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Physician Assistant Exam: Types of Acne

Acne is a common issue that affects many people and will be covered on the Physician Assistant Exam (PANCE). Acne comes in two basic flavors for the test: acne rosacea and acne vulgaris.

Acne rosacea

Acne rosacea is a maculopapular rash on the face and cheeks that can turn the affected area bright red. It’s more common in young to middle-aged females. Common presenting symptoms include a reddened face, especially the cheeks and nasolabial fold. The nose can be red, and the affected skin can burn and itch.

In severe cases, you may see rhinophyma, which is skin thickening associated with irregular contours occurring on the nose. In addition to papular lesions, you can see small, dilated blood vessels called telangiectasias.

The cause of rosacea is unknown, although it can be triggered by the extremes of weather and also by certain foods and chemicals, such as caffeine. The initial treatment is usually the combination of a topical metronidazole such as metronidazole gel (MetroGel) in addition to an oral doxycycline (Vibramycin).

The lesion of rosacea is sometimes confused with the butterfly macular rash of systemic lupus erythematosis. The big difference is that lupus spares the nasolabial fold.

Acne vulgaris

Acne vulgaris (common acne) can make the affected person use vulgar language. Acne vulgaris is the acne that everyone’s familiar with. It’s characterized by many types of skin lesions on the face. From pimples to papules to lumps to bumps, it’s all there.

Acne vulgaris is actually a disease of the pilosebaceous follicles. Factors involved in this condition include thickening of the follicles, increased production of an oily substance (sebum) by the sebaceous glands, and increased inflammation. A very high-sugar diet and some dairy products can cause an acne flare.

The treatment is good hygiene. Avoid pimple picking, which can only lead to scarring. Medications for treating acne are topical and oral. For really bad flares, antibiotics include doxycycline or the macrolides. Retinoic acid derivatives can be prescribed in topical form. In addition, benzoyl peroxide is commonly prescribed for mild to moderate acne.

Isotretinoin (Amnesteem), a prescription medication used to treat acne, has some side effects that you need to be aware of. They include photosensitivity and alopecia as well as inflammatory bowel disease and elevated liver function tests. Isotretinoin is highly teratogenic (category X). Although isotretinoin is a commonly prescribed drug, its significant side effect profile requires prescribers to undergo special training before treating a patient.

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