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Chapter 22 & 23 Urticaria, mastocytoses and rosacea > Disorders of sebaceous glands > Flashcards

Disorders of sebaceous glands Flashcards

1
Q

T/F the sebaceous gland is apocrine

A

F holocrine

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2
Q

sebaceous glands occur on the palms and soles

A

F

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3
Q

there are many sebaceous glands on the dorm hand and feet

A

F sparse

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4
Q

meibomian glands of the eyelids and tyson’s glands of the prepuce are sebaceous glands

A

T

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5
Q

what are fordyce spots

A

free sebaceous glands in the margin of the upper lip often visible as pale-yellow bodies

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6
Q

Human skin surface lipid consists of what

A

glycerides, FFAs, wax esters, squalene, cholesterol esters

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7
Q

In children the sebum is 95% the surface lipid T/F

A

F

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8
Q

sebum helps protect against fungal and bacterial infection T/F

A

T

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9
Q

4 factors in the aetiology of acne

A

increase in sebum hypercornification of the pilosebaceous duct colonisation of the duct with P Acne inflammation

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10
Q

There is an increased incidence of atopic dermatitis in ppl with acne T/F

A

F decreased

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11
Q

Indications for an endocrine evaluation in ppl with acne

A

severe/sudden onset, therapy resistent, rapid relase post isotretinoin, irregular menses, hirsutism, hyperseborrhoea

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12
Q

What is HAIR-AN

A

hyperandrogenism, insulin resistance and acanthuses nigricans

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13
Q

At what age do you get worried about seeing acne

A

between 2-7

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14
Q

Hormonal tests for unusual acne

A

days 2-5 of menstrual cycle: Total & free T, SHBG, DHEA, androstenedione, prolactin, FSH, LH, FSH, LH, TFTs, lipids, glucose. Cortisol and 17 alpha hydroxyprogesterone USS ovaries

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15
Q

Poor prognostic factors for acne

A

early onset, family hx, more severe sebum, early onset relative to menarche, truncal, scarring, persistent

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16
Q

Topical treatment for back acne

A

avoid heat, oily environment, check meds/steroids/supplements. IL steroids 5% glycol acid, 10% propylene glycol in ethanol

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17
Q

Topical treatment for acne

A

BPO retinoids clindamycin 1%, erythromycin 2%, dapsone 5% azalea acid 15%, nicotinamide 4% 2% salicylic acid

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18
Q

associations with acne fulminans

A

osteolytic bone lesions fever, arthralgias, myalgias, hepatosplenomegaly. SAPHO EN

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19
Q

who gets acne fulminans

A

boys 13-16

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20
Q

What lab abnormalities might you expect with acne fulminans

A

elevated ESR, proteinuria, leukocytosis and anaemia lytic lesios on xray, increased uptake on technetium scintillography

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21
Q

P acnes are gram negative non motile rods T/F

A

F Gram +ve

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22
Q

P acnes fluoresce with the wood’s lamp

A

T

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23
Q

Management of acne fulminans

A

pred, reduce over 6 weeks isotretinoin at 4 weeks: 0.25mg/kg iniitally, then increase to achieve complete clearance. infliximab may be helpful dapsone may help - especially if associated EN

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24
Q

Clinical features of acne fulminans

A

abrupt, inflammatory and ulcerated nodular acne on chest and back which is painful bleeding crusts over ulcers fever painful joints including sacroiliac, ankles, shoulders malaise loss of appetite and weight loss enlarged liver and spleen

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25
Q

What is acne conglobatat

A

severe nodulocystic acne where there are interconnecting abscesses and sinuses. (part of the follicular occlusion triad)

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26
Q

acne mechanica occurs when

A

repeated friction and mechanical obstruction of pilosebaceous unit e.g. chin straps, collars, violin players

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27
Q

Drug induced acne - signs

A

abrupt, monomorphic eruption of inflammatory papules and pustules

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28
Q

Examples of drugs which may cause acne

A

steroids, bromides, iodides, isoniazid, lithium, phenytoin, progesterone, sertraline, risperidone, cetuximab, cyclosporin

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29
Q

What is apert’s syndrome

A

craniosyntosis , early epiphyseal closure, hypertelorism, prone to development of severe pustular acne

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30
Q

What syndromes may predispose to acne

A

cushings, HAIR-AN, PCOS, SAHA, late onset congenital adrenogenital syndrome, apert’s syndrome

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31
Q

comedogenicity is tested how

A

via a rabbit’s ear test - placing the ingredients in the external ear canal of rabbits and check the amt of hyperkeratosis

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32
Q

What is chloracne due to

A

exposure to aromatic hydrocarbons.

