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Clin Med III: Dermatology > Disorders of Sebaceous & Apocrine Glands > Flashcards

Disorders of Sebaceous & Apocrine Glands Flashcards

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1
Q

an extremely common, usually self-limited chronic inflammatory condition of the pilosebaceous unit

A

acne vulgaris

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2
Q

pathogenesis of acne vulgaris involves multiple factors, including: (4)

A
  1. increased sebum
  2. follicular hyperkeratinization
  3. proliferation of Cutibacterium acnes
  4. inflammation
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3
Q

Acne Vulgaris typically begins at puberty as a result of ?

A

androgen stimulation of pilosebaceous unit and changes in keratinization at the follicular orifice

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4
Q

4 components of acne

A
  1. Follicular plugging = blocks sebum drainage
  2. Stimulation of sebaceous glands
  3. Overgrowth of C. acnes
  4. Inflammatory response
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5
Q

Acne vulgaris is MC found on areas of skin with greatest density of sebaceous follicles, such as ?

A

the face, back, and upper chest.

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6
Q

T/F: Men are more likely to have acne in adulthood, as it is thought to be hormonally driven

A

F: women not men

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7
Q

While a benign condition, acne can lead to ____ and _____. Therefore, initiation of tx in the earliest stages is preferable.

A

permanent scarringsignificant psychosocial distress

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8
Q

what medication is MC known to cause acne?

A

systemic or are using topical corticosteroids, or individuals using anabolic steroids

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9
Q

characteristic lesions of acne (4)

A
  1. open comedones (blackheads)
  2. closed comedones (whiteheads, noninflammatory base)
  3. erythematous inflammatory papules
  4. pustules
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10
Q

Nodules and cysts can result in scarring, including ____ or ____

A

pitted
hypertrophic scars

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11
Q

besides the MC areas for acne to appear, adult women in particular can have acne where else?

A

deeper-seated, tender red papules are common along the mandibular jaw

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12
Q

type of acne that is comprised of monomorphic inflammatory papules and pustules rather than open and closed comedones (blackheads and whiteheads).

A

Drug-induced acneiform eruptions

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13
Q

diagnostic pearls that causes acne in women

certain habits

A

touching, rubbing, over-cleansing the face with numerous products, and wearing cosmetics may exacerbate acne.

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14
Q

besides the MC areas for acne, in men acne tends to be more severe where?

A

trunk

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15
Q

diagnostic pearls that causes acne in men

certian habits/activites

A

Consider external agents such as grease from working in fast-food restaurants, occlusion from sports equipment or hats, and drugs.

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16
Q

An ____ of acne severity is necessary for choosing the appropriate therapy.

A

assessment

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17
Q

itchy acne/putsules esp on upper back, shoulders, and scalp of adolescents and young adults, consider doing ____ testing to assess for _____, which could be treated with an antifungal shampoo such as ketoconazole.

A
  • scraping a pustule for potassium hydroxide (KOH)
  • Pityrosporum folliculitis
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18
Q

management pearls for acne

A
  • Acne often resolves after the teenage years.
  • Severe cases of nodulocystic acne will require more aggressive treatment.
  • Acne typically requires consistent, regular care over months to see improvements.
  • Make sure pt has correct expectation and applies topical medication to entire area of potential acne involvement, not just to individual lesions as spot tx.
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19
Q

mild acne therapy

A
  • Topical retinoids
  • Benzoyl peroxide (BPO)
  • Topical antibiotics
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20
Q

medications that can be used for mild acne therapy

A
  • Benzoyl peroxide (BPO)
  • Topical retinoids
  • Topical abx
  • Oral abx
  • Oral retinoid (isotretinoin)
  • Azelaic acid
  • Salicylic acid
  • Hormonal therapy
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21
Q

how to apply retinoid to avoid excessive irritation and dryness?

A

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

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22
Q

MOA of retinoid?
MC SE?
CI?

