week 2- Acne

Question 1

which gland for acne vulgaris

Answer 1

pilosebaceous gland

Question 2

key features of acne vulgaris

Answer 2

follicular hyperkeratinization, microbial colonization with Cutibacterium acnes, sebum production, and complex inflammatory mechanisms involving both innate and acquired immunity

Question 3

which bacteria for acne

Answer 3

cutibacterium acnes

Question 4

how many people ages 12-24 affected by acne

Answer 4

85%

Question 5

prevalence and severity of acne

Answer 5

higher prevalence in females
higher severity in males

Question 6

association with acne

Answer 6

-education level
-parental history
-skin sebum levels
-geopgraphy, diet, ethnicity

Question 7

higher prevalence for race in acne

Answer 7

• African American and Latin American populations have a slightly higher prevalence of acne compared to Asian American and Caucasian populations
• However, geographically, many populations outside of Canada and the United States see less prevalence of acne which has implicated a standard American diet as an influencing factor in acne pathogenesis

Question 8

papule
nodule
pustule

Answer 8

• Papule – a small, raised, solid, circumscribed lesion less than 1 cm in diameter
• Nodule – a palpable, raised, solid, circumscribed lesion greater than 1 cm in diameter
• Pustule – a small, circumscribed, inflamed, pus-filled lesion

Question 9

comedo
closed comedo
open comedo

Answer 9

• Comedo – dilated hair follicle filled with keratin, bacteria, and sebum. Plural = comedones.
• Closed comedo – opening is obstructed and accompanied by an inflammatory response. Commonly called a whitehead
• Open comedo – opening is not obstructed and capped with a pigmented mass of skin debris. Commonly called a blackhead

Question 10

blackhead and whitehead aka

Answer 10

blackhead- open comedo
whitehead- closed comedo

Question 11

diagnose acne based on

Answer 11

presence of comedones, papules, pustules and nodules on the face, chest, or upper back.

-hyperpigmentation (fair skin)

Question 12

when to do workup for hyperandrogenism if acne present

Answer 12

if signs of PCOS, virilization, atypical presentation

Question 13

4 point severity scale for acne

Answer 13

1 (mild): open and close comedones with few inflammatory papule and pustules

2 (moderate): papule and pustule mainly on face

3 (moderately severe): numerous papule and pustules, occasional inflamed nodules, also on chest and back

4 (severe): many large, painful nodules and pustules

AKA
1. comedonal
2. mild papulopustular
3. moderate papulopustular
4. severe papulopustular/nodular

Question 14

mild vs severe acne

Answer 14

mild- uninflamed comedones
severe- nodules

Question 15

classfiy acne

Answer 15

drug induced acne
occupational acne
chemical acne
mechanical acne

Question 16

drug induced acne from

Answer 16

topical and systemic corticosteroids

Antibiotics like penicillins and macrolides
–>Can also be caused by cotrimoxazole, doxycycline, ofloxacin, and chloramphenicol

anticonvulsants (phenytoin)
antipsychotics (olanzapine, lithium)
antifungals
chemotherapy drugs
antidepressants
antituberculosis drugs
naproxen
hydroxycloroquine

Question 17

steroid acne (from corticosteroids) presents as

Answer 17

monomorphous papulopustules located mainly on the trunk and extremities, with less involvement of the face, and typically occurs after systemic administration of corticosteroids

Question 18

antibiotics (penicillin and macrocodes) cause what type of acne and associated with what

Answer 18

acute generalized pustular eruptions without comedones.

associated with fever and leukocytosis

Question 19

occupational acne from

Answer 19

halogenated aromatic hydrocarbons AKA chloracnegens

((dioxin exposure))

Question 20

chemical acne AKA acne cosmetics from

Answer 20

heavy oil-based hair products and cosmetics and resolves with discontinuation of these products

Question 21

mechanical acne (Acne mechanica) from

Answer 21

pressure and friction that induce acneiform eruptions

areas of restrictive clothing, prolonged contact with synthetic clothing fibers, use of sports equipment, etc.

