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Follicular skin diseases

Acne key points test

To make sure you have understood the key points of this section, choose the best option(s):

Which of the following lesions arise in acne vulgaris? * Vesicles * Nodules * Plaques *! Papules Explanation: Acne vulgaris is characterized by comedones and inflammatory papules and pustules. Comedonal acne has a predominance of: #! Uninflamed lesions # Papules and pustules # Nodules and cysts #! Follicles plugged with sebum and keratin Explanation: Comedones are uninflamed "blackheads" and "whiteheads", which are hair follicles plugged with sebum and keratin. There is scientific evidence that which of the following factors aggravate acne? # Eating carrots #! Locally applied petroleum jelly #! 5-α testosterone # Hypercholesterolaemia Explanation: Although many acne sufferers attribute flares to dietary factors, chocolate has not been proved to be responsible. However there have been laboratory and clinical studies confirming that occlusive emollients may aggravate acne. Acne often develops at puberty in response to locally active androgens. It is not associated with disorders of lipid metabolism. Sebum production is greater in which circumstances? #! Increased 5-α reductase activity #! Parkinson’s disease # Pre-pubertal females # Hypertriglyceridaemia Explanation: Seborrhoea is provoked by androgens; type 1 5-α reductase in the skin converts less active androgens into testosterone and 5-α testosterone (DHT). It is not known whether Parkinson’s disease causes seborrhoea or if the skin is oily because there is a reduction in the activity of facial musculature. Hypertriglyceridaemia does not result in seborrhoea. Inflammatory acne lesions are due to which of the following factors? #! Inflammatory mediators released from sebaceous duct cells # Circulating hypertriglyceridaemia #! Bacterial lipases break down triglycerides into free fatty acids #! Squeezing pimples, which ruptures the follicle wall Explanation: Inflammatory acne lesions result from inflammatory mediators released by sebaceous duct cells and bacteria, and rupture of the sebaceous duct. Nodulocystic acne should be referred to a dermatologist for: *! Isotretinoin capsules * Dexamethasone tablets * Cyst removal by dermabrasion * Methotrexate tablets Explanation: Nodulocystic acne is unsightly and may cause scarring and necessitates prompt referral to a dermatologist for specialist care, usually including oral isotretinoin. Individual cysts are sometimes treated with intralesional steroid injections or excision. Dexamethasone is rarely prescribed for acne. The combination of severe acne with fever, arthralgias and malaise is known as: * Acne conglobata *! Acne fulminans * Hidradenitis suppurativa * Acne keloidalis Explanation: Acne fulminans is a rare and very severe form of acne conglobata associated with systemic symptoms including fever, arthralgias, malaise and weight loss. Chronic purulent discharging nodules in the groin and axillae may be due to: * Acne conglobata * Acne fulminans *! Hidradenitis suppurativa * Acne keloidalis Explanation: Hidradenitis suppurativa causes tender nodules, fluctuant cysts, discharging abscesses, sinuses and scarring in the axillae, submammary areas, buttocks and groin.