Acne

Acne
By: David M. Bracciano, D.O.

Acne Vulgaris
* Chronic inflammatory disease of the pilosebaceous follicles
* Comedones, papules, pustules, cysts, nodules, and often scars
* Face, neck, upper trunk, and upper arms
* Disease of the adolescent
* 90% of all teenagers
* May also begin in twenties
* Usually involution by 25
* Occurs primarily in oily{seborrheic} areas of the skin
* Face occurs; cheeks> nose>forehead>chin
* Ears; comedones in concha, cysts in lobules
* Retroauricular and nuchal cysts

Comedo
* Commonly known as the blackhead
* Basic lesion of acne
* Produced by hyperkeratosis of the lining of the follicles
* Retention of keratin and sebum
* Plugging produced by the comedo dilates the mouth of the follicle
* Papules are formed by inflammation around the comedones

Severity of Acne
* Typical mild acne; comedones predominate
* More severe cases; pustules and papules predominate, heal with scar if deep
* Acne Conglobata; suppurating cystic lesions predominate, and severe scarring results
Types
* Acne comedo; mild case were eruption is composed almost entirely of comedones on an oily skin
* Papular acne; inflammatory papules, most common in young men with coarse, oily skin
* Atrophic acne; residual atrophic pits and scars
Etiology
* Keratin plug in lower infindibulum of hair follicle
* Androgenic stimulation of sebaceous, proliferation of propionbacterium acnes which metabolizes sebum to produce free fatty acids
Pathogenesis
* Disruption of the follicular epithelium permits discharge of the follicular contents into the dermis
* Causes the formation of inflammatory papules, pustules, and nodulocystic lesions
* FFA are chemotactic to components of inflammation
* Effects of tetracycline are obtained by the reduction of FFA
* Antibiotics do not produce involution of the inflammatory lesions present, but inhibit the formation of new lesions
* Topical retinoic acid acts on keratinization, causing horny cells to lose their stickiness
* Androgens enlarge the sebaceous glands
* In women consider hyperandrogenic state

Histology
Treatment
Antibacterials
Tetracyclines
Minocycline
Bacterial Resistance
Oral Contraceptives
Hormonal Therapy
Isotretinoin
Topical Treatment
Benzoyl Peroxide
Topical Retinoids
Topical Antibacterials
Other Topicals
Surgcial Treatment
Intralesional Corticosteroids
Complications of Acne
Acne Conglobata
Acne Fulminans
SAPHO Syndrome
Tropical Acne
Premenstrual Acne
Preadolescent Acne
Neonatal Acne
Infantile Acne
Acne Venenata
Acne Cosmetica
Acne Detergicans
Acne Aestivalis
Excoriated Acne
Acneiform Eruptions
Gram Negative Folliculitis
Acne Keloidalis
Hiradenitis Suppurativa
Perifolliculitis Capitis Abscedens
Acne vs. Rosacea
Ocular Rosacea
Granulomatous Rosacea
Rosacea Etiology
Differential Diagnosis Rosacea
Inflammatory rosacea
Rosacea Treatment
Rosacea Rhinophyma
Pyoderma Faciale
Perioral Dermatitis

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Dermatology

Dermatology
By: Katrice L. Herndon, MD
Internal Medicine/Pediatrics

Acne Vulgaris

* Acne is a self-limited disorder primarily of teenagers & young adults.
* Acne is a disease of pilosebaceous follicles.
* 4 factors are involved:
* External Factors that contribute to Acne
* Acne vulgaris typically affects those areas of the body that have the greatest number of sebaceous glands:
* In addition to the typical lesions of acne vulgaris, scarring and hyperpigmentation can also occur.
* Hyperpigmentation is most common in patients with dark complexions
* Classification of Acne

Acne Vulgaris What is this?

Acne Rosacea
* Rosacea is an acneiform disorder of middle-aged and older adults.
* Characterized by vascular dilation of the central face, including the nose, cheek, eyelids, and forehead.
* The cause of vascular dilatation in rosacea is unknown.
* The disease is chronic.
* rosacea is a chronic disorder characterized by periods of exacerbation and remission.
* Increased susceptibility to recurrent flushing reactions that may be provoked by a variety of stimuli including hot or spicy foods, drinking alcohol, temperature extremes, and emotional reactions.
* The earliest stage of rosacea is characterized by facial erythema and telangiectasias.
* Patients with rosacea may develop severe sebaceous gland growth that is accompanied by papules, pustules, cysts, and nodules.
Allergic Contact Dermatitis
Psoriasis
Psoriasis Treatment
Vitiligo
Pityriasis Rosea
Cellulitis
Erysipelas
Ecthyma
Treatment
Tinea Vesicolor
Cutaneous Warts
Differential Diagnosis
Secondary Syphilis
Treatment
Herpes Zoster
Treatment
Actinic Keratosis
References

