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Derm Acne & Warts
Dermatology Acne and Warts
| Question | Answer |
|---|---|
| Two types of acne that are into adulthood | hormonal acne in women, acne conglobata |
| Dilated clogged pores | acne vulgaris |
| Blackheads | open comedeons (oxydation happens which turns black) |
| whiteheads | closed comedons |
| puss bumps | pustules |
| Deep painful knots | Cysts |
| _____ stimulate sebaceous glands increasing sebum production | androgens |
| Cysts, fissures, abscess formation, deep scarring are characteristic of | acne conglobata. Men>women, oily skin has high association |
| Acne treatment behavior | no picking!!!, no mechanical "exfoliation" (st. ives apricot scrub). Do mild gentle cleansing twice daily. Role of diet (milk hormones?), oil free non-comedogenic products |
| Chemical exfoliants | Retinoids (increases cell turnover, prevents new comedone formation). Azelaic acid (antikeratinizing, antibacterial and antiinflammatory). |
| Which is more efficacious, gels or creams? | gels, but are more drying. |
| Retinoid facts | 4-6 weeks for effects, worse before better, contraindicated in pregnant patients |
| Benzoyl peroxide (BPO) | workhorse of acne. Has very little resistance. Remember that it has the power to bleach (use night time regimen). It is an antibacterial |
| Which topical antibiotic has high P. acnes resistance? | erythromycin |
| ____ is a topical tx for inflammatory acne with no resistance | Dapsone (aczone) |
| Tetracycline contraindications | pregnancy and peds (teeth) |
| Vertigo, bluish gray discoloration, lupus-like syndrome, serum sickness and pseudotumor cerebri are AEs of | minocycline |
| how long should you tx with minocycline, doxycycline, tetracycline | 2-4 weeks |
| Pregnant women and peds may be treated with | Erythromycin |
| Indicated for severe, nodular, cystic, inflammatory, recalcitrant acne. Tightly regulated prescribing by the FDA | Isotretinoin (accutane) |
| For your patients with adult acne, hirsutism, PCOS, premenstrual flare | Oral estrogens (in younger patients) |
| _____ is an androgen receptor blocker for females | Spironolactone. CATEGORY X. HYPERKALEMIA is a possible AE and requires baseline evaluation |
| Other therapy for acne | intralesional steroids, comedo extraction "acne surgery", photodynamic therapy, laser therapy |
| Acne complications | scarring, keloids, psychological impact, pyogenic granulomas |
| acne found in the axillae, inguinal folds, perianal, rarely scalp. Plugging of the sweat duct | Hidradenitis Suppurativa (chronic relapsing condition) |
| Hallark of this is double comedone (two blackheads side by side) | Hidradenitis |
| Tx for Hidradenitis Suppurativa | Oral abx: cyclines BID for antibacterial and anti-inflammatory benefits, intralesional triamcinalone, oral prednisone over 14 days, surgical management (I &D) |
| other causes of acne | steroid acne, drugs, cutting oils, infectious folliculitis (S. aureua, P.ovale, P. aeruginosa - hot tub folliculitis) |
| Rosacea epidemiology | F>M, 30-50 years old, celtics esp. |
| Rosacea presentation | resembles acne: erythema, papules, pustules, but NO COMEDONES. Redness, flushing, papules, telangectasia |
| Rhinophyma is a common complication of | Rosacea, late manifestation |
| Tx for Rosacea | Topicals: metronidazole, Sulfa agents, azelaic acid. Oral meds: ORACEA (low dose doxycycline) |
| Notes on Oracea | no resistance! 40mg timed release doxycycline |
| Triggers of Rosacea | hot or spicy food/drink, sun, ETOH, exercise |
| Pattern tends to be symmetrical around the border of mouth, extending to the nasolabial foldsCharacteristic erythematous base with grouped 1-2 mm erythematous papules. Pustules may be present. Comedones notably absent | Perioral Dermatitis. Tiny grouped bumps around the openings of the face. NO COMEDONS |
| What to avoid in perioral dermatitis | Avoid cinnamon products, tartar control toothpastes, whitening agents, heavy facial moisturizers, ask about topical steroids – all thought to be triggers |
| Tx for perioral dermatitis | dump triggers and start with topicals. erythro, clinda, looking for antiinflammatory. |
| Cause of warts | Viral infection: HPV |
| Warts occur more often, in greater number and last longer in | immunosuppressed patients |
| Veruccae obscure | normal skin lines (whereas callous does not). Also, warts have black spots, and callouses do not |
| black inside a wart | birds-eye view of dying off blood vessels; this is a good sign |
| The common wart is called | Verruca Vulgaris. typical pt age 5-20, prefers hands, verrucous surface, thrombosed capillaries, loss of dermatoglyphics (skin lines) |
| are warts contagious? | yes, even to one's own self. |
| "skin tags" in kids are suggestive of | verruca vulgaris with filiform projection |
| Flat warts (slightly raised) | Verruca Plana; 5-20 years old common |
| Warts on pressure points of feet | verruca plantaris. More growing into the skin. Coalesced warts: Mosaic wart |
| Which HPV types have a malignant potential | HPV 6, 11, 16 & 18 |
| Genital wart | condyloma acuminata. Frequently recur following treatment |
| Cauliflower is always _______ until proven otherwise | condyloma. In kids, think sexual abuse. |
| Wart tx | Time, cryotherapy (liquid nitro), chemicals |
| Cryotherapy wart tx | treat lesion until white halo forms and lingers for about 10 seconds. a few bursts, not a constant spray. |
| Chemical destruction of warts | cantharadrin, podophyllin, retinoids, salicylic acid, 5-FU |
| Risk of Liquid Nitrogen | Permanent white polkadot (hypopigmentation) |
| High risk condyloma acuminata lesions are often | hyperpigmented. (16 &18 are high risk) |
| Warts Tx with Immunomodulators: | Imiquimod (Aldara), Cimetidine, Squaric Acid |
Created by:
ltm12