Duke PA Acne & Wars
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| what is acne | a common inflammatory disease of the hair follicles and sebum producing glands of the skin
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| acne affects __% of all teens | 90
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| 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
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| acne is most commonly in adolescents aged __ | 15-18
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| pathogenesis of acne | multifactorial-an interaction among hormones, keratin, subum, and bacteria determines course and severity
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| acne usually goes away by age __ although it may persist into late adulthood | 25
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| gender most affected by acne | no gender preference
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| __ stimulate sebaceous glands to increase production | androgens
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| __ proliferates causeing more plugging of pores leading to comedones | P. acnes
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| thinning of follicular wall as inflammation increases leads to | inflammatory papules
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| rupture of follicular wall and reaction to foreign body results in | pustules and cysts
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| main causes of acne | clogged pores and bacteria
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| blackheads | open comedones
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| whiteheads | closed comedones
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| red bumps | inflammatory papules
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| puss bumps | inflammatory pustules
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| deep painful knots | cysts
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| 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
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| 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
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| behavioral elements in the management of acne | no picking, no mechanical exfoliation/harsh abrasives, mild/gentle cleansing 2x daily, oil free non comedogenic products
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| medication that increases cell turnover, prevents new comedone formation | retinoids
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| example of retinoids | tretinoin (Retin A, Atralin), adapalene (differin), tazarotene (Tazorac)
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| medication that is antikeratinizing, antibacterial, and antiinflammatory | Azelaic acid (Finacea, Azelex)
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| retinoids for the skin is not a __ treatment | spot
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| retinoids are contraindicated in | pregnancy
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| AE's of retinoids | dry skin/irritation, sun sensitivity
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| topical comedolytics | glycolic acid preps, salicylic acid preps
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| the workhorse of acne meds | benzoyl peroxide-topical antibacterial
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| not for patients with a hx of UC, pseudomembranous colitis, less P. acnes resistance than Erythromycin | Clindamycin TA
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| emerging P. acnes resistance to | Erythromycin
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| topical antibiotics used to treat acne | Clindamycin, Erythromycin, sulfur containing preps, metronidazole, Benzoyl peroxide, dapsone (Aczone)
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| used for inflammatory acne | dapsone (Aczone)
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| oral acne antibacterials | minocycline, doxycycline, tetracycline, erythromycin, clindamycin, ampicillin, cephalosporins, TMP/SMX (2nd line)
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| indicated for sever nodular cystic, inflammatory, recalcitrant acne (referral). tightly regulated by FDA, extremely teratogenic | isotretinoin (Accutane)
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| accutane is usually given over a __ month period | 5
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| 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
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| androgen receptor blocker used for those who are poor OCP candidates. cat x | spironolactone
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| used for patients with adult acne, hirsutism, PCOS, premenstrual flares. Suppresses sebaceous gland uptake of testosterone | oral estrogen
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| other treatments for acne | intralesional steroids, triamcinalone, comedo extraction, photodynamic therapy, laser therapy
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| aka acne inversa | hidradenitis suppurativa
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| plugging of apocrin duct-->duct dilation-->inflammatory change/bac growth-->rupture of gland-->ulceration/fibrosis-->sinus tract formation | hidradenitis suppurativa
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| hidradenitis suppurativa usually occurs in which areas | axillae, inguinal folds, perianal, rarely scalp
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| hallmark of hidradenitis suppurativa | double comedone
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| complications of acne | scarring, keloids, psychological impact, pyogenic granulomas
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| hidradenitis suppurativa treatment | oral antibiotics (tetracycline, minocycline), intralesional triamcinalone, oral prednisone, I & D, excision by surgery
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| other causes of "acne" | steroid, drugs (lithium, tetracycline, phenytoin, OCPs, INH), cutting oils/other occlusives, infectious folliculitis
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| causes of infectious folliculitis | S. aureus, P. ovale
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| causes of hot tub folliculitis | P. aeruginosa
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| epidemiology of rosacea | mostly female, 30-50 yo, peak 40-50, celtic
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| rosacea triggers | hot or spicy food/drink, sun, EtOH, exercise