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Children and Adolescents with Bipolar Disorder

Children and Adolescents with Bipolar Disorder
By: Boris Birmaher MD
Department of Child Psychiatry
Western Psychiatric Institute and Clinic
University of Pittsburgh Medical Center

Do children and adolescents have Bipolar Disorder (BP)?
Bipolar Disorder in Youth
Clinical Manifestations
Bipolar Disorder – Classical Clinical Manifestations
DSM-IV Manic episode
DSM-IV Hypomanic episode
Bipolar Disorder Clinical Manifestations
DSM-IV Major depression episode
Subtypes of Bipolar Disorder
Bipolar I disorder
o Manic
o Depressed
o Mixed
o Rapid cycling
o Psychotic

Bipolar II disorder (hypomania and MDD episodes)
Cyclothymic disorder (hypomania and mild depressions)
Bipolar Not Otherwise Specified (NOS)
Difficulties Diagnosing Pediatric Bipolar Disorder
Developmental Manifestations of Manic Symptoms in Children
To clarify the diagnosis:
Retrospective Studies of Adults with BP-I
Frequent Prodromal Features Before Onset of BP-I
WPIC Child Mood & Anxiety Disorder Outpatient Clinic
Hamilton Depression Scores
Child & Adolescent Bipolar Services (CABS)
Course and Outcome of Bipolar Youth (COBY)
Demographics (COBY) (Cont’)
COBY Subjects – Lifetime Presence of Psychiatric Diagnoses
Prepubertal Bipolar Disorder
In General, BP in youth can presented as:
* Typical phenotype (DSM Bipolar I and II)
o Many have frequent episodes and mixed bipolar episodes
* Typical phenotype but for a short time (DSM-IV BP NOS or rapid cycling)
o Many have frequent episodes and mixed episodes
* Broad phenotype (DSM-IV BP NOS or rapid cycling)
Clinical Manifestations - Questions?
In addition to different subtypes of BP disorder, severity of symptoms, and rapid changes in symptomatology it is difficult to diagnose BP in children because:

1) Coexisting disorders
2) Overlap in symptoms with other disorders
Bipolar Disorder - Comorbidity
Bipolar Disorder - Differential Diagnoses
Diagnostic Overlap between Mania & ADHD
DSM-IV Criteria
Hyperactivity / goal-directed activity
DSM-IV Criteria
Distractibility
Inflated self-esteem / grandiosity Commonly associated
Epidemiology
BP-I Natural Course Multicenter
Pilot Study
BPD-I Natural Course
Course and Outcome of Bipolar Youth (COBY)
Diagnosis at Intake:
Bipolar Disorder - Natural Course
Natural Course General Conclusions
Sequela
Bipolar Disorder - Sequela
Pediatric Bipolar Disorder - WPIC Mood & Anxiety D/O Outpatients
Pediatric Bipolar Disorder Oregon Study
Predictors of Bipolar Disorder
Bipolar Disorder- Family Studies
Children of Parents with BP
NIMH-Bipolar Offspring Study (BIOS)
Bipolar Offspring Study (BIOS) Instruments
BIOS - SAMPLE
BIOS - Demographics – Offspring Preliminary Analyses
BIOS- Probands
Lifetime Disorders
BIOS- Offspring of BP parents-Lifetime Disorders- Definite/Probable
Any Substance/alcohol
Offspring of BP vs. Controls-CBCL Scores
Treatment
Bipolar Disorder - Psychoeducation
Pharmacological Treatment
Divalproex Treatment for Bipolar Disorder
Lithium for Adolescents with Acute Mania
Side Effects/Laboratory Tests Prior and During Psychopharmacological Treatment
Check for presence of “side effects” prior to starting treatment
Bipolar Depression - Treatment
Psychosocial Treatments
Family-Focused Treatment of Bipolar Disorder
Family-Focused Treatment for Adolescent Bipolar Patients
Interpersonal and Social Rhythms Therapy (IPSRT)
Bipolar Disorder – Treatment Other Considerations
Bipolar Disorder- Conclusions

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