months.

Question 60

What am I? What sex? What 3 factors influence it? What is the tx?

Answer 60

perioral dermatitis predominantly in females factors: topical fluorinated glucocorticoids (including inhalers) fluorinated toothpaste OCP tx: D/C steroid use. Topical and oral antibiotics

Question 61

What are the 4 different stages of acne?

Answer 61

microcomedone comedone inflammatory papule/ pustule nodule

Question 62

What stage of acne? -hyperkeratotic infundibulum -cohesive corneocytes -sebum secretion

Answer 62

microcomedone

Question 63

What stage of acne? -accumulation of shed corneocytes and sebum -dilation of fillicular ostium

Answer 63

comedone

Question 64

What stage of acne? -further expansion of follicular unit -proliferation of P. acnes -perifollicular inflammation

Answer 64

inflammatory papule/pustule

Question 65

What stage of acne? -rupture of follicular wall -marked perifollicular inflammation -scarring

Answer 65

nodule

Question 66

When is acne the most common for men and women?

Answer 66

Acne is more common in men during the teenage years more common in women in adulthood

Question 67

What is the OTC retinoid tx option?

Answer 67

Adapalene (Differin gel)

Question 68

Retinoid creams should be used every ______ night starting out

Answer 68

3rd night

Question 69

Rosacea develops between the ages of _____ and _____. What is the MC side effects of topical retinoids?

Answer 69

30 and 50 dryness

Question 70

What is the recommended frequency of serum pregnancy testing for females pts during treatment?

Answer 70

two tests prior to starting and one test monthly

Question 71

consider looking at the answers from the acne case studies to really make sure you know the pt education they are looking for for every severity of acne

Answer 71

if they release the answer key?? not sure yet