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Definition of acne a common inflammatory disease of the hair follicles and sebum producing glands of the skin
acne affects __% of all teens 90
risk factors for acne teenagers, women and girls 2-7 days before periods, pregnant women, medications (cortisone), direct exposure to greasy or oily substances or certain cosmetics, family history of acne, friction or pressure on your skin
acne is most commonly in adolescents aged __ 15-18
pathogenesis of acne multifactorial-an interaction among hormones, keratin, subum, and bacteria determines course and severity
acne usually goes away by age __ although it may persist into late adulthood 25
gender most affected by acne no gender preference
__ stimulate sebaceous glands to increase production androgens
__ proliferates causeing more plugging of pores leading to comedones P. acnes
thinning of follicular wall as inflammation increases leads to inflammatory papules
rupture of follicular wall and reaction to foreign body results in pustules and cysts
main causes of acne clogged pores and bacteria
blackheads open comedones
whiteheads closed comedones
red bumps inflammatory papules
deep painful knots cysts
follicular plugging and dilation, affects face/neck/upper trunk/arms, with/out inflammation and pustule formation, may lead to cyst formation, may lead to scarring or keloid formation acne vulgaris
severe chronic cystic acne, highly inflammatory, cysts/fissures/abscess formation/deep scarring. Men>women (oily skin), begins at puberty and worsens with time, trunk>face acne conglobata
behavioral elements in the management of acne no picking, no mechanical exfoliation/harsh abrasives, mild/gentle cleansing 2x daily, oil free non comedogenic products
medication that increases cell turnover, prevents new comedone formation retinoids
example of retinoids tretinoin (Retin A, Atralin), adapalene (differin), tazarotene (Tazorac)
medication that is antikeratinizing, antibacterial, and antiinflammatory Azelaic acid (Finacea, Azelex)
retinoids for the skin is not a __ treatment spot
retinoids are contraindicated in pregnancy
AE's of retinoids dry skin/irritation, sun sensitivity
topical comedolytics glycolic acid preps, salicylic acid preps
the workhorse of acne meds benzoyl peroxide-topical antibacterial
not for patients with a hx of UC, pseudomembranous colitis, less P. acnes resistance than Erythromycin Clindamycin TA
emerging P. acnes resistance to Erythromycin
topical antibiotics used to treat acne Clindamycin, Erythromycin, sulfur containing preps, metronidazole, Benzoyl peroxide, dapsone (Aczone)
used for inflammatory acne dapsone (Aczone)
oral acne antibacterials minocycline, doxycycline, tetracycline, erythromycin, clindamycin, ampicillin, cephalosporins, TMP/SMX (2nd line)
indicated for sever nodular cystic, inflammatory, recalcitrant acne (referral). tightly regulated by FDA, extremely teratogenic isotretinoin (Accutane)
accutane is usually given over a __ month period 5
AE's of accutane dry skin, chelitis, headaches, myalgias, arthralgias, bone pain, osteopenia, mood changes/depression, elevated glucose/TG, hepatotoxicity, decreased night vision, hearing changes
androgen receptor blocker used for those who are poor OCP candidates. cat x spironolactone
used for patients with adult acne, hirsutism, PCOS, premenstrual flares. Suppresses sebaceous gland uptake of testosterone oral estrogen
other treatments for acne intralesional steroids, triamcinalone, comedo extraction, photodynamic therapy, laser therapy
aka acne inversa hidradenitis suppurativa
plugging of apocrin duct-->duct dilation-->inflammatory change/bac growth-->rupture of gland-->ulceration/fibrosis-->sinus tract formation hidradenitis suppurativa
hidradenitis suppurativa usually occurs in which areas axillae, inguinal folds, perianal, rarely scalp
hallmark of hidradenitis suppurativa double comedone
complications of acne scarring, keloids, psychological impact, pyogenic granulomas
hidradenitis suppurativa treatment oral antibiotics (tetracycline, minocycline), intralesional triamcinalone, oral prednisone, I & D, excision by surgery
other causes of "acne" steroid, drugs (lithium, tetracycline, phenytoin, OCPs, INH), cutting oils/other occlusives, infectious folliculitis
causes of infectious folliculitis S. aureus, P. ovale
causes of hot tub folliculitis P. aeruginosa
epidemiology of rosacea mostly female, 30-50 yo, peak 40-50, celtic
rosacea triggers hot or spicy food/drink, sun, EtOH, exercise; ? association with demodex mite
difference in appearance of rosacea and acne absent comedones
distribution of rosacea forehead, cheeks, chin, nose, may involve eyes
rosacea is characterized by redness, flushing, papules, telangiectasia, rhinophyma (men)
topical treatments of rosacea D/C triggers (EtOH, sun, spicy); topical metronidazole vs erythromycin vs Na sulfacetamide vs azelaic acid
oral meds for rosacea tetra/doxy/minocycline
treatment to consider for telangiectasia and rhinophyma associated with rosacea laser
patterm of perioral dermatitis symmetrical around the border of the mouth, extending to nasolabial folds
characteristic appearance of perioral dermatitis erythematous base with grouped 1-2mm erythematous papules, pustules may be present, comedones notably absent
things to avoid with perioral dermatitis cinnamon, tartar control, whitening agents, heavy facial moisturizers, topical steroids
treatment of perioral dermatitis topical metronidazole, erythro, clinda
keratin plugs that form within follicular ostia comedones
occlusion and pressure on the skin causing acne acne mechanica
rarely __ is seen in XYY genotype (tall males, slightly mentally retarded, with aggresive behavior), or in females with polycystic ovary syndrome acne conglobata
in the overwhelming majority of acne patients __ levels are normal hormone
goal of acne therapy remove plugging of pilar drainage, reduce sebum production, treat bacteria colonization
treatment for mild acne topical antibiotics, benzoyl peroxide, topical retinoids
treatment for moderate acne topical antibiotics, benzoyle peroxide, topical retinoids, oral antibiotics
treatment for severe acne topical antibiotics, benzoyle peroxide, topical retinoids, oral antibiotics, then as a last resort isotretinoin
what is considered severe acne cystic, conglobate, or acne refractory to treatment
patients with rosacea are often perceived as being __ alcoholics
pathognomonic for early rosacea facial flushing
enlarged nose associated with rosacea rhinophyma
eye involvment associated with rosacea red eyes, chronic blepharitis, conjunctivitis, episcleritis, corneal ulcers may develop (rare)
antibiotic use in rosacea oral is more effective than topical
Acneiform: can be mistaken for acne Rosacea; Perioral Dermatitis
Created by: Adam Barnard Adam Barnard