Acne and Related Disorders — MCQs

A 16-year-old boy presents with multiple inflammatory papules and pustules on his face and chest. He reports that the lesions started appearing about 2 years ago. Examination reveals comedones, inflammatory papules, and pustules primarily on the face and upper trunk. Which of the following mechanisms best explains the pathogenesis of this condition?

Q65

A 28-year-old woman presents with multiple erythematous papules and pustules on her face that worsen with sun exposure and spicy foods. She reports flushing episodes affecting her central face. Examination reveals facial erythema, telangiectasias, and inflammatory papules. Which of the following medications is most appropriate for long-term management?

Q66

Which of the following is the most common side effect of Isotretinoin used for acne vulgaris?

Q67

A 24-year-old woman presents with multiple nodular, cystic, and pustular lesions on her face and shoulders for 2 years. What is the drug of choice for her treatment?

Q68

Which is a specific lesion of acne vulgaris?

Q69

Rhinophyma complicates-

Q70

A 40 year old woman presents with a 2 year history of erythematous papulopustular lesions on convexities of the face. There is a background of erythema & telangiectasia. The most likely diagnosis is –

Acne and Related Disorders Indian Medical PG Practice Questions and MCQs

Question 61: An obese 45-year-old lady who is a chronic smoker came with tender subcutaneous nodules with chronic inflammation with scarring under her left axilla. She is likely to be suffering from:

A. Xeroderma pigmentosum
B. Pyoderma gangrenosum
C. Lipodystrophy
D. Hidradenitis suppurativa (Correct Answer)

Explanation: ***Hidradenitis suppurativa*** - This condition commonly presents with **tender subcutaneous nodules**, chronic inflammation, and scarring, typically in **intertriginous areas** such as the axillae. - Risk factors like **obesity** and **smoking** are highly associated with its development and severity. *Xeroderma pigmentosum* - This is a rare genetic disorder characterized by extreme **photosensitivity** and a high risk of **skin cancer** due to defective DNA repair. - It does not present with tender subcutaneous nodules or chronic inflammation in the axillae. *Pyoderma gangrenosum* - This condition is characterized by rapidly enlarging, painful **ulcerative skin lesions** with undermined borders, not primarily by subcutaneous nodules. - It is often associated with systemic diseases like **inflammatory bowel disease** or **rheumatoid arthritis**. *Lipodystrophy* - This refers to a group of disorders characterized by the selective **loss of adipose tissue**, which can be generalized or partial. - It does not typically involve tender, inflamed subcutaneous nodules or the formation of scars in the axilla.

Question 62: Which of the following is the causative agent for acne fulminans?

A. Staphylococcus aureus
B. Malassezia furfur
C. Propionibacterium acnes (Cutibacterium acnes) (Correct Answer)
D. Streptococcus pyogenes

Explanation: ***Propionibacterium acnes (Cutibacterium acnes)*** - **Acne fulminans** is a severe, ulcerative form of acne that is considered an **autoinflammatory syndrome** rather than a simple bacterial infection - While the exact etiology remains unclear, ***Cutibacterium acnes*** (formerly *Propionibacterium acnes*) plays a significant role in the pathophysiology - It is believed that acne fulminans may result from a **hypersensitivity reaction to *C. acnes* antigens** or an exaggerated immune response to the bacterium - *C. acnes* is the **most relevant microorganism** associated with all forms of acne, including acne vulgaris and severe variants like acne fulminans - Treatment often includes systemic corticosteroids (to control inflammation) combined with isotretinoin *Staphylococcus aureus* - *Staphylococcus aureus* causes **bacterial skin infections** such as folliculitis, impetigo, furuncles, and cellulitis - While secondary bacterial superinfection with *S. aureus* can complicate acne lesions, it is **not the primary organism** associated with acne fulminans *Malassezia furfur* - *Malassezia furfur* (now classified as *Malassezia globosa* or *M. restricta*) is a **yeast** that causes **pityriasis versicolor** and **Malassezia folliculitis** (also called fungal acne or pityrosporum folliculitis) - It is **not involved** in the pathogenesis of acne vulgaris or acne fulminans *Streptococcus pyogenes* - *Streptococcus pyogenes* is a common cause of **streptococcal infections** including pharyngitis, impetigo, erysipelas, and cellulitis - It is **not associated** with acne or acne fulminans pathogenesis

Question 63: An adolescent male presents with severe acne lesions and sinus tracts. Which is the most effective drug for this condition?

