Snapshot A 25-year-old woman presents to her dermatologist’s office for acne. She reports that she had severe acne when she went through puberty. However, this resolved before she graduated from high school. In the past year, as she prepared applications for medical school, she reports that she is getting acne every month around the time of her menstruation. She also reports having worse acne when her stress levels coincide with her menstruation, though this is just speculation. On physical exam, she has no active lesions, but marked post-inflammatory hyperpigmentation consistent with the resolution of previous acne lesions. She is started on oral contraceptives for management of her acne, along with a topical retinoid. Introduction Clinical definition common chronic skin condition characterized by inflammatory and non-inflammatory lesions Epidemiology incidence very common demographics up to 85% of teenagers but can affect adults as well more severe around puberty location face, back, neck, chest, and upper arms risk factors menstrual cycle emotional stress occlusion of skin with greasy products excessive sweating pregnancy milk consumption Etiology multifactorial androgen production medications steroids Pathogenesis blockage or outlet obstruction of pilosebaceous unit, forming comedones from ↑ sebum production abnormal desquamation of keratinocytes and its accumulation colonization of bacteria Propionibacterium acnes inflammatory lesions result from leakage of sebum from comedones into dermis secretion of proinflammatory cells by Propionibacterium acnes ↑ androgen production also play a role in acne formation Associated conditions polycystic ovary syndrome Cushing syndrome congenital adrenal hyperplasia Prognosis in many cases, acne will resolve in adulthood however, hormonal acne may persist Presentation Symptoms nodular or cystic acne may be painful Physical exam inflammatory lesions erythematous papules, pustules, cysts, or nodules non-inflammatory lesions are comedones, which are dilated hair follicles filled with keratin, sebum, and bacteria open comedones are known as blackheads closed comedones are known as whiteheads scarring pitting and puckered indentation in skin Studies Making the diagnosis most cases are clinically diagnosed Differential Hidradenitis suppurativa Rosacea Folliculitis Treatment Management approach multiple factors go into the decision to treat acne, including severity of acne, type of acne, presence or potential for permanent scarring, concern for side effects, and adherence to therapy Medical benzoyl peroxide topical or wash indication for mild comedonal acne antibiotics topical indications for mild non-comedonal acne used in conjunction with benzoyl peroxide or topical retinoid drugs clindamycin erythromycin systemic indications for mild to moderate non-comedal acne should not be used long-term or as monotherapy drugs tetracycline minocycline doxycycline retinoids topical indications for mild to moderate acne, especially with comedones and inflammatory acne often first-line when combined with an antimicrobial agent (topical or systemic) drugs adapalene tazarotene tretinoin systemic indications for moderate to severe acne, especially cystic acne for patients with existing or potential for permanent scarring contraindicated in pregnancy drugs isotretinoin adverse effects include teratogenicity, hypertriglyceridemia, idiopathic intracranial hypertension, hepatotoxicity, cheilitis, and photosensitivity Requires measurement of urine beta-hCG (pregnancy test) before administration due to teratogenicity hormonal therapy indications for severe acne or acne refractory to other therapy for acne that seem to correspond with menstrual cycle drugs oral contraceptives spironolactone Complications Permanent acne scarring and cosmetic disfigurement
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.MK.15.4666) A 17-year-old male is diagnosed with acne vulgaris during a visit to a dermatologist. He is prescribed a therapy that is a derivative of vitamin A. He has no other significant past medical history. Which of the following is the major side effect of this therapy? QID: 107097 Type & Select Correct Answer 1 Hyperglycemia 12% (11/93) 2 Hyperlipidemia 37% (34/93) 3 Fatigue 3% (3/93) 4 Xerophthalmia 32% (30/93) 5 Alopecia 13% (12/93) M 4 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (M1.MK.14.9) A 16-year old girl presents to your clinic with skin findings similar to that seen in Figure A. You are considering treatment with Isotretinoin. What test must this patient have prior to starting isotretinoin? QID: 103802 FIGURES: A Type & Select Correct Answer 1 Complete blood count 3% (3/107) 2 Pregnancy test 88% (94/107) 3 Chest x-ray 0% (0/107) 4 Basic metabolic panel 4% (4/107) 5 No testing needed 5% (5/107) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic
All Videos (1) Login to View Community Videos Login to View Community Videos Acne Vulgaris Dermatology - Acne Vulgaris E 2/14/2015 161 views 3.0 (1) Dermatology | Acne Vulgaris Dermatology - Acne Vulgaris Listen Now 12:30 min 7/18/2021 25 plays 5.0 (1)