A
  • decreases cohesion and increases turnover of epidermal cells
  • dryness (MC); photosensivity
  • CI: Pregnancy
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23
Q

types of retinoids (6)

A
  • Tretinoin (0.025%-0.1% q 24 h at PM)
  • Tazarotene (0.05%-0.1% cream or gel applied q24hrs)
  • Adapalene (0.1%-0.3% every 24 hours at bedtime; the 0.1% gel now OTC)
  • Trifarotene (Aklief) Newest retinoid
  • Tretinoin combo (tretinoin + clinda phosphate)
  • Adapalene combo (adapalene + BPO)
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24
Q

which acne medication has the advantage of having no bacterial resistance?
Multiple fixed-combinations with retinoids and topical abx

A

BPO

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25
SE of BPO
* Skin irritation (erythema, xerosis, scaling, * stinging, tightening, burning sensation) * Bleaching of hair/clothing
26
1st line for Mild-moderate inflammatory acne (papulopustular)
Clindamycin and Erythromycin however NOT indicated for monotherapy
27
what is added to clinda/erythromycin for mild-moderate inflammatory acne?
**BPO** to reduce bacterial resistance Patients often experience skin irritation
28
For moderate acne -with inflammatory papules or deeper-seated lesions, consider adding what tx? options?
oral medication * Doxycycline or minocycline * Add 100 mg q12h to topical regimen (retinoid + BPO) * oral abx x 3 mo, after which the dose can be tapered to 100 mg once daily for a month or two before stopping.
29
MOA of general oral ABX? SE?
* inhibits C. acnes; Quicker results than the use of topicals * MC S/E upset stomach and photosensitivity
30
SE and CI of tetracyclines
* CI: pregnancy and young children * SE: photosensitivity
31
macrolides have what preg category?
**B** Increased resistance
32
first line orab abx for acne vulgaris
tetracyclines macrolides
33
second line oral abx?
* Bactrim * cephalexin
34
what oral abx has a risk for SJS, TEN?
bactrim
35
which second line oral abx for acne is less effective but have a preg cat B (relatively safe)?
cephalexin (avoid bactrim in preg)
36
what medication is resevered for severe resistant nodular/cystic acne?
oral retinoids - isotretinoin
37
dosing for isotretinoin
1. 0.5-1 mg/kg/day divided BID x 15-20 weeks (4-6 Months) 2. Therapeutic goal of 120-150 mg/kg - typically need 2 months break before restarting
38
MC SE of oral retinoids? Other SE?
**Dryness** of skin and mucous membranes (eyes sometimes) * HA * Thoughts of suicide and depression * Possible increased LFTs and Hypertriglyceridemia * myalgia
39
NEVER prescribe oral retinoids with ____ (side effect profile goes way up - **Pseudotumor cerebri**)
oral tetracycline
40
an **absolute** CI in oral retinoids
pregnancy!!
41
what is iPLEDGE? Difference between male vs female in iPLEDGE?
a program by the U.S. FDA intended to **manage the risk of birth defects** caused by **isotretinoin** 1. Instruction brochure; Enroll patient 1. Males are easy!!! 1. Female - 2 forms of birth control - Negative preg test before start x 2 - No blood donation during tx
42
labs needed during iPLEDGE
1. Baseline CMP / Lipid Monthly and preg test - Lipids >700-800mg/dl consider stopping or starting lipid lowering drug
43
regimen for noninflammatory comedonal acne?
Topical retinoids
44
regimen for mild papulopustular acne?
Topical Antimicrobial (BPO + ABX) AND Retinoid
45
regimen for Moderate papulopustular
Topical retinoid + oral ABX + BPO Hormonal Therapy
46
regimen for Severe nodular
* Topical retinoid + oral ABX + BPO * Oral Isotretinoin (monotherapy) * Hormonal therapy
46
pt ed about acne
1. PROVIDE REALISTIC EXPECTATIONS - 6-8 weeks before improvement - Can get worse before it gets better 1. Washing BID 1. Detergent/softener/dryer sheets 1. Diet (link with dairy) 1. Avoid hand contact 1. Avoid products full of perfumes/fragrances
47
facial flushing and localized erythema, telangiectasia, papules, and pustules on the nose, cheeks, brow, and chin. It commonly develops in individuals between the ages of 30 and 50
Rosacea
48
