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DU PA Acne & Warts
Duke PA Acne & Wars
| Question | Answer |
|---|---|
| what is 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 |
| puss bumps | inflammatory pustules |
| 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 |
| difference in appearance of rosacea and acne | absent comedones |
| distribution of rosacea | forhead, cheeks, chin, nose, may involve eyes |
| rosacea is characterized by | redness, flushing, papules, telangiectasia, rhinophyma (men) |
| topical treatments of rosacea | metronidazole, sulfacetamide/sulfur, 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 |
| pathogenesis of warts | human papilloma virus |
| how do you know it is a wart (varuccae) | warts obscure normal skin lines, frequently occur in sites of skin trauma, warts unlike callouses, demonstrate necrotic capillaries (patients think these are the seeds) |
| the common wart | verruca vulgaris |
| prevalence is 5% in children, typical patient aged 5-20 years, prefers hands, verrucous surface, thrombosed capillaries, loss of dermatoglyphics | verruca vulgaris |
| the flat wart | verruca plana |
| typical patient aged 5-20 years, prefers face/dorsal hands/wrists/knees, commonly spread by shaving, flat topped surface, pink to brown, usually multiple, frequently in linear formation | verruca plana |
| prefers pressure points on the feet, verrucous surface, thrombosed capillaries, often multiple, coalescent (mosaic warts) | verruca plantaris |
| the genital wart | condyloma acuminata |
| low risk agents for condyloma acuminata | HPV 6 or 11 |
| high risk agents for condyloma acuminata | HPV 16 or 18 |
| condyloma acuminata is the most common __ with 1 million new cases per year | STD |
| areas of distribution for condyloma acuminata | cervix, vulvovaginal skin, anus, penis, perianal skin |
| appearance of condyloma acuminata | lobulated surface, cauliflower like, usually gray or pink |
| appearacne of high risk condyloma acuminata | hyperpigmented |
| prevention of condyloma acuminata | Gardasil |
| what do most wart treatments actually do | kill infected tissue, but not the HPV |
| treat warts with cryotherapy until | white halo forms and lingers for 10 seconds |
| can repeart cryotherapy in __ weeks | 2-4 |
| how many freeze-thaw cycles can be done | 2 |
| physical destruction of warts | laser, cautery, duct tape occlusion, excision |
| chemical destruction of warts | cantharadrin (beetle juice), podophyllin, retinoids, salacylic acid, 5-FU |
| immunomodulation of warts | imiquimod (Aldara), cimetidine, squaric acid |
| warts may occur in greater number and last longer in __ | immunosuppressed persons |
| what to suspect when condyloma acuminate are seen in children | sexual child abuse |
| genital warts __ after treatment | frequently recur |
| cutaneous HPV infections will likely __ | spontaneously resolve |
| 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 |
Created by:
bwyche
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