Professional Documents
Culture Documents
Module Instructions
The following module contains a number
of blue, underlined terms which are
hyperlinked to the dermatology glossary,
an illustrated interactive guide to clinical
dermatology and dermatopathology.
We encourage the learner to read all the
hyperlinked information.
2
Case One
Jim Reynolds
swer: c
How would you describe Jims skin exam?
Acne Vulgaris
Acne Vulgaris
Moderate
omedonal acne
without evidence of
carring.
ote the mild postnflammatory
yperpigmentation.
Acne Vulgaris
Acne Vulgaris
Severe nodulocystic
acne with presence of
scarring
nswer: e
Which is (are) related to the pathogenesis
of acne vulgaris?
a.
b.
c.
d.
e.
Oral antibiotics
Topical benzoyl peroxide
Topical retinoid creams
All of the above
swer: d
Which of the following agents are effective
n treating acne vulgaris?
a.
b.
c.
d.
Oral antibiotics
Topical benzoyl peroxide
Topical retinoid creams
All of the above
Acne Scarring
cne should be
eated aggressively
o avoid permanent
carring and cysts
efer patients with
fficult to control
cne or the presence
f scarring to
ermatology
Topical Retinoids
(tretinoin, all trans retinoic acid)
Benzoyl Peroxide
Topical Antibiotics
Oral Antibiotics
Minocycline pigmentation
Oral Isotretinoin
swer: b
Which of the following treatment regimens was
rescribed for Jims acne?
a. Isotretinoin 1mg/kg/day divided BID (main side effects
include xerosis, cheilitis, elevated liver enzymes,
hypertriglyceridemia)
b. Minocycline 100mg po BID (can cause vestibular toxicity,
manifested as dizziness, ataxia, nausea and vomiting)
c. Tetracycline 500mg po once daily (common side effects
include GI upset and photosensitivity)
d. None of the above
Patient Education
Case Two
Ms. Emily Garcia
ir loss noted
frontal and
rietal scalp.
swer: a
Ms. Garcia was given spironolactone and her
cne resolved. Why did this medication work?
a. Spironolactone has anti-androgenic effects
b. Spironolactone has anti-comedonal activity (not
true)
c. Spironolactone when used appropriately has
anti-bacterial activity (not true)
d. The diuretic effect of spironolactone eliminated
sodium resulting in less sebum (not true)
Cushing Syndrome
Gram negative folliculitis
Polycystic ovarian syndrome
S. aureus folliculitis
swer: c
Based on the history and exam, what is the most
kely diagnosis?
Androgens in Acne
Oral contraceptives
The following oral contraceptives have been
approved by the FDA for treatment of acne: Yaz,
Ortho Tri-cyclen, Estrostep
There is good evidence and consensus opinion that
other estrogen-containing OCPs are also effective
Case Three
Ms. Sherri Johnson
Bacterial folliculitis
Pellagra from niacin deficiency
Rosacea
Seborrheic dermatitis
Systemic lupus erythematosus
wer: c
hat is the most likely diagnosis?
Bacterial folliculitis (Would expect multiple follicular pustules and
papules for a shorter duration, without background of erythema)
Pellagra from niacin deficiency (Erythema and edema which
fade with a dusky brown-red coloration on sun-exposed areas.
Lesions become hyperkeratotic and scaly)
Rosacea
Seborrheic dermatitis (Would expect erythematous patches and
plaques with greasy, yellowish scale accentuated on the central
face)
Systemic lupus erythematosus (Rash of SLE does not present
with pustules)
Alcohol
Heat/hot beverages
Hot, spicy foods
Sunlight
All of the above
nswer: e
Which of the following might trigger Ms.
Johnsons rosacea?
a.
b.
c.
d.
e.
Alcohol
Heat/hot beverages
Hot, spicy foods
Sunlight
All of the above
Rosacea Triggers
Alcohol
Sunlight
Hot beverages (heat)
Hot, spicy food
If it makes you flush it can flare rosacea
Includes emotional stress
rythematotelangietatic Rosacea
Erythema and
telangiectasias
scattered on the nose
and cheeks.
There are no
papules, pustules, or
comedones present.
Papulopustular Rosacea
Erythema with papules
and pustules on the
nose and chin.
Patient also has
erythematous patches
on the cheeks bilaterally.
Phymatous Rosacea
Facial erythema,
scattered papules,
pustules on the nose,
forehead, cheeks and
chin. Thickened,
highly sebaceous skin.
This patient also has
severe rhinophyma.
Rosacea Treatment
sotretinoin is
considered in severe
cases
These patients should
be referred to a
dermatologist
Surgical approaches are
used to treat
rhinophyma
Back to
Case Three
a.
b.
c.
d.
Avoidance of alcohol
Oral tetracycline
Use sunscreen daily
All of the above
swer: d
Which of the following
reatments would you
ecommend for Ms. Johnson?
a.
b.
c.
d.
Avoidance of alcohol
Oral tetracycline
Use sunscreen daily
All of the above
nswer: False
The medical management of rosacea may
not diminish the erythema
Laser therapy may be helpful for
telangiectasias and erythema
Photoprotection is also helpful in treating
the erythema of rosacea
Acknowledgements
References
ger T, Hong J, Saeed S, Colaco S, Tsang M, Kasper R. The Websed Illustrated Clinical Dermatology Glossary. MedEdPORTAL; 2007.
ailable from: www.mededportal.org/publication/462.
mes WD, Berger TG, Elston DM, Chapter 13. Acne (chapter).
drews Diseases of the Skin Clinical Dermatology. 10th ed.
References
horge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD,
nningham FG, "Chapter 16. Amenorrhea" (Chapter). Schorge JO,
haffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG:
iams Gynecology:
://www.accessmedicine.com/content.aspx?aID=3156564.
auss JS, Krowchuk DP, Leyden JJ, Lucky AW, Shalita AR, Sigfried EC, et
Guidelines of care for acne vulgaris management. J AM Acad Dermatol.
7;56:651-63.