A. Minocycline
B. Doxycycline
C. Isotretinoin (Correct Answer)
D. Topical dapsone

Explanation: ***Isotretinoin*** - This patient presents with **severe acne**, likely cystic or nodular, given the mention of "sinus tracts," which often correlates with **acne conglobata**. - **Isotretinoin** is the most effective treatment for severe acne as it targets all four pathogenic factors of acne: **sebaceous gland activity**, **follicular hyperkeratinization**, *C. acnes* proliferation, and inflammation. *Minocycline* - Minocycline is an **oral antibiotic** used for moderate to severe inflammatory acne, primarily due to its anti-inflammatory properties and ability to reduce *C. acnes*. - While effective for some inflammatory acne, it is **less effective than isotretinoin** for severe, nodulocystic acne or acne with sinus tracts and is not a definitive cure. *Doxycycline* - Doxycycline is another **oral tetracycline antibiotic** commonly used for moderate to severe inflammatory acne due to its anti-inflammatory effects and reduction of *C. acnes*. - Similar to minocycline, it is a good option for inflammatory acne but **insufficient for very severe, recalcitrant acne** with sinus tracts, where isotretinoin is superior. *Topical dapsone* - Topical dapsone is an **anti-inflammatory agent** primarily used for mild to moderate inflammatory acne, particularly papules and pustules. - It is **not effective for severe nodulocystic acne** or acne associated with sinus tracts and would not be appropriate as monotherapy for this presentation.

Question 64: A 16-year-old boy presents with multiple inflammatory papules and pustules on his face and chest. He reports that the lesions started appearing about 2 years ago. Examination reveals comedones, inflammatory papules, and pustules primarily on the face and upper trunk. Which of the following mechanisms best explains the pathogenesis of this condition?

A. Bacterial colonization by Propionibacterium acnes
B. Genetic predisposition to follicular keratinization disorders
C. Increased sebum production and follicular hyperkeratinization (Correct Answer)
D. Hormonal influence on sebaceous gland activity

Explanation: ***Increased sebum production and follicular hyperkeratinization*** - This option most comprehensively describes the primary mechanisms of **acne vulgaris** by combining two key pathophysiologic elements: **increased sebum production** (often androgen-driven) and **follicular hyperkeratinization** leading to comedone formation. - The combination of these factors creates an environment conducive to *Propionibacterium acnes* proliferation and subsequent inflammation, leading to the clinical manifestations of papules, pustules, and comedones. *Bacterial colonization by Propionibacterium acnes* - While **bacterial colonization** by *Cutibacterium acnes* (formerly *Propionibacterium acnes*) is crucial in the inflammation of acne, it is a secondary event that occurs *after* sebum overproduction and follicular hyperkeratinization. - *C. acnes* thrives in the anaerobic environment of blocked follicles and metabolizes sebum, leading to the production of pro-inflammatory mediators, but it is not the initial trigger for the process described. *Genetic predisposition to follicular keratinization disorders* - **Genetic predisposition** can influence acne severity and susceptibility, and abnormal follicular keratinization is a component of acne pathogenesis. - However, referring to it broadly as "follicular keratinization disorders" is too general; acne's specific mechanism involves *hyper*keratinization of the follicular epithelium, combined with other factors, making this option less specific and comprehensive than the correct answer. *Hormonal influence on sebaceous gland activity* - **Androgens** significantly stimulate **sebaceous gland activity** and lead to increased sebum production, which is a critical initial step in acne pathogenesis, especially during adolescence. - While hormonal influence is a primary *trigger* for increased sebum, it doesn't encompass the physical blockage of the follicle due to hyperkeratinization, which is another essential component of comedone formation.

Question 65: A 28-year-old woman presents with multiple erythematous papules and pustules on her face that worsen with sun exposure and spicy foods. She reports flushing episodes affecting her central face. Examination reveals facial erythema, telangiectasias, and inflammatory papules. Which of the following medications is most appropriate for long-term management?

A. Topical steroids
B. Oral antihistamines
C. Oral isotretinoin
D. Oral tetracyclines (Correct Answer)

Explanation: ***Oral tetracyclines*** - The patient's symptoms (facial flushing, erythematous papules and pustules, telangiectasias worsening with sun exposure and spicy foods) are classic for **rosacea**. - **Oral tetracyclines** (e.g., doxycycline in sub-antimicrobial doses) are a first-line long-term treatment for the inflammatory papules and pustules of rosacea due to their **anti-inflammatory properties**. *Topical steroids* - While topical steroids can reduce inflammation, their long-term use on the face can actually **exacerbate rosacea**, leading to steroid-induced rosacea and skin atrophy. - They are generally contraindicated for long-term management of rosacea due to potential side effects like **telangiectasias** and rebound flares. *Oral antihistamines* - **Oral antihistamines** are primarily used for allergic reactions and histamine-mediated conditions, such as urticaria. - They do not address the pathogenesis of rosacea's inflammatory papules, pustules, or vascular components and thus are not effective for long-term management. *Oral isotretinoin* - **Oral isotretinoin** is a potent retinoid used for severe, refractory acne, and sometimes for severe granulomatous rosacea. - However, for typical inflammatory rosacea like this case, its significant side effect profile (e.g., teratogenicity, mucocutaneous dryness) makes it less appropriate as a first-line long-term management compared to safer options like tetracyclines. *Topical antifungals* - **Topical antifungals** are used to treat fungal infections (e.g., tinea, candidiasis). - Rosacea is an inflammatory condition and not caused by a fungal infection, so topical antifungals would not be an effective long-term treatment.