Question 22

neonatal acne in how many newborns

Answer 22

20%

Question 23

when does neonatal acne devleop

Answer 23

usually 2 weeks old (before 6 weeks)

Question 24

neonatal acne caused by

Answer 24

exposure to hormones in utero or via breastmilk

Question 25

milia is

Answer 25

small (1 – 2 mm) white or yellow papules under the surface of the skin caused by keratin retention

Question 26

milia and miliria in how many newborns

Answer 26

40-50% milia 40% miliaria

Question 27

milia in which areas

Answer 27

forehead, cheeks, nose, and chin, but they may also occur on the upper trunk, limbs, penis, or mucous membranes

Question 28

milia in adults usually from

Answer 28

cosmetic products (looks like comedones but its not acne; misdiagnose)

Question 29

miliaria is from

Answer 29

sweat retention caused by partial closure of eccrine structures

Question 30

2 types of miliaria

Answer 30

1. miliaria crystallina 2. miliaria rubra

Question 31

miliaria crystallina

Answer 31

Caused by superficial eccrine duct closure * Consists of 1 – 2 mm vesicles without surrounding erythema most commonly on the head, neck, and trunk

Question 32

miliaria rubra is AKA

Answer 32

heat rash

Question 33

miliaria rubra

Answer 33

* Caused by deeper level of sweat gland obstruction * Lesions are small erythematous papules and vesicles usually occurring on covered portions of the skin

Question 34

infantile acne occurs

Answer 34

after 6 weeks old common at 3-6 months can last 2 years

Question 35

childhood acne based on age

Answer 35

neonatal acne- 2 to 6 weeks infantile ance- > 6 weeks ( up to 2 years) mid-childhood acne- 1 to 7 yrs old preadolescent acne -7-12 years old

Question 36

cause of infantile acne

Answer 36

physiologic imbalances in androgen products * Immature adrenals can produce elevated DHEAS which typically normalizes by 6 months of age * LH levels surge between 6 and 12 months of age resulting in increased gonadal testosterone production in males sometimes cosmetic

Question 37

when to be worried about infantile acne

Answer 37

when Tanner stages are not consistent with age, increased height velocity, hirsutism, refer to pediatric endocrinologist

Question 38

mid-childhood acnes

Answer 38

1-7 yrs comedones and inflammatory lesions on forehead, cheeks nose rare since androgens should be low at this age --> pediatric endocrinologist referral

Question 39

preadolescent acne

Answer 39

1st sign of puberty 7-12 yrs old comedones in T-zone via rise of androgens in puberty

Question 40

DDX for acne if secondary

Answer 40

hyperandrogenism: PCOS, adrenal hyperplasia, insulin resistance, hyperprolactinemia, Cushing’s disease, and certain cancers.

Question 41

SAPHO syndrome (systemic disorder presenting with acne) what is the acronym

Answer 41

A rare inflammatory disorder of bone, joints, and skin characterized by the presence of synovitis, acne, pustulosis, hyperostosis, and osteitis

Question 42

PAPA, PASH, and PAPASH syndromes from

Answer 42

over activation of immune system; increase production of the IL-1 family and neutrophil-rich cutaneous inflammation * PAPA syndrome * A rare autosomal dominant disorder caused by mutations in the CD2-binding protein characterized by pyogenic sterile arthritis, pyoderma gangrenosum, and acne * PASH syndrome * A rare hereditary autoinflammatory disorder characterized by pyoderma gangrenosum, acne, and hidradenitis suppurativa * PAPSH syndrome * A rare autoinflammatory disorder characterized by pyogenic arthritis, acne, pyoderma gangrenosum, and hidradenitis suppurativa

Question 43

acne conglobata

Answer 43

* tender, disfiguring, double or triple interconnecting comedones, cysts, inflammatory nodules, and deep burrowing abscesses on the face, shoulders, back, chest, upper arms, buttocks, and thighs * Cysts often contain purulent, foul-smelling material that is discharged on the skin surface

