Acne

Question 1

Causes of acne

Answer 1

• Acne triad: androgen stimulation leads to more sebum produced
• P. acnes breaks down sebum to produce FFAs (leads to WBC recruitment and inflammation)
• Hyperkeratosis of follicular lining leads to formation of comedone (keratinous plug) and subsequent dilation and rupture of lower portion of follicle

Question 2

Factors that control the sebaceous gland

Answer 2

• Testicular testosterone in men

- Pre and post menopausal androgens in women (adrenal and ovarian in pre-menopausal, only adrenal in post-menopausal)

Question 3

Acne pathogenesis

Answer 3

• Begins w/ increased sebum production of sebaceous gland
• Accumulation of shed keratin and sebum leads to early/late comedone (blackhead, open comedone)
• Infestation w/ p. acnes leads to regression of sebaceous gland and mild inflammation (pustule, or closed comedone, whitehead)
• Transitions to nodule w/ marked inflammation
• Blackhead-> whitehead due to oxidation of keratin at comedone surface

Question 4

Rx of acne

Answer 4

• Topical treatments (retinoid, benzoyl peroxide, erythromycin, ect)
• Oral antibios (tetracycline, erythromycin, amoxicillin)
• Side effects: sun sensitivity, hypersensitivity rxn, yeast vaginitis

Question 5

Rx goals for acne

Answer 5

• Treat comedone genesis and follicular obstruction
• Treat excessive sebum
• Treat p. acnes
• Treat inflammation

Question 6

Acutane

Answer 6

• 13 cis retinoic acid
• Greatly reduces sebum production and acne formation
• Side effects: hyperlipidemia, ligament fibrosis and calcinosis, increased AST/ALT, teratogenic
• If lipid levels rise above 500 stop Rx