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76 Cards in this Set
- Front
- Back
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ACNE BASICS
- Acne is a dz of what structure? - inherited? |
- Pilosebaceous unit
- Inherited predisoposition |
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ACNE BASICS
- Most intense areas affected are associated with what? |
- where Sebaceous glands are most numerous and large
(Face, Chest, Back) |
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ACNE BASICS
- Acne begins with what normal physiological event? - give example when this happens during life? |
- Increase in Sebum production
- Pubery --> Testosterone hormone changes |
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ACNE BASICS
- Associated microbial dude |
- Propionibacterium acnes
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ACNE BASICS
- what causes the formation of comedones? |
- Follicular epithelial lining is Altered
thus Forming a PLUG called Comedones |
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ACNE BASICS
- List the steps in pathogenesis |
From Normal (--> MC PP)
1.) Microcomedone stage 2.) Closed comedone ==> Open Comedone 3.) Papule 4.) Pustule (or cyst) |
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ACNE BASICS
- Pattern Dx system involves what 3 things? |
- Lesion impact + complications
- Impact of Dz (disfigurement) - Degree of severity |
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ACNE BASICS
- Classification into what 2 categories? |
- Non-inflammatory
- Inflammatory |
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ACNE BASICS
- Non-inflammatory has what subcategories? |
- Closed comedones (white head)
- Open comedones (black heads) |
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ACNE BASICS
- Inflammatory category has what subcategories? |
- Pustule
- Papule (<5 mm) - Nodule (>5 mm) and/or cysts |
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ACNE BASICS
- Inflammatory lesions (PPN) with a severity grading of MILD has what characters? |
- Few to Several papules or pustules
- NO nodules |
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ACNE BASICS
- Inflammatory lesions (PPN) with a severity grading of MODERATE has what characters? |
- Several to Many papules or pustules
- Few to Several Nodules |
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ACNE BASICS
- Inflammatory lesions (PPN) with a severity grading of SEVERE has what characters? |
- Numerous or Extensive papules or pustules
- Many Nodules |
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ACNE BASICS
T/F : Certain foods make acne worse |
False
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ACNE BASICS
T/F : Dirty skin makes acne worse |
False
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ACNE BASICS
T/F : Acne worse with sexual activity |
False
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ACNE BASICS
T/F : Acne improves in 24 hours s/p TX |
False
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ACNE BASICS
T/F : Sweating makes acne worse |
True
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ACNE BASICS
T/F : Humidity makes acne worse |
True
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ACNE BASICS
T/F : Acne worse during Menstruation |
True
(Acne may worsen premenstrually) |
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ACNE BASICS
T/F : Stress makes acne worse |
True
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ACNE BASICS
- list Tx strategies x4 |
- Antibacterial effect
- Anti-inflammatory effect - Inhibit Sebaceous Gland F(x) - Normalize Pattern of Follicular Keratinization |
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ACNE BASICS
- Main Goal of Acne Tx? |
- Prevent long term scarring
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ACNE BASICS
- Acne is the MC? |
- Derm Dz
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ACNE BASICS
- Usual onset is? - Gender Frequency preference? - More severe in? |
- Adolescence (but anytime too)
- Males - Males |
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ACNE BASICS
- Acne affects young women how? |
70% have premenstrual flares
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ACNE BASICS
- Common pitfalls? x2 |
- Using more than 2 meds
- Insufficient Patient Education (or Unrealistic expectations) |
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ACNE BASICS
- Acne etiology is a combo of what 3? |
- Hormonal (andorgen)
- Bacterial (P.acnes) - Follicular (Hyperkeratosis) |
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ACNE BASICS
- Acne Morphology x5 |
Papules & Pustules
Comedones & Cysts Nodules |
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ACNE BASICS
- TX will NOT improve Acne for how long? |
4 to 6 weeks
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ACNE BASICS
- Acne exacerbated by? x7 |
("WO BITCH")
- Washing vigorously - Occlusions of mechanical nature - Bromides - Iodides - Topical preps that Occlude - Chlorinated Hydrocarbons - Hydrantoin |
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ACNE TREATMENT
- For MILD acne, how do you treat face? |
- apply ONE agent thinly to entire face
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ACNE TREATMENT
- For MILD acne, if using 2 agents, use how? |
- at separate times
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ACNE TREATMENT
- For MILD acne, apply agents when? |
- After washing with MILD soap & water
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ACNE TREATMENT
- For MILD acne, what are the choices that can be used? x6 |
(BAB'S TT)
- Benzoyl peroxide - Azelaic acid - Birth control - Salicylic acid - Tretinoin - Topical Ab |
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ACNE TREATMENT
- For MILD acne treatment, how long should you use before judging its effectiveness? |
- 6 to 8 weeks
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ACNE TREATMENT
- For MILD acne treatment, what are the Side Effects of Benzoyl Peroxide |
(the antibacterial drug can cause)
- Hypersensitivity Rxn (1-5%) - Oxidating RxN : (bleach clothes/hair) |
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ACNE TREATMENT
- For MILD acne treatment, what are the options for Topical Ab? x4 |
(ECMS are all Rx)
- Erythromycin - Clindamycin - Meclocyclin - Sodium Sulfacetamide |
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ACNE TREATMENT
- For MILD acne treatment, which topical Ab comes in cream form? - ointment form? - pad form? |
- Meclocycline
- Erythromycin - Erythromycin |