Question 44

acne conglobata from

Answer 44

diseases that are dysfunctional in follicular unit

Question 45

acne conglobata can occur in

Answer 45

isolation or present with a systemic inflammatory condition, including SAPHO syndrome, PAPA syndrome, PASH syndrome, or PAPASH syndrome also related to use of thyroid hormone, exposure to halogenated aromatic hydrocarbons (occupational acne), and the use of, or sudden discontinuation of, anabolic steroids

Question 46

acne fulminans AKA acne maligna

Answer 46

*painful, ulcerating, and hemorrhagic clinical form of acne with a very sudden onset * May or may not be associated with systemic symptoms such as fever and polyarthritis * May cause bone lesions

Question 47

causes of acne fulminant

Answer 47

high doses of isotretinoin when initiating treatment in patients with severe acne * Also associated with anabolic steroid use

Question 48

acne conglobata vs fulminans occurance

Answer 48

less than 200 cases of acne fulminates ever conglobata uncommon but usually if use anabolic steroids in athelets

Question 49

acne conglobata vs fulminans differentiate presentation

Answer 49

* Acne fulminans typically involves cysts and acutely inflamed lesions * Acne conglobata involves polyporous comedones which are not present in acne fulminans

Question 50

acne excoriee

Answer 50

excoriation disorder in which patients have a conscious, repetitive, and uncontrollable desire to pick, scratch, or rub acne lesions skin picking --> lesions

Question 51

excoriation disorders linked to

Answer 51

obsessive compulsive

Question 52

diagnosis of acne excoriee

Answer 52

* Repeated attempts to decrease picking behavior * Skin picking causes clinically significant distress or impairment in social, occupational, or other areas of functioning * Skin picking is not attributable to the physiologic effect of a substance (e.g. cocaine) or another medical condition (e.g. scabies) * Skin picking is not better explained by symptoms of another mental disorder (e.g. delusions or tactile hallucinations in a psychotic disorder)

Question 53

solid facial edema is rare but associated with

Answer 53

longstanding acne vulgaris

Question 54

clinical presentation of solid facial edema

Answer 54

localized, symmetric, non-pitting, non-painful edema over the glabellar region, midface, nasal saddle, and infraorbital regions

Question 55

who mostly gets solid facial edema

Answer 55

males in their late teens or early twenties who present with a multi-year history of acne followed by a recent onset of persistent edema

Question 56

rosacea (NOT ACNE)

Answer 56

long-term inflammatory skin condition that causes reddened skin and a rash, usually on the nose and cheeks

Question 57

eye problem from rosacea

Answer 57

ocular rosacea

Question 58

where does rosacea affect

Answer 58

center of the face, but in rare cases, it can extend to other parts of the body, such as the sides of the face, the ears, neck, scalp, and chest

Question 59

symptoms of rosacia

Answer 59

facial redness (flushing or blushing) tingle and burn rash and bumps telangiectasia (dilated small blood vessels) skin thickening on nose eye irritation, swell, stye

Question 60

perioral dermatitis typically effects

Answer 60

common acneiform eruption that usually affects women 20–45 years of age but can affect all adults and children

Question 61

perioral dermatitis presentation

Answer 61

* Presents with discrete monomorphic papules and pustules on an erythematous base with or without scale distributed symmetrically around the mouth with a clear zone between the vermilion border and the affected skin * It can extend to the nasolabial folds and skin around the lateral canthi (periorbital dermatitis)

Question 62

what triggers perioral dermaitits

Answer 62

topical corticosteroids

Question 63

folliculitis

Answer 63

hair follicle disorder presents with follicular-based pustules and/or inflammatory papules on any hair-bearing area, but most commonly on the trunk, buttocks, thighs, axillae, face, and scalp

Question 64

causes of folliculitis (infectious or non infectious)

Answer 64

* Bacteria are the most common cause (Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa) * Fungal folliculitis caused by Malassezia is common and can become chronic if not treated * Mechanical folliculitis can be caused by hair removal practices, tight clothing, and ingrown hairs