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34 Cards in this Set
- Front
- Back
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What is the commonality in acne, rosacea, hirsuitism and alopecia?
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they all occur around the pylosebaceous unit
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Where do sebaceous glands empty their contents?
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into the hair follicle
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At puberty, what changes happen at the pilosebaceous unit?
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-hyperkeratinization blocks pores
-sebaceous gland hyperplasia and hypersecretion --> as a result, P. acnes grows --> leads to inflammation |
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What are the 4 stages in the pathogenesis of acne
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early comedome
later comedome inflammatory papule/pustule nodule/cyst |
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What is the difference between open and closed comedome? What is the same?
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whitehead - closed -> hair follicle is completely closed
blackhead - open -> keratin is stuck they are both non-inflammatory |
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What are the treatments for mild acne?
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-topical retinoids
-benzoyl -topical abx (clindamycin, erythomycin) -keratolytics (salicylic acid) |
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What are the treatments for moderate acne?
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topical retinoids
birth control pills oral abx (tetracycline, erythromycin) ** tetracycline does bad things to the teeth of children under 12 and fetusses ** |
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What are the treatments for severe acne?
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systemic retinoid (acutane)
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How does OCP work in women for acne?
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OCP reduces your circulating testosterone
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If you have strictly comedomal acne (no inflammation), then what would you use?
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-topical retinoid
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If you have inflammatory acne, what would you use?
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-topical retinoid + systemic abx
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What is rosacea?
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-a lot of redness
-tendency to flush easily -acne-like component -starts in the 20s and 30s -an inflammatory process around the hair follicles |
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What are the clinical features of rosacea?
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-erythema, flushing
-inflammatory papules -telangiectasiae -rhinophyma -nose, cheeks, glabella, chin, eyes, cornea |
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Someone has a red face with teleangectasias and no comedomes. What is it?
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rosacea
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What does this guy have?
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ocular rosacea
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How do you manage roasacea?
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-avoid triggers (EtOH, heat, cold, wind, spices)
-topical metronidazole -systemic tetracyclines -laser surg, rhinophyma |
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What treatment do you avoid in rosacea?
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TOPICAL CORTICOSTEROIDS
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What is the definition of hirsutism?
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excess terminal hair growth in women where it is normally found on men
-it is specifically in androgen sepcific areas |
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What is the pathophys of hirsutism?
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-androgen precursor in the ovary (androstendedione)
-available (free) testosterone converted to dihyrdrotestosterone (DHT) -binds to androgen receptors in androgen dependent areas |
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What is the key ingredient in hirsutism, androgenetic alopecia and acne in women?
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binding of DHT to the androgen receptors!
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Where can the abnormalities be in hirsutism?
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-ovary: too much androgen precursor
-adrenals: too much DHEA -skin: too sensitive to availability of testosterone |
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What feedback mechanisms serve to reduce free testosterone?
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-estrogen (ovaries)
-cortisol (adrenals) |
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What happens when DHT binds to a receptor on a hair follicle?
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convert vellus hairs into coarse, dark terminal hairs
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Someone has hirsutism, but normal androgen levels. Why?
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-increased sensitivity of the hair follicles to androgen
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What is worrying in hirsutism history?
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-rapid onset
-rapid progression -menstrual irregularity -infertility -severity -other virilization signs (muscularity, deep voice) -central obesity -acanthosis nigricans |
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When would you test for elevated androgen levels in women with hirsutism?
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moderate or severe hirsutism
OR any degree of hirsutism if it is -sudden onset -rapid progression OR associated with ANY of: -menstrual irregularity -infertility -central obesity -acanthosis nigricans -clitoromegaly |
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What is the investigation for hirsutism?
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-total and bioavailable testosterone
-DHEAS, LH, FSH -chol/TG/glucose -pregnancy test if amennorheic |
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What is the most common symptom associated with hirsutism
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-polycystic ovarian syndrome
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What drugs are associated with hirsutism?
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-anabolic steroids
-valproic acid -androgenic progestins |
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What is the treatment for hirsutism?
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-removal
-oral contraceptives with an antiandrogen -eflornithine cream -dc drugs |
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What is the pathogenesis for androgenic alopecia?
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-not an inherent problem in production of androgens
-increased sensitivity to DHT |
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What is the pattern of alopecia in women?
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-preservation of hairline
-diffuse thinning -frontal scalp and crown |
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If a woman presents with a history "I'm losing tons of hair everytime I shower"
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-it is NOT androgenic alopecia
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What is the treatment of androgenic alopecia?
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men: topical minoxidi, oral finasteride, hair transplantation
women: topical minoxidil, OCP, spironolactone (androgen receptor antagonist), hair transplant |
