72 terms

Acne Vulgaris

pimples and more!

Terms in this set (...)

disease of the pilosebaceous unit
Acne Vulgaris
characteristics of Acne Vulgaris
-Affects males and females who live in westernized societies and are near puberty
-Age of onset: 10-17 years old or after 25 years old
-Males usually suffer from the severe form of acne and females from the persistent form
-In most cases acne becomes less active as adolescence ends
There is genetic predisposition in many cases
etiology and pathogenesis of Acne Vulgaris
Etiology and Pathogenesis
Increased sebum production by androgens
Abnormal desquamation of follicular epithelium
Keratinous material becomes more dense and blocks secretion of sebum
Leads to the development of the comedo
Propionibacterium acnes proliferation and colonization
Inflammation ensues and causes rupture of the comedone into the dermis resulting in the formation of pustules or cysts
drugs that may contribute to Acne Vulgaris
Lithium, OCPs, anabolic steroids
contributing factors to Acne Vulgaris
Emotional stress
Pressure on the skin
Football helmets (forehead guards, chin straps) hats, picking at lesions
Oil-based cosmetics
Acne and diet
High- sugared foods : soda, candy, simple carbohydrates
Foods high in iodine
In some females, milk worsens acne
These are areas of the body you would expect to find Acne Vulgaris
Upper back
Upper arms
What are the 3 classifications of acne?
mild, moderate, and severe
what are the factors that go into acne classification?
Total number of lesions
Complications such as drainage, hemorrhage, scarring and pain
Occupational disability
Psychosocial impact
Response to previous treatment
these are non-inflammatory acne lesions
open and closed comedones
these are inflammatory acne lesions
Nodules (cysts)
2 characteristics of mild acne
comedones, no scarring
features of moderate acne
papules, pustules, and mild scarring
what you would see in severe acne...
pustules, nodules, and moderate scarring
in what type of acne would you see severe scarring?
How do you treat mild acne?
-Start with Benzoyl peroxide in am and topical retinoids at bedtime
-If not improved in 8 weeks, add topical antibiotic
How do you treat moderate acne?
Benzoyl peroxide+ topical antibiotic in AM
Topical tretinoin (retinoid) in PM
If not improved in 2-3 months, switch to oral abx therapy
Topical therapy should be continued for extended period following improvement
how do you treat severe acne?
Combination of topical retinoid and oral antibiotic
Continue therapy until no new lesions appear (2-4 months) followed by taper and eventually discontinuing oral abx
Intralesional kenalog is helpful in resolution of cysts and nodules
these are first line oral antibiotics...
2nd line treatments
why would 1st line antibiotics not work?
Gram-negative acne are resistant to tetracyline
examples of Topical antibacterial/anti-inflammatory
Benzoyl peroxide
Clindamycin phosphate
Azelaic acid
examples of topical retinoids
Tretinoin, tazorac, adapalene
What should you not use on pregnant women?
topical retinoids
topical retinoids are used at what point to treat acne?
first line treatment
another name for severe acne
cystic acne
clinical features of severe acne
Numerous papules and pustules
Deep communicating cysts and scarring
Significant involvement of back/arms/chest
Anxiety, insecurity, social isolation
When do you use systemic isotretinoin?
If you have had scarring, long hx of acne, failed other treatments
mechanism of action of isotretinoin
shut down sebum production
stats of success for isotretinoin
85% of patients are clear in 4 months
important questions regarding hygiene for acne patients
How often do they wash their face and with what? soap/hands/washcloth/buff puff
Do they pick at the lesions?
what types of foods can exacerbate acne?
refined sugars and milk
important aspects of history when treating acne in females
Response of acne to menses in females
Signs of virulization - PCOS, Cushing's disease, androgen-secreting tumors
4 important parts of patient education on acne
Minimize use of irritating products
Apply acne medication to entire affected zone
Avoid picking and squeezing lesions
Apply retinoid on a clean, dry face at bedtime
excoriations and blood crusted lesions...
indicate picking
perioral dermatitis is considered a form of what?
eczema, but resembles acne
clinical features of perioral dermatitis
Pink, pinpoint papules/pustules on an erythematous base with some scaling
Nasolabial folds, chin and upper lip
Clear zone around vermillion border
Pustules may be seen lateral to eyes
Most common in females 16-45 years of age
etiology of perioral dermatitis
Etiology: unknown
Prolonged use of topical steroids on face
Excessive use of cream moisturizers
Associated with Estrogen (OCP, soy products)
Aggravated by acne drying agents: BPO, retinoids
Response is seen in 2-4 weeks
Topical pimecrolimus cream is effective
treatment of perioral dermatitis
what skin condition did we discuss that uses pimecrolimus in its treatment
atopic dermatitis
What is Hidradenitis Suppurativa (HS)
Chronic inflammatory dermatosis primarily affecting intertriginous areas such as the axilla, groin, perineum, and inframammary region
What does the pathophysiology of HS involve?
Once thought to be a disease of apocrine glands, pathogenesis is found to be involving hair follicles with apocrine sweat gland involvement being secondary event
demographics of HS
greater number of female cases than male; 2nd to 3rd decade of life
clinical findings of HS
-Inflammatory nodules, multiple tender abscesses, fibrosis, sinus tracts, scarring
-Extensive, deep dermal inflammation
-The healing process permanently alters the dermis
Treatment of HS
Incise and drain large cysts
Isotretinoin has not shown to be as effective as it is for acne vulgaris
Weight loss and smoking cessation
Surgical excision of sinus tracts in those cases of severe, scarring disease
Age of onset of Rosacea
not common in children
makes Rosacea worse
Many kinds of foods are capable of triggering flushing attacks and most likely do so by increasing body temperature
In order to lose body heat, blood vessels dilate which worsens rosacea
Some foods may also cause flushing by stimulating the release of histamines which dilates blood vessels
clinical features of Rosacea
Erythema, Edema, Papules and Pustules, Telangiectasias
No comedones!
Forehead, cheeks, nose, the eyes (ocular rosacea)
The V of the chest
Seborrheic dermatitis, lupus erythematosus, acne vulgaris, perioral dermatitis, sarcoidosis
Differential Dx of Rosacea
Signs of severe Rosacea
Rhinophyma (enlarged nose)
Chin (gnathophyma)
Forehead (metophyma)
Ear (otophyma)
Eyelid (blepharophyma)
cause of severe Rosacea
Increased connective tissue with inflammation and sebaceous gland hyperplasia
Rosacea Managment
For all stages of disease include topical therapy in regimen
Topical medications used morning and night
Treatment of papulopustular Rosacea
-Oral antibiotics
-First-line treatment for papulopustular and ocular rosacea is doxycycline
Treating Telangiectasia
Cosmetic lasers that target hemoglobin
hallmark lesion of urticaria
characteristic of wheals
Circumscribed, erythematous or white, edematous lesion
Round or oval and polymorphic
Size of pencil eraser to dinner plate
Symptoms include pruritis, burning, stinging
mediator of urticaria
histamine; vasodilator
etiology of urticaria
Type 1 hypersensitivity reactions (IgE-mediated) are responsible for most cases of acute urticaria
Circulating antigens are often foods, drugs, inhalants, venom from insects (yellow jackets) that bind to IgE, releasing histamine
Nonimmunologic release of histamine
Certain drugs such as acetylcholine & opiates
Food such as strawberries, cheese, eggplant
React directly on mast cells to release histamine
Physical Urticaria
Mast cell degranulation induced by physical and external stimuli
common substances causing acute urticaria
Foods (usually immediately or up to 60 minutes after ingestion)
Fish, shellfish, nuts, tomatoes, cow's milk, soy, eggs
Food additives
Aspartame, food dyes, sulfites
Penicillins, aspirin and other NSAIDs, sulfonamides, alcohol
Sinusitis, cholecystitis, gastritis, UTI, fungal (dermatophytosis, deep fungal infections) viral (hepatitis, mononucleosis, coxsackie, herpes simplex)
Pollens, mold spores, animal dander, house dust
Contact urticaria
Plants, bacitracin, potato, apple, latex rubber, henna
what length of time qualifies as chronic urticaria?
Patients who have a history of hives lasting for 6 or more weeks are classified as having chronic urticaria
chronic urticaria is more common in...
More common in middle-aged women
Most chronic urticaria is caused by
autoimmune thyroid disease (Hashimoto's thyroiditis or Grave's disease)
How long do attacks of physical urticaria last?
1/2 hour to 2 hours
What are the types of physical urticaria?
pressure(frequent), cholinergic(frequent), solar(frequent), aquagenic(rare) and cold(rare)
what is cholinergic urticaria in response to?
Round, red, papular wheals that occur in response to exercise, heat, or emotional stress.
-Most common physical urticaria and known as "skin writing"
-Major Darier's sign
questions to ask if there's a possibility of urticaria
-insect bite or not?
-does patient know the cause?
-take detailed history
-try Darier's sign
-last thing is to order labs
Management of acute and chronic with....
H1 - antihistamine
common site of Acanthosis Nigricans
Intertriginous sites, such as the neck and axillae
lesions of Acanthosis Nigricans are characterized by
VELVETY, hyperpigmented plaques on the skin
What are the most frequently associated disorders with Acanthosis Nigricans?
obesity and diabetes milletus
Acanthosis Nigricans develops in kind of pattern?
How do you treat Acanthosis Nigricans?
topical therapies that normalize epidermal proliferation
topical retinoids
topical vitamin D analogs,
Systemic retinoids - only in severe case