american osteopathic college of dermatology€¦ · •demodex folliculorum, staphylococcus...
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Rosanne Paul, DO
Madeline Tarrillion, DO
Miesha Merati, DO
Gregory Delost, DO
Emily Shelley, DO
Jenifer R. Lloyd, DO, FAAD
American Osteopathic College of Dermatology
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Disclosures
• We do not have any relevant disclosures.
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Cleveland before June 2016
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Cleveland after June 2016
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Overview• Acne Vulgaris
– Pathogenesis
– Clinical Features
• Variants
– Treatments
• Rosacea
– Pathogenesis
– Classification & clinical features
• Rosacea-like disorders
– Treatment
• Folliculitis & other follicular disorders
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Acne vulgaris
Bolognia et al. Dermatology. 2012.
• Pathogenesis
• Multifactorial
• Genetics – role remains uncertain
• Sebum – hormonal stimulation
• Comedo
• Inflammatory response
• Propionibacterium acnes
• Hormonal influences
• Diet
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Acne vulgaris
Bolognia et al. Dermatology. 2012.
• Clinical Features
• Face & upper trunk
• Non-inflammatory lesions
• Open & closed comedones
• Inflammatory lesions
• Pustules, nodules & cysts
• Post-inflammatory hyperpigmentation
• Scarring
• Pitted or hypertrophic
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Bolognia et al. Dermatology. 2012.
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Acne variants
Bolognia et al. Dermatology. 2012.
• Acne fulminans
• Acne conglobata
• PAPA syndrome
• Solid facial edema
• Acne mechanica
• Acne excoriée
• Drug-induced
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Acne variants
Bolognia et al. Dermatology. 2012.
• Occupational
• Chloracne
• Neonatal acne (neonatal cephalic pustulosis)
• Infantile acne
• Endocrinological abnormalities
• Apert syndrome
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Bolognia et al. Dermatology. 2012.
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Acne variants
Bolognia et al. Dermatology. 2012.
• Acneiform eruptions
• Tropical acne
• Radiation acne
• “Pseudoacne” of the transverse nasal crease
• Idiopathic facial aseptic granuloma
• Childhood flexural comedones
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Bolognia et al. Dermatology. 2012.
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Treatment
Zaenglein et al. JAAD. 2016.
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Rosacea
Two et al. JAAD. 2015.
• Pathogenesis
• Unknown and remains controversial
• Dysregulation of the innate immune system
• Increased expression cathelicidiin (LL-37), AMP, kallikrein 5 (KLK5)
• Microorganisms
• Demodex folliculorum, Staphylococcus epidermidis, Helicobacter pylori, Baccilus oleronius
• UV light radiation
• Neurogenic dysregulation
• Abnormal barrier function
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Rosacea
Bolognia et al. Dermatology. 2012.
• Classification & clinical features
• Erythematotelangiectatic (ETR)
• Papulopustular (PPR)
• Phymatous
• Ocular
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Rosacea-like disorders
Bolognia et al. Dermatology. 2012.
• Lupus miliaris disseminata facei
• Roscea fulminans
• Morbihan’s disease
• Periorificial dermatitis
• Rosaceiform dermatitis
• Steroid-induced rosacea
• Pityriasis folliculorum
• Haber’s syndrome
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Treatment
Bolognia et al. Dermatology. 2012.
• Educate patient on the chronic and intermittently flaring nature of this skin condition
• Based on subtype and severity
• ETR
• PPR
• Phymatous
• Ocular
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Treatment of rosacea-like disorders
Bolognia et al. Dermatology. 2012.
• Morbihan’s Disease
• Periorificial dermatitis
• Rosaceiform dermatitis
• Steroid-induced rosacea
• Pityriasis folliculorum
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Folliculitis
Bolognia et al. Dermatology. 2012.
• Superficial folliculitis
• Eosinophilic folliculitis
• AIDS-associated eosinophilic folliculitis
• Eosinophilic pustular folliculitis of infancy
• Disseminated and recurrent infundibulofolliculitis
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Treatment
Bolognia et al. Dermatology. 2012.
• Superficial folliculitis
• Eosinophilic folliculitis
• AIDS-associated eosinophilic folliculitis
• Eosinophilic pustular folliculitis of infancy
• Disseminated and recurrent infundibulofolliculitis
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Folliculitis
Bolognia et al. Dermatology. 2012.
• Deep folliculitis
• Sycosis
• Pseudofolliculitis barbae
• Acne keloidalis
• Follicular occlusion tetrad
• Hidradenitis suppurativa
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Treatment
Bolognia et al. Dermatology. 2012.
• Deep folliculitis
• Sycosis
• Pseudofolliculitis barbae
• Acne keloidalis
• Follicular occlusion tetrad
• Hidradenitis suppurativa
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Other follicular disorders
Bolognia et al. Dermatology. 2012.
• Disorders of follicular keratinization
• Erythromelanosis follicularis faciei
• Keratosis pilaris atrophicans
• Lichen spinulosus
• Phrynoderma
• Trichostasis spinulosa
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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Bolognia et al. Dermatology. 2012.
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#ClevelandAgainstTheWorld
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Resources
• McMichael, Amy, et al. “Folliculitis and Other Follicular Disorders.” Dermatology, by
Jeal L. Bolognia et al., 3rd ed., Elsevier Saunders, 2012, pp. 571-585.
• Powell, Frank C. and Siona Ni Raghallaigh. “Rosacea and Related Disorders."
Dermatology, by Jean L. Bolognia et al., 3rd ed., Elsevier Saunders, 2012, pp. 561-
569.
• Two, Aimee M., et al. "Part I. Introduction, categorization, histology, pathogenesis and risks factors." Journal of the American Academy of Dermatology, vol. 72, no. 5, May 2015, pp. 749-58, www.jaad.org/article/S0190-9622(14)01875-1/fulltext. Accessed 11 Feb. 2017.
• Zaenglein, Andrea L., et al. "Guidelines of care for management of acne vulgaris." Journal of the American Academy of Dermatology, vol. 74, no. 5, May 2016, pp. 945-73, www.jaad.org/article/S0190-9622(15)02614-6/fulltext. Accessed 11 Feb. 2017.
• Zaenglein, Andrea L., and Diane M. Thioboutot. "Acne Vulgaris." Dermatology, by
Jean L. Bolognia et al., 3rd ed., Elsevier Saunders, 2012, pp. 545-59
.