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33
Q

Detergent acne due to

A

alkaline soap washing. Some soaps contain weak acnegenic compounds eg hexachlorophene

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34
Q

% of newborns who get neonatal acne

A

>20%

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35
Q

Neonatal acne usually involves comedones on the cheek and nasal bridge

A

F typically NOT comedones

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36
Q

Treatment for neonatal acne

A

ketoconazole cream, azaleas acid cream, tretinoin, BP 2.5%

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37
Q

Comedones occur in infantile acne T/F

A

T

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38
Q

Isotretinoin is effective for the treatment of chloracne

A

F - doesn’t work as sebaceous gland as already undergone atrophy - use topical retinoid, gentle cautery

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39
Q

treatment of a comedo naevus

A

Keratin filled pits in a grouped or linear arrangement

40
Q

T/F pyogenic granulomas often appear post isotretinion

A

T

41
Q

What conditions are associated with seborrhoea

A

acromegaly, parkinsonism Reduced by isotretinoin, spironolactone

42
Q

What may happen to osteoma cutis (which may occur as a complication of acne) if the patient is treatment with minocycline

A

Becomes pigmented.

43
Q

Types of acne scars

A

icepick, box, rolling/atrophic, keloid

44
Q

Gram negative folliculitis presentation

A

sudden eruption of multiple small pustules or nodular lesions, usually premolar or prenatal post long term oral or topical ab treatment.

45
Q

Tx of gram negative folliculitis

A

stop ab trimethoprim 600mg daily or ampicillin 250mg aid or oral isotretinoin

46
Q

Associations with pyoderma faciale

A

crohns, high dose Vit B

47
Q

SAPHO

A

synovitis, acne, pustulosis, hyperostosis and osteitis

48
Q

Treatment of fordyce spots

A

CO2 laser, oral isotretinoin

49
Q

Histo features of steatocystoma multiplex

A

a true sebaceous cyst eosinophilic cuticle lack of granula layer sebaceous lobules in wall, may have vellum hair

50
Q

Treatment options for sebaceous hyperplasia

A

hyfrecate, CO2, TCA, cryo, vascular laser, isotretinoin, topical retinoids

51
Q

The comedone is formed in the isthmus of the follicle

A

F infundibulum

52
Q

Early non specific inflammation in acne results in less scarring than does a delayed, specific inflammatory response

A

T

53
Q

The number of P acnes in acne lesions is associated with increased severity T/F

A

F

54
Q

The principle androgen mediating sebum production is Testosterone T/F

A

F DHT

55
Q

Infants have increased levels of DHEAS T/F

A

T

56
Q

Skim milk is positively associated with acne prevalence and severity

A

T

57
Q

What conditions are associated with the FGFR2 gene and acne

A

apert syndrome, acneiform/comedonal acne

58
Q

The transverse nasal crease separates what

A

the alar cartilage and the triangular cartilage

59
Q

Pseudo acne of the transverse nasal crease is a hormonal form of acne T/F

A

F

60
Q

What is an idiopathic facial aseptic granuloma

A

chronic, painless, solitary nodule with an acneiform appearance on the cheek s of young children. FB type giant cells on H&E. Resolve spontaneously after 11 months without treatment

61
Q

What is this? Management plan

A

Acne fulminans

Oral pred 0.5-1mg/day, oral isotretinoin low dose introduced slowy after 3-4 weeks

emollient oil, potent topical steroid for 2-3 weeks to crusts

62
Q

What is this?

Aeitology?

Treatment

A

Fordyce spots - heterotopic sebaceous glands

Tx: nothing, CO2 laser, oral isotretinoin, PDT, micropunch excision

63
Q

What is this?

What gene?

A

PAPA syndrome - pyogenic arthritis, PG, acne

PSTPIP1 (CD2 antigen binding protein)

64
Q

What is this?

A

Pseudoacne of the transverse nasal crease

65
Q

cultures usually neg, H&E shows FB giant cells

A

Idiopathic facial aseptic granuloma

Resolves sponanteously after 11 months

66
Q

8 yo axilla

A

Childhood flexural comedones

average age of Dx is 6

no association with HS, Acne vulgaris or precocious puberty

67
Q

New onset pustules in patient with known acne on doxy for 12/12

A

Gram negative folliculitis

swab

treat with amoxil/trimethoprim depending on culture

isotretinoin may be helpful

68
Q

A pustular flare often occurs 3-4 weeks into topical retinoid treatment T/F

A

T

69
Q

Minocycline may be more effective than doxy in acne because…

A

more lipophilic, greater penetration into the sebaceous follicle

70
Q
A

Chloracne from dioxin poisoning

71
Q

What is this? - onset was gradual non painful

A

Morbihan’s disease

erythematous, firm, non pitting swelling of upper face. Peau d’orange appearance

considered to be endpoint of rosacea or allergic contact.

prolonged low dose isotretinoin may be helpful

72
Q

Types of eosinophilic folliculitis

A

Classic type – this occurs most commonly in Japan (Ofuji)

Eosinophilic folliculitis associated with advanced Human Immunodeficiency Virus (HIV) infection

Infantile eosinophilic folliculitis

Cancer-associated eosinophilic folliculitis

Medication-associated eosinophilic folliculitis

73
Q

What is this?

BG - explosive crop, some annular plaques with central clearing, intense pruritis

A

eosinophilic folliculitis -

often peirpheral blood eosinophiia

Tx: open wet dressings

oral indomethacin 50mg/day

UVB, oral minocycline, oral dapsone

74
Q

T/F HIV associated eosinophilic follicluitis occurs in HIV infected patient whose CD4 count is <600

A

F <300

75
Q

Disseminate and recurrent infundibulofolliculitis is aka

A

Hitch and Lund disease

76
Q
A

Disseminate and recurrent infundibular folliculitis aka Hitch and Lund syndrome

improvement with oral vitamin-A, isotretinoin, and PUVA. Some patients may find relief with cooling and soothing emollients.

It generally resolves by itself after some years.

77
Q

What is this?

A

acne agminata or lupus miliaris disseminatus faciei

78
Q

Clinical features and Dx

A

Erythromelanosis follicularis faciei et colli

multiple pin point follicular papules superimposed on a red brown patch

associated with KP of upper arms

In type 1 skin, may not have melanosis therefore overlap with keratosis pilaris rubra

Tx: Urea, tretinoin, alapalene. sal acid peels and glycoloic acid peels. Photoprotection

79
Q

Types of KP atrophican

A

KP atrophicans faciei(ulerythema ophryogenes)= AD

Atrophderma vermuiculatum

Keratosis follicularis spinulosa decalvans = XR

Folliculitis spinulosa decalvans

80
Q

Keratosis pilaris atrophicans faciei (ulerythma ophryogenes)

A

Erythematous follicular papules with central keratotic plug, eventually follicular atrophy

scarring alopecia of lateral eyebrows

81
Q

Associations with Keratosis pilaris atrophican faciei (ulerythema ophryogenes)

A

Noonan syndrome

cardio facio cutaneous syndrome

cornelia de lange syndrome and woolly hair.

82
Q

What is this

A

Atrophoderma vermiculatum

83
Q

Dx and course

A

lichen spinulosa

texture likened to that of a nutmeg grater

usually asymptomatic, arises suddenly, enlarges over a week.

Most often in chidlren, favours neck, arms, abdomen and buttocks

can persist indefinately

84
Q

How is lichen spinulosa different to KP

A

KP has perifollicular erythema and lacks discrete clusters

85
Q

DDx of lichen spinulosis

A

KP

PRP (Juvenile)

keratosis circumscripta

LPP

Phrynoderma

86
Q

which nutritional deficiency is this?

A

vit A deficiency - usually favours extensor sites, face is last site to be invovled and hands and feet are spared

87
Q

What is this and treatment

A

Acne keloidalis nuchae

Swab

Education - avoid tight shaves, tight collars

Topical antimicrobial cleaners/shampoos such as gentle foaming benzoyl peroxide washes or chlorhexidine can help prevent secondary infection.

Tar shampoos may provide an effective alternative. In addition, mild keratolytic agents containing alpha-hydroxy acids or topical retinoids may help soften the coarse hairs. Patients should discontinue hair greases.

potent or superpotent topical steroids with or without the use of topical retinoids.

Topical abs eg clindamycin, oral abs eg doxy

IL CS

Cryotherapy

88
Q

In acne there is increased corneocyte adhesion and proliferation T/F

A

T

89
Q
A
90
Q

P acnes secretesl lipases which cleaves lipids into FFA which activates TLR1

A

F TLR2

91
Q

The inflammation in acne is released via IL2, IL8, TNFalpha through TLR1 pathway

A

F IL1 and TLR2 pathway

92
Q

T/F topical retinoids down regulate TLR2

A

T

93
Q

In a patient with acne, if DHEA and 17OH is elevated where are the androgens coming from?

A

The adrenal gland

94
Q

Where do pustules in gram negative folliculitis generally occur

A

centrofacial, especially perinasal

95
Q

what is this? and tx

A

Fox fordyce

Topical retinoids

Topical steroids

Oral antibiotics

Clindamycin solution

Antiandrogenic hormonal therapy

Chapter 22 & 23 Urticaria, mastocytoses and rosacea (4 decks)

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