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ACNE TREATMENT
- For MILD acne treatment, what risk is associated with Sodium Sulfacetamide? |
- Bacterial resistance after 6 to 12 months of use
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ACNE TREATMENT
- For MILD acne treatment, which topical is useful in patients with very very dry skin? |
- Meclocycline
(thats why its in Cream form) |
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ACNE TREATMENT
- For MILD acne treatment, what are the Topical Retinoids that are available? x3 |
(R-AR)
- Retin A - Avita - Retin A Micro |
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ACNE TREATMENT
- For MILD acne treatment, what are the Retinoid-Like topical options? x2 |
- Tazarotene
- Adapalene |
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ACNE TREATMENT
- For MILD acne treatment, which Retinoid or Retinoid-Like Topical may be useful for Oily skin? |
- Tazarotene
(tho initially irritating) |
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ACNE TREATMENT
- For MILD acne treatment, what can be useful in Combo with Tretetinoin or Topical Ab? |
- Salicyclic Acid (OTC Keratolytic)
(can also use azelaic acid) |
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ACNE TREATMENT
- For MILD acne treatment, Azelaic acid is useful for which patients? - must avoid where? |
- Patients Intolerable to Tretinoin or Benzoyl Peroxide
- Broken skin |
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ACNE TREATMENT
- For MILD acne treatment, what type of Birth control pill should be used? |
- Pill with Low Androgenic portential
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ACNE TREATMENT
- How does Acne manifest during pregnancy? |
- Improves
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ACNE TREATMENT
- For MODERATE acne treatment, what is the strategy? |
(MOD TX = MOD)
Mild Acne Tx + Oral Ab + Deletion of Comedones |
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ACNE TREATMENT
- For MODERATE acne treatment, what PO Ab's are available? x4 |
(B MET)
- Bactrim (TMP-SMX) - Minocycline - Erythromycin - Tetracycline |
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ACNE TREATMENT
- For MODERATE acne treatment, which PO Ab has fewer GI side effects? - what's the drawback tho? |
- Minocycline
- Expensive |
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ACNE TREATMENT
- For SEVERE acne treatment, |
(Severe = MISC)
- Moderate regimen x 3 months - Isotretinoin for severe nodulocystic acne - Steroid injections - Consult |
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ACNE TREATMENT
- For SEVERE acne treatment, what is rarely used? |
- Prednisone
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ACNE TREATMENT
- For SEVERE acne treatment, what TX option provides improvement after stopping the Tx? |
Isotretinoin (Accutane)
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ACNE TREATMENT
- For SEVERE acne treatment, which Tx option is highly teratogenic? - Thus, what precaution is used? |
- Isotretinoin (Accutane)
- 2 forms birth control x 1 month prior to use |
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ACNE PATIENT EDUCATION
- what should be told to patient? x5 |
(MO ASS)
- Makeup should be water based - Oil free moisturizers used - Avoid scrubbing - Simple regimen is best - Six to 8 week response |
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ACNE PATIENT EDUCATION
- what is key to FTIP? |
- Compliance
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POSTADOLESCENT ACNE: WOMEN
- What is common in Professional Women in terms of acne? |
- Low grade, Persistent acne
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POSTADOLESCENT ACNE: WOMEN
- what is the dominant lesion? |
- Closed Comedones
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POSTADOLESCENT ACNE: WOMEN
- what is typically experienced? |
- Premenstrual Flare ups
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POSTADOLESCENT ACNE: WOMEN
- most patients have what Hx? |
- No acne during adolescence
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ACNE ROSACEA
- manifests generally how? - dominant lesion seen? |
- "rosy" Dilation of central face
- diverse (PPNC), but NO Comedones |
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ACNE ROSACEA
- unique to middle aged men how? |
- have Rhinophyma
(hyperplasia of nose) |
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ACNE ROSACEA
- is this chronic or acute? - Treatment goal is what? |
- chronic
- Control |
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ACNE ROSACEA
- what clinical feature is unique that should be observed for? |
Periodic Facial Flushing after (SAT's)
- Spicy food - Alcohol - Temp. increase |
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ACNE ROSACEA
- What topicals can be given for Tx? |
- Benzoyl peroxide
- Ab - Tretinoin |
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ACNE ROSACEA
- besides topicals, what else can be given for Tx? |
- PO Ab
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ACNE ROSACEA
- Severe, recalcitrant cases get what? |
- Isotrentinoin
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ACNE ROSACEA
- what is the Tx strategy for Acne Rosacea? x3 |
- Topicals
- Oral Ab - Referral for Surgery, dermabrasion, laser |
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ACNE ROSACEA
- what Tx contraindication must be noted? |
- Potent Topical steroids exacerbate Dz
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ACNE ROSACEA
- preferred Topical Ab? |
- Metronidazole
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ACNE ROSACEA
- what PO drugs are available? |
- Doxycycline
- Tetracycline - Minocycline |
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ACNE ROSACEA
- PO drugs are useful for? - How do you utilize PO antibiotics? - above strategy is different from what other strategy? |
- Nodular lesions
- TX until improvement occurs, then taper - Differs from Topical Tretinoin, where you start with lowest dose, then go up |
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ACNE ROSACEA EDUCATION
- must avoid excessive what? x4 |
(Must avoid the PAST)
- Precipitating foods (spicy) - Alcohol - Sunlight - Temperature extremes |
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ACNE ROSACEA EDUCATION
- Flares may require what Tx modification? |
- Higher "Pulse" Tx
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ACNE ROSACEA EDUCATION
- most important thing to tell patient |
- there is no cure, so must control it
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