possible cause of Rosacea
Demodex mites may play a pathogenic role in some patients.
49
rosacea primarily affects who?
lighter skin phototypes, and females tend to present at a younger age than males.
50
rosacea is reported less commonly in skin types **IV-VI** why?
darker skin types are less prone to photodamage, and flushing and telangiectasias are harder to visualize
51
4 main subtypes of rosacea
1. Erythematotelangiectatic 1. Papulopustular 1. Phymatous 1. Ocular rosacea.
52
* Presents with persistent erythema of the central portion of the face with intermittent flushing. * Telangiectasias * Patients often complain of stinging or burning sensations on the skin. **MC subtype.** dx?
Erythematotelangiectatic rosacea
53
Acneiform papules and pustules predominate * Erythema and edema of the central face with relative sparing of the periocular areas. * (lacks open comedones, Differentiate between acne) dx?
Papulopustular rosacea
54
* Chronic inflammation and edema marked **thickening of the skin with sebaceous hyperplasia**, resulting in an enlarged, **cobblestoned appearance** of affected skin. **MC on the nose (rhinophyma)**. * **MC Men** dx?
Phymatous rosacea
55
Presents with conjunctivitis, blepharitis, and hyperemia. * Patients complain of dry, irritated, itchy eyes. * Keratitis, scleritis, and iritis are potential but infrequent complications * Ocular rosacea can occur in patients with or without cutaneous findings. dx?
Ocular rosacea
56
rosacea features
* Flushing - Erythema; Telangiectasia (Cheeks/forehead) * Papules/pustules/nodules - Nose/cheeks/forehead * Hyperplasia and fibrosis of the sebaceous glands: -phyma
57
roscaea sx
* Burning * Stinging * Edema * Plaques * Flushing
58
rosacea triggers
* Weather * Food and drink * Exercise * Emotions * Topical products * Hormonal imbalances * Medications (Niacin)
59
conservative therapy for rosacea
* avoidance of known triggers, including spicy foods, alcohol, emotional stress, hot beverages (eg, hot soup, coffee, tea), extremes of temperature, etc. * Appropriate SPF and sun avoidance * Camouflage makeups with green- or yellow-tinted preparations are helpful in masking underlying redness.
60
topicals for rosacea
* Metronidazole preparations * Ivermectin cream * Sodium sulfacetamide with 5% sulfur * 15% azelaic acid gel * Brimonidine gel and oxymetazoline topical
61
systemic therapies for rosacea
1. **_Tetracyclines_: mainstay** - **Doxy OR minocycline** 2. Oral metronidazole 3. Azithromycin 4. Isotretinoin also effective in treating severe papulopustular rosacea
62
management for Telangiectasias / erythematotelangiectatic rosacea
1. Camouflage cosmetics 1. brimonidine 0.33% topical gel 1. vascular lasers 1. intense pulsed light therapy
63
rosacea: management for Flushing
1. Clonidine 1. intense pulsed light 1. pulsed dye laser 1. nadolol
64
rosacea: management for Rhinophyma
Surgical paring / sculpting, electrosurgery, and laser
65
management for Rosacea fulminans
1. Prednisolone while isotretinoin is being initiated and then tapered over several weeks. 1. Isotretinoin continued for several months.
66
* Discrete erythematous micropapules and microvesicles * Often confluent in perioral and periorbital skin * Occurs mainly in females predominantly dx?
Perioral Dermatitis
67
RF for Perioral Dermatitis
1. topical fluorinated glucocorticoids (including inhalers) 1. fluorinated toothpaste 1. OCP
68
tx perioral dermatitis
D/C steroid use. Topical and oral antibiotics
69
* hyperkeratotic infundibulum * cohesive corneocytes * sebum secretion which stage of acne?
microcomedone
70
* accumulation of shed corneocytes and sebum * dilation of fillicular ostium which stage of acne?
comedone
71
* further expansion of fillicular unit * proliferation of proprionibacterium acnes * perifollicular inflammation which stage of acne?
inflammatory papule/pustule
72
* rupture of follicular wall * marked perifollicular inflammation * scarring which stage of acne?
nodule

Clin Med III: Dermatology (13 decks)

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