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