Acne and Its Development Factors

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Questions and Answers

Which factor is NOT considered to contribute to the development of acne?

Hyperproliferation of bacteria

Excessive sebum production

Low environmental humidity (correct)

Inflammatory mediators

What characterizes acne vulgaris?

A mixed eruption of inflammatory and non-inflammatory lesions (correct)

Presence of only comedones

Only inflammatory lesions are present

Localized exclusively to the face

What is a common age range for the prevalence of acne?

25 to 30 years

35 to 45 years

16 to 18 years (correct)

0 to 12 years

Which statement about the severity classification of acne is true?

Severe acne contains nodules and pseudocysts Signup and view all the answers

Which of the following is a provocation factor for acne flares?

High dietary sugar content Signup and view all the answers

What type of acne typically occurs in infants?

Infantile acne Signup and view all the answers

Which of the following features is characteristic of severe acne?

Formation of nodules Signup and view all the answers

Which hormone-related condition can provoke acne?

Polycystic ovarian disease Signup and view all the answers

What is typically unnecessary for most cases of acne diagnosis?

Hormonal testing Signup and view all the answers

Which statement about acne prevalence is correct?

Acne affects both sexes across all races Signup and view all the answers

What is a common precipitant for acne fulminans?

Use of anabolic steroids Signup and view all the answers

Which of the following is a characteristic feature of acne fulminans?

Fluctuating fever Signup and view all the answers

Which treatment is commonly used for managing severe cases of acne fulminans?

Systemic corticosteroids Signup and view all the answers

What is the primary cause of acne mechanica?

Repeated skin friction or pressure Signup and view all the answers

Among the following, which condition is least likely to be associated with acne fulminans?

Melanoma Signup and view all the answers

What is the primary treatment recommended for moderate acne?

Antibiotics such as tetracyclines Signup and view all the answers

Which medication is indicated for secondary infections in patients with acne fulminans?

Erythromycin Signup and view all the answers

Which of the following is a characteristic feature of nodulocystic acne?

Solitary or multiple inflammatory nodules Signup and view all the answers

What is a likely clinical feature found in 20% of patients with acne fulminans?

Painful joints Signup and view all the answers

Which of the following is considered an underlying factor for developing acne mechanica?

Sports equipment Signup and view all the answers

What type of scars are commonly associated with acne conglobata?

Atrophic scars Signup and view all the answers

What should be the focus when treating persistent nodules or cysts in acne?

Injecting localized steroids Signup and view all the answers

How is nodulocystic acne primarily diagnosed?

Clinical diagnosis Signup and view all the answers

Which systemic treatment is recommended to be initiated after controlling symptoms with steroids in acne fulminans?

Isotretinoin Signup and view all the answers

Which intervention is typically ineffective for treating nodulocystic acne?

Topical retinoids Signup and view all the answers

What psychological effects can result from acne conditions?

Social withdrawal and anxiety Signup and view all the answers

In what age range is nodulocystic acne most commonly seen?

Adolescents and early adulthood Signup and view all the answers

Which of the following is not a known risk factor for nodulocystic acne?

Dietary fat intake Signup and view all the answers

What is a potential complication of nodulocystic acne?

Keloid scars Signup and view all the answers

Which of the following accurately describes acne conglobata?

It involves the trunk, limbs, and buttocks Signup and view all the answers

What is the primary treatment approach for acne mechanica?

Removing the source of pressure or friction Signup and view all the answers

Which ingredient is widely recognized for its role in acne treatments and acts as a deep cleanser?

Benzoyl peroxide Signup and view all the answers

What is a significant consequence of picking at acne lesions, as mentioned in the content?

Increased risk of scarring Signup and view all the answers

What is the nature of acne excorie, particularly in young females?

It involves the presence of scratch marks and pigmentation Signup and view all the answers

Which statement is true regarding topical antibiotics in the treatment of acne mechanica?

They are often combined with other medications Signup and view all the answers

What psychological condition may be associated with individuals who excessively pick at their acne?

Body dysmorphic disorder Signup and view all the answers

Which type of acne arises from occupational exposure to certain chemicals?

Occupational acne Signup and view all the answers

What is a common characteristic of papules and pustules?

They are recognized as pimples Signup and view all the answers

Which topical vitamins are mentioned as beneficial for reducing inflammation in acne treatment?

Retinoids and nicotinamide Signup and view all the answers

What psychological behavior may suggest underlying stress or anxiety related to acne in individuals?

Spending extended time in front of the mirror Signup and view all the answers

Study Notes

Acneiform Disorders

Acne is a chronic disorder affecting the hair follicles.
It affects males and females of all races and ethnicities.
It's prevalent in adolescents and young adults, with 85% of 16-18 year-olds affected, but can occur in children and adults.
Acne is caused by a combination of factors; exact mechanisms aren't fully understood.
Factors include: familial tendency, endogenous and exogenous androgenic hormones, acne bacteria, innate immune activation with inflammatory mediators, and distension and occlusion of hair follicles.

Flares of Acne

Flares can be triggered by: polycystic ovarian disease, drugs (steroids, hormones, anticonvulsants, epidermal growth factor receptor inhibitors), occlusive cosmetics, high environmental humidity, and diets high in dairy products and high glycemic foods.

Acne Diagnosis

Routine tests are usually unnecessary for acne unless symptoms are atypical.
If atypical, consider skin swabs for microscopy and culture, along with hormonal tests in females.

Acne Vulgaris

Acne vulgaris is the most common type, characterized by a mixed eruption of inflammatory and non-inflammatory skin lesions.
It affects both sexes and all races, though primarily affects adolescents but spans a wide age range.
Further characterisation includes infantile acne, acne in children, and adult acne.
The pathogenesis includes four important factors: excessive sebum production, hyperkeratinization of pilosebaceous follicles, hyperproliferation (with Cutibacteria acne), and inflammation.

Clinical Features of Acne Vulgaris

Acne commonly affects the face, but can spread to the neck, chest, and back.
Forms include inflammatory papules, pustules, and nodules, or non-inflamed comedones and pseudocysts.
Appearance can be further classified by open and closed uninflamed comedones (blackheads and whiteheads), inflamed papules and pustules, nodules and pseudocysts in severe cases, post-inflammatory pigmentation, erythematous, and scars.
Severity is classified as mild, moderate, or severe, based on total lesion count (<30, 30-125, >125 respectively).

Complications of Acne Vulgaris

Complications of acne vulgaris include post-inflammatory hyperpigmentation, scarring (including keloid scars), and psychological effects.

Treatment for Acne Vulgaris

Treatment depends on factors like patient's age, extent and severity of acne, and response to past treatments.
Mild acne may include topical anti-acne preparations such as tretinoin, azelaic acid, adapalene, and benzoyl peroxide.
Moderate acne may require antibiotics like tetracyclines and/or antiandrogens such as birth control pills.
Severe acne may necessitate oral isotretinoin.

Nodulocystic Acne

Nodulocystic acne is a severe form, affecting face and upper trunk, presenting with nodules and cysts that often scar.
It is typically a disorder of adolescence and early adulthood, most common in males, but can occur in a juvenile form before age 6.
Specific risk factors include genetic factors, drugs (anabolic steroids, etanercept, imatinib), dietary supplements such as whey, and haemodialysis.
Clinical features include solitary or multiple inflammatory nodules and pseudocysts, firm, fluctuant, and/or tender lesions, and involvements of the face, neck, and trunk.

Acne Conglobata

Acne conglobata is a rare, severe form of nodulocystic acne.
Characterized by groups of multiple comedones and inflammatory papules, pustules, and nodules.
Lesions involve the trunk, limbs, and buttocks.
Interconnecting abscesses and draining sinuses are often present.
Secondary infection may cause pain and malodour.
Healing and scarring is typically slow, and the condition is persistent, lasting into the 30s or 40s.

Complications of Nodulocystic Acne

Complications include psychological effects, keloid, hypertrophic and atrophic scars, and pyogenic granuloma.
Diagnosis is clinical, although hormone studies might be considered for those with suggestive clinical features.
Treatment for nodulocystic acne is often oral isotretinoin to lessen scarring, with a minimum five-month course, and possible further treatments depending on need.
Intralesional steroids may also be used for individual persistent or large inflammatory nodules or cysts.

Acne Fulminans

Acne fulminans is a severe, rare form of acne conglobata associated with systemic symptoms.
Nearly always affects adolescent males.
Potential causes include increased androgens (male hormones), genetic and autoimmune complex disease, and hypersensitivity reaction to bacteria (Cutibacteria acnes).
The condition can be precipitated by testosterone and anabolic steroids, either legitimately prescribed or illegally taken.
Clinical features include abrupt onset, inflammatory and ulcerated nodular acne on chest and back (painful), crusty ulcerations on the upper trunk, severe acne scarring, fluctuating fever, painful joints (sacroiliac joints in 20% of cases and ankles, shoulders, and knee joints), malaise, loss of appetite and weight loss, and an enlarged liver and spleen.
Treatment involves systemic corticosteroids (prednisone, 20-60mg/day), anti-inflammatory medications (salicylates, aspirin), dapsone (50-100mg/day), ciclosporin, high doses of oral antibiotics (erythromycin 2g/day) for secondary infections, isotretinoin, and tumour necrosis factor (TNF-α) inhibitors.

Acne Mechanica

Acne mechanica develops from repeated friction or pressure against the skin.
This includes tight-fitting clothing such as shirts with collars, sports gear, accessories (hats and bras), medical equipment (casts and surgical tape), and repeated skin contact with hands and seating, for instance, chairs and car seats.
Acne mechanica is characterized by inflammatory lesions, including papules, pustules, and nodules.
Treatment involves removing the source of friction or pressure, along with localised treatment such as topical benzoyl peroxide, antibiotics (where indicated based on suspected bacteria), and vitamins (retinoids and nicotinamide).

Occupational Acne

Occupational acne stems from physical contact with industrial chemicals (such as halogenated polycyclic hydrocarbons, coal tar derivatives, wood preservatives), and can be characterized by comedones predominantly.
This condition sometimes has unusual sites of lesions and is more common in middle-aged males.

Acne Excoriee

Acne excoriee describes the condition where people pick pus-filled acne pimples, causing a more aggravated form of the condition.
This is often seen as a means to resolve pimples, leading to an increase in inflamed lesions and potential scarring.
Patients may have no active acne spots but only scratch marks, sores, pigmentation, and scars from picking, which is a form of anxiety, potentially body dysmorphic disorder.
Treatment entails breaking the habit of picking (psychosocial interventions and potentially medications) and using topical treatments (if inflammatory lesions persist) for existing acne.

Drug-Induced Acne

Drug-induced acne can be caused by systemic corticosteroid use (topical can also contribute) as well as various medications, including halogens (iodides, chlorides), antiepileptics, ciclosporin, lithium, and B vitamins, etc.
Characterized by lesions appearing after medication administration.

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Test your knowledge on acne, its characteristics, and the factors contributing to its development. This quiz covers various aspects of acne vulgaris, prevalence, severity classification, and provoking factors. Perfect for students and individuals interested in dermatology.