Question 66: Which of the following is the most common side effect of Isotretinoin used for acne vulgaris?

A. Xerosis
B. Hair loss
C. Facial erythema
D. Cheilitis (Correct Answer)

Explanation: ***Cheilitis*** - **Cheilitis** (dry, cracked lips) is the most frequently reported side effect due to the drug's effect on sebaceous glands and subsequent reduction in sebum production. - This symptom affects nearly all patients on isotretinoin therapy. *Xerosis* - While **xerosis** (dry skin) is a common side effect of isotretinoin, it is typically less pervasive and severe than cheilitis. - Patients often experience generalized skin dryness, but it usually doesn't affect all patients to the same degree as labial dryness. *Hair loss* - **Hair loss** (alopecia) is a known but less common side effect, usually mild and reversible upon discontinuation of the drug. - It does not affect the majority of patients undergoing isotretinoin treatment. *Facial erythema* - **Facial erythema** (redness) can occur due to skin sensitivity and dryness, but it's not as universal or prominent as cheilitis. - It is more of an indirect effect of the drug, rather than a direct and universal consequence of its mechanism of action.

Question 67: A 24-year-old woman presents with multiple nodular, cystic, and pustular lesions on her face and shoulders for 2 years. What is the drug of choice for her treatment?

A. Isotretinoin (Correct Answer)
B. Azithromycin
C. Doxycycline
D. Acitretin

Explanation: ***Isotretinoin*** - This patient presents with **severe nodulocystic acne**, characterized by multiple nodular, cystic, and pustular lesions, which is the primary indication for oral isotretinoin. - Isotretinoin is a potent systemic retinoid that **reduces sebum production**, inhibits _Propionibacterium acnes_, normalizes keratinization, and has anti-inflammatory effects, leading to significant and often long-term remission. *Azithromycin* - Azithromycin is an **antibiotic** that can be used for inflammatory acne, but it is typically reserved for patients who cannot tolerate or are resistant to other tetracycline-class antibiotics. - While it has anti-inflammatory properties, it is generally **less effective for severe nodulocystic acne** compared to isotretinoin. *Doxycycline* - Doxycycline is a **tetracycline antibiotic** commonly used for moderate to severe inflammatory acne due to its anti-inflammatory effects and ability to reduce _P. acnes_ bacteria. - However, for **severe nodulocystic acne**, systemic antibiotics like doxycycline are often insufficient as monotherapy and **isotretinoin is the preferred treatment** for its superior efficacy in such cases. *Acitretin* - Acitretin is a systemic retinoid primarily used for **severe psoriasis** and other keratinization disorders. - It is **not indicated for the treatment of acne** and has a different safety profile and mechanism of action compared to isotretinoin.

Question 68: Which is a specific lesion of acne vulgaris?

A. Wheals
B. Papules
C. Comedones (Correct Answer)
D. Pustules

Explanation: ***Comedones*** - **Comedones are the pathognomonic (specific) lesion of acne vulgaris** and represent the primary lesion from which all other acne lesions develop - They result from follicular obstruction by sebum and keratin, forming **blackheads (open comedones)** and **whiteheads (closed comedones)** - Formed due to retention of follicular keratinocytes and increased sebum production, leading to characteristic **clogged pores** - Without comedones, a diagnosis of acne vulgaris cannot be made *Papules* - While papules are a common finding in acne vulgaris, they are **secondary inflammatory lesions** that arise from rupture and inflammation of comedones - They are small, solid, elevated lesions <1 cm in diameter representing an inflammatory response to follicular contents - Not specific to acne as papules occur in many other dermatological conditions *Pustules* - Pustules are also secondary inflammatory lesions in acne, representing **papules that have accumulated purulent material (pus)** - They appear as visible collections of pus surrounded by an inflammatory halo - Indicate a more advanced stage of the acne inflammatory process, but are not the defining lesion *Wheals* - **Wheals are NOT a feature of acne vulgaris** and are instead associated with **urticaria (hives)** or allergic reactions - They are transient, erythematous, edematous plaques resulting from histamine release leading to dermal edema - Completely unrelated to the pathophysiology of acne

Question 69: Rhinophyma complicates-

A. Psoriasis
B. Pemphigus
C. Acne rosacea (Correct Answer)
D. Acne vulgaris

Explanation: ***Acne rosacea*** - **Rhinophyma** is a severe manifestation of **rosacea**, characterized by sebaceous gland hypertrophy and