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| difference in appearance of rosacea and acne | absent comedones
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| distribution of rosacea | forhead, cheeks, chin, nose, may involve eyes
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| rosacea is characterized by | redness, flushing, papules, telangiectasia, rhinophyma (men)
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| topical treatments of rosacea | metronidazole, sulfacetamide/sulfur, azelaic acid
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| oral meds for rosacea | tetra/doxy/minocycline
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| treatment to consider for telangiectasia and rhinophyma associated with rosacea | laser
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| patterm of perioral dermatitis | symmetrical around the border of the mouth, extending to nasolabial folds
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| characteristic appearance of perioral dermatitis | erythematous base with grouped 1-2mm erythematous papules, pustules may be present, comedones notably absent
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| things to avoid with perioral dermatitis | cinnamon, tartar control, whitening agents, heavy facial moisturizers, topical steroids
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| treatment of perioral dermatitis | topical metronidazole, erythro, clinda
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| pathogenesis of warts | human papilloma virus
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| 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)
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| the common wart | verruca vulgaris
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| prevalence is 5% in children, typical patient aged 5-20 years, prefers hands, verrucous surface, thrombosed capillaries, loss of dermatoglyphics | verruca vulgaris
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| the flat wart | verruca plana
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| 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
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| prefers pressure points on the feet, verrucous surface, thrombosed capillaries, often multiple, coalescent (mosaic warts) | verruca plantaris
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| the genital wart | condyloma acuminata
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| low risk agents for condyloma acuminata | HPV 6 or 11
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| high risk agents for condyloma acuminata | HPV 16 or 18
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| condyloma acuminata is the most common __ with 1 million new cases per year | STD
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| areas of distribution for condyloma acuminata | cervix, vulvovaginal skin, anus, penis, perianal skin
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| appearance of condyloma acuminata | lobulated surface, cauliflower like, usually gray or pink
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| appearacne of high risk condyloma acuminata | hyperpigmented
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| prevention of condyloma acuminata | Gardasil
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| what do most wart treatments actually do | kill infected tissue, but not the HPV
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| treat warts with cryotherapy until | white halo forms and lingers for 10 seconds
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| can repeart cryotherapy in __ weeks | 2-4
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| how many freeze-thaw cycles can be done | 2
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| physical destruction of warts | laser, cautery, duct tape occlusion, excision
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| chemical destruction of warts | cantharadrin (beetle juice), podophyllin, retinoids, salacylic acid, 5-FU
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| immunomodulation of warts | imiquimod (Aldara), cimetidine, squaric acid
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| warts may occur in greater number and last longer in __ | immunosuppressed persons
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| what to suspect when condyloma acuminate are seen in children | sexual child abuse
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| genital warts __ after treatment | frequently recur
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| cutaneous HPV infections will likely __ | spontaneously resolve
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| keratin plugs that form within follicular ostia | comedones
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| occlusion and pressure on the skin causing acne | acne mechanica
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| rarely __ is seen in XYY genotype (tall males, slightly mentally retarded, with aggresive behavior), or in females with polycystic ovary syndrome | acne conglobata
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| in the overwhelming majority of acne patients __ levels are normal | hormone
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| goal of acne therapy | remove plugging of pilar drainage, reduce sebum production, treat bacteria colonization
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| treatment for mild acne | topical antibiotics, benzoyl peroxide, topical retinoids
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| treatment for moderate acne | topical antibiotics, benzoyle peroxide, topical retinoids, oral antibiotics
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| treatment for severe acne | topical antibiotics, benzoyle peroxide, topical retinoids, oral antibiotics, then as a last resort isotretinoin
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| what is considered severe acne | cystic, conglobate, or acne refractory to treatment
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| patients with rosacea are often perceived as being __ | alcoholics
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| pathognomonic for early rosacea | facial flushing
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| enlarged nose associated with rosacea | rhinophyma
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| eye involvment associated with rosacea | red eyes, chronic blepharitis, conjunctivitis, episcleritis, corneal ulcers may develop (rare)
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| antibiotic use in rosacea | oral is more effective than topical
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