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 |