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Derm Clin Med II Exam with correct answers
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Derm Clin Med II Exam with correct answers Derm Clin Med II Exam with correct answers Derm Clin Med II Exam with correct answers
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Derm Clin Med II ExamA 14-year-old boy with dozens of erythematous papules, pustules, and cysts. On closer examination,
he also has atrophic scars on the lateral forehead, consistent with permanent scarring from previous
acne lesions.
This patients diagnosis and treatment would be? - CORRECT ANSWER Acne Vulgaris
Noninflammatory - open or closed comedones
Inflammatory - papulopustular
Treatment is based on diagnosis
Comedonal Acne - topical retinoids (Tretinoin, 0.025% twice weekly) Benzoyl peroxide gel.
- if not tolerant to tretinoin can use Adapalene gel 0.5% QD/BID
Mild inflam:
Erythromycin or Clindamycin + Benzoyl Peroxide gels - can use Tretinoin at night.
Moderate: comedones larger papules -Doxycycline 100mg BID, minocycline 50-100 mg QD/BID,
Cephalexin 500 BID x 3 months.
+ Benzoyl peroxide
Severe:
Oral Isotretinoin (vitamin A analog) (if not pregnant or might become) ipledge
1st line Treatment for Comedonal Acne - CORRECT ANSWER Comedonal Acne - topical retinoids
(Tretinoin, 0.025% twice weekly) Benzoyl peroxide gel.
- if not tolerant to tretinoin can use Adapalene gel 0.5% QD/BID
,What are 4 main reasons acne occurs? - CORRECT ANSWER 1. Increased sebum production (more
androgens)
2. Clogged sebaceous glands (d/t proliferation of the follicular keratinocytes)
3. Propionibacterium acne overgrowth (cutibacterium)
4. Inflammation
What bacteria causes most acne? - CORRECT ANSWER Cutibacterium acnes (propionibacterium
acnes)
What medications can worsen or induce acne? - CORRECT ANSWER Lithium
Steroids
Oral contraceptives
Androgens
Open Comedones are - CORRECT ANSWER Blackheads
-Seen in Acne Vulgaris, are small follicular papules containing a central black keratin plug
<5mm domed shaed, smooth.
Closed Comedones - CORRECT ANSWER White heads
-Seen in Acne Vulgaris, are follicular papules without a visible central plug.
<5mm papules.
Nodular/Cystic Acne is characterized by? - CORRECT ANSWER Hard lesions found deep in the skin
where the hair follicle becomes plugged with dead skin cells (Painful/tender)
Severity/grading of inflammatory
acne - CORRECT ANSWER Mild: Comedones, small amount of papules/pustules
Moderate: comedones, large # of papules/pustules
,Severe: nodules (>5mm) or cystic acne)
1st line treatment for mild papulopustular acne (inflammatory) - CORRECT ANSWER Mild inflam:
Erythromycin or Clindamycin (topical) + Benzoyl Peroxide gels - can use Tretinoin at night.
Last line for severe acne therapy? - CORRECT ANSWER Acutnane (isotretinoin)
Teratogenic (vitamin A analog) ipledge, 2 forms of OCPs
What differentiates acne vs rosacea - CORRECT ANSWER Comedones are a hallmark of acne
vulgaris that are NOT seen with rosacea.
A 35-year-old woman comes to your office complaining of "pimples in my armpit." She said that it
first appeared five days ago and they are itchy and mildly painful. She denies fever, nausea,
vomiting, and recent travel - she has never had any prior lesions like this in the past. She admits to
going to a party where she used a hot tub two weeks ago. Both axillae have short, 2-mm hairs, and
lack lymphadenopathy. You note multiple papules and pustules in the right axillae. The lesions are
mildly tender to palpation.
What is patients diagnosis and the organism responsible? - CORRECT ANSWER Folliculitis
-Pseudomonas aeruginosa - most common cause of hot-tub related folliculitis.
Treatment: Warm compress, antibacterial (chlohexidine), topical mupirocin or benzoyl peroxide
*Hot tub folliculitis usually resolves without treatment*
Patient presents with itching and burning in their axilla, on exam their are papules with surrounding
erythema that are tender to touch. You suspect folliculitis, a wet mount (KOH) Majocchi granuloma.
What is the treatment - CORRECT ANSWER Fungal folliculitis
Treat: oral terbinafine
, Folliculitis is - CORRECT ANSWER Superficial infection of the hair follicle -> small pustules/papules
with surrounding erythema
What is the most common cause of folliculitis - CORRECT ANSWER Staph aureus
A 25-year-old female presents with an itchy rash consisting of erythematous follicular pustules on
the inner thighs bilaterally. The folliculitis is most likely caused by which bacteria? - CORRECT
ANSWER Staphylococcus aureus
A type of noninfectious folliculitis caused ingrown hairs from shaving agaisnt the grain - CORRECT
ANSWER Pseudofolliculitis barbae
First line treatment for folliculitis - CORRECT ANSWER Warm Compress
Antibacterial soap (chlorhexidine)
Topical antibiotics ( mupirocin)
These are 1st line
Also topical clindamycin or erythromycin works well in mild infectious folliculitis.
Treatment to moderate cystic inflammatory (papular) acne
acne vulgaris - CORRECT ANSWER Moderate: Doxycycline 100mg BID
minocycline 50-100 mg QD/BID
Cephalexin 500 BID x 3 months.
+ Benzoyl peroxide
Severe cystic acne treatment - CORRECT ANSWER Severe:
Oral Isotretinoin (Accutane)
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