Term
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Definition
| self-limiting disease involving the sebaceous follicles |
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Term
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Definition
comprised of a large sebaceous gland and a small-medium hair
found on the face, upper chest, and back |
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Term
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Definition
attached to hair follicle through a duct
secretes sebum, flows through duct into follicle and then onto skin
associated with hair follicles all over the body
largest and greatest density on the face |
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Term
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Definition
comprised of various lipids - squalene, cholesterol, cholesterol esters, wax esters, triglycerides
bacteria in the hair follicle feed off of the sebum - break down TG-->FFA
FFA are very inflammatory |
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Term
| mechanism of sebaceous gland secretion |
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Definition
holocrine secretion
entire cell disintegrates once it fills up
requires androgens to produce sebum |
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Term
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Definition
-most common skin disease in the US
-peak incidence in adolescence
-may be familial
-clinically pleomorphic; variety of lesion types in the same person |
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Term
| clinical manifestations of acne |
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Definition
primary site: FACE, lesser extent on the upper chest, back, shoulders
one lesion type may predominate but usually there are several types of lesions (clinically pleomorphic)
lesions are either inflammatory or non-inflammatory |
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Term
| non-inflammatory acne lesions |
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Definition
COMEDONES
-open or closed
-plugs of keratin and lipid
-the starting lesion in acne |
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Term
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Definition
"blackhead"
-flat or slightly raised
-visible opening
-central dark color from melanin deposition and lipid oxidation |
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Term
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Definition
cane be hard to see
pale and slightly elevated
no visible opening |
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Term
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Definition
-impaction of keratin and lipid and follicle
-dilated follicle filled with keratin and lipid
-balloon like thinning of the follicle wall
-open comedo has a wide follicular opening to the skin surface (exposes keratin to air)
-close comedo has narrow follicular opening |
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Term
inflammatory acne lesions
papules and pustules |
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Definition
1-5mm pink-red bumps centered at the follicle
pustule are filled with white pus (neutrophils) |
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Term
| histology of inflammatory acne lesion |
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Definition
-rupture of follicle causes a marked inflammatory reaction from exposed lipid and keratin materials
-inflammation from debris (keratin, lipid, bacteria) in the dermis
-lesion may be an inflammatory papule, pustule, or nodule depending on the site and extent of inflammation |
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Term
inflammatory acne lesions
nodules |
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Definition
markedly inflamed, large, deep, firm, tender lesions
may be called a cyst when there is significant pus and serosanguineous fluid
very destructive, painful
"nodulocystic acne" - severe inflammatory acne |
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Term
| sequela of inflammatory acne |
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Definition
scarring
keloids
post-inflammatory pigment alterations |
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Term
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Definition
-acne will often eventually resolve on its own w/o tx - but scarring may be permanent
-early treatment necessary to prevent scarring
-often occur with severe inflammatory acne (nodular/cystic)
-sharply punched out pit and nodular hypertorphic scars are characteristic |
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Term
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Definition
| raised, thickened, and grows larger than the original area of skin injury |
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Term
| post-inflammatory pigment alterations |
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Definition
acne inflammation can often leave behind a dark, light, or reddish discoloration
often fade on its own, but may take years
hypopigmentation change may be permanent |
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Term
4 main factors in acne pathogenesis
why do we get it? |
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Definition
follicular hyperkeratinization
colonization with Propionibacterium acnes
increased sebum production
inflammation |
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Term
acne pathogenesis
follicular hyperkeratinization |
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Definition
-the first and most important step
-primary change in the follicle is altered keratinization
-initial changes occur near where the sebaceous duct joins the follicle
-keratin shed becomes more dense and sticky (unknown why)
-sticky keratin debris accumulates and plugs follicle = "keratin plug" |
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Term
acne pathogenesis
increased sebum production |
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Definition
-sebum production increases with puberty
-rates of production are higher in people with acne
-reducing sebum secretion improves acne
-reasoning behind this remains unknown |
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Term
acne pathogenesis
colonization with P. acnes bacteria |
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Definition
-P. acnes is the main bacteria found in the follicle
-more P. acne is people with acne, but amount of bacteria NOT correlated with severity of acne
-P. acnes release lipases that breakdown TG-->FFA (FFA are inflammatory)
-P. acnes releases degradative enzymes which are inflammatory
-P. acnes releases factors that attract neutrophils
-neutrophils may enter follicle and ingest P. acnes, releasing enzymes that damage the follicle |
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Term
| treatment principles for acne |
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Definition
-correct follicular hyperkeratinization
-decrease P. acnes population
-decrease sebaceous gland activity
-produce and anti-inflammatory effect
non-inflammatory acne: focus on correcting altered keratinization
inflammatory acne: use multiple approaches |
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Term
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Definition
explain nature of acne and mechanism behind treatment to enhance compliance
dispel myths -- it's NOT related to poor hygiene
resolution of acne while on therapy is SLOW (months)
long-term therapy is required |
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Term
| topical treatments for acne |
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Definition
topical retinoids - reverse altered keratinization
antibiotics/antimicrobials - decrease P. acnes |
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Term
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Definition
-break up comedones
-bind to nuclear retinoic acid receptors and alter gene expression
-helps with post inflammatory hyperpigmentation
-prevent new acne lesions by inhibiting microcomedo formation
-cornerstone of treatment and maintenance therapy |
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Term
| types of topical retinoids |
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Definition
retinoic acid (tretinoin)
adapalene
tazarotene |
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Term
| antibiotics, antimicrobials |
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Definition
-decrease the bacterial population
-decreased inflammation
-often used in combination to help against bacterial resistance |
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Term
| types of antibiotics/antimicrobials |
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Definition
antibiotics: topical erthromycin and clindamycin
antimicrobial: benzoyl peroxide |
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Term
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Definition
-miscellaneous topical acne treatment
-softens keratin, preventing follicular plugging
-keratolyitc; breaks up comedones |
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Term
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Definition
-miscellaneous topical acne treatment
-keratolytic and anti-inflammatory
-breaks up comedones and decreases inflammation |
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Term
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Definition
-miscellaneous topical acne treatment
-mechanism of action unclear, may be related to inhibition of leukocyte trafficking/antimicrobial proterties
-helpful for inflammatory papules and pustules |
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Term
| systemic treatments for acne |
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Definition
oral antibiotics; hormonal
used for moderate to sever inflammatory acne |
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Term
| oral antibiotics for systemic treatment of acne |
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Definition
-decreases P. acnes
-direct anti inflammatory activity
-several weeks required before maximal benefit
tetracycline, doxycycline, minocycline, erythromycin |
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Term
| hormonal therapy for systemic treatment of acne |
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Definition
-decreased sebaceous gland activity by interfering with androgren stimulation of glands
-oral contraceptive pills
-only for women with acne |
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Term
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Definition
-oral retinoid used only in severe inflammatory/nodulocystic acne
-produces profound inhibition of sebaceous glands, decreases P. acnes, and affects follicular keratinization
-completeness and longevity of remission in most people
-VERY TERATOGENIC, strict monitoring program |
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Term
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Definition
-most severe (though rare) form of acne
-occurs in teenage boys
-sudden appearance of large inflammatory lesions on face, neck, chest, back, arms; ulcerate
-variale systemic manifestations: fever, arthralgias, myalgias, hepatosplenomegaly, osteolytic bone lesions
-tx with systemic steroids and isotretinoin |
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Term
| treatment of acne scarring |
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Definition
-difficult to treat
-early treatment is best
-improved with: laser tx, chemical peels, excision, dermabrasion, fillers
-steroid injections for keloids |
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Term
| treatment of post-inflammatory erythema |
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Definition
TIME
retinoids
lasers that target the redness |
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Term
| treatment of hyperpigmentation |
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Definition
TIME
retinoids
hydroquinone
azaleic acid
chemical peels
laser |
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Term
| treatment of hypopigmentation |
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Definition
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Term
| acne associated with endocrine abnormalities |
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Definition
most acne patients do NOT have any underlying endocrine problems
when to suspect in woman:
-hirsuitism (thick, dark, terminal hair in abnormal locations such as beard area)
-irregular menstrual cycles
-pattern hair loss
-deepened voice
can commonly be caused by PCOS |
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Term
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Definition
-chronic inflammatory skin condition most commonly affecting the face
-papules and pustules
-common in fair skinned poeple
-onset usually after age 30 |
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Term
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Definition
erythematotelangiectatic (vascular)
papulopustular (inflammatory)
phymatous
ocular
-patients may have clinical features of any/all subtypes |
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Term
| erythematotelangiectatic rosacea |
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Definition
-recurrent face flushing that becomes persistent
-flushing episodes >10minutes
-can occur with various environmental, emotional stimuli
-development of telangiectasias (more prominent in sun-damaged skin) |
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Term
| papulopustular (inflammatory) rosacea |
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Definition
-similar to papules and pustules of acne but no comedones
-individual lesions persist for weeks
-background erythema and telangiectasia are common
-perivascular and perifollicular lyphocyte involvement and histiocytes without comedones |
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Term
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Definition
-marked skin thickenings and irregular surface nodularities of the nose, chin, forehead, ears, eyelids
-sebaceous gland overgrowth
-most commonly affects the nose (rhinophyma)
-sebaceous gland hypertrophy, fibrosis
-can also get redness, telangiectasia, papules/pustules
-most disfiguring type |
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Term
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Definition
-5-10% of rosacea patients have ocular involvement
-blepharitis, recurrent stye, conjunctivitis, keratitis, corneal ulceration
-dry eyes, swollen eyes, tearing, burning, blurry vision, photophobia
-ocular involvement is independent of severity of facial rosacea
important to ask all patients about ocular involvement when suspecting rosacea |
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Term
| granulomatous rosacea variant |
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Definition
discrete red-brown papules that are more persistent
histology shows granulomatous inflammation
usually no backgroud redness |
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Term
| pyoderma faciale / rosacae fulminana |
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Definition
-abrupt onset of coalescing inflammatory papules and pustules leading to plaques on the face
-ma have draining sinuses
-more common in younger females
-can have mild fever and myalgias |
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Term
factors in rosacae pathogenosis
why do we get it? |
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Definition
-unknown etiology
-genetic predisposition
-likely multifactorial: vascular hyperreactivity, chronic sun exposure, deodex skin mites, pro-inflammatory molecules (cathelicin) |
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Term
| rosacea patient education |
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Definition
-avoid irritants: soap, alcoholic cleansers, abrasives
-protect against sunlight
-dietary limitations to food that promotes flushing and erythema (spicy, alcohol)
-it is difficult to treat the flushing and erythema |
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Term
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Definition
topicals
systemics
laser
surgical approach |
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Term
| topical rosacea treatments |
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Definition
metronidazole, azaleic acid, sulfur-based products
-greatest effect on papules, pustules (less so on erythema)
-does not alter flushing or telangiectasias
-used during mild/quiet episodes
-antimicrobial and antiinflammatory actions |
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Term
| systemic treatments for rosacea |
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Definition
tetracycline, doxycycline, minocycline, erythromycin, isotretinoin
-papulopustular responds well to oral antibiotics
-oral antibiotics can reduce erythema but not flushing or telangiectasias
-isotretinoin is effective and is used in severe treatment resistant cases |
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Term
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Definition
lasers used to target blood vessels
helpful in getting rid of redness and telangiectasia
often need repeat treatments |
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Term
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Definition
| "sandpaper" taken to phymatous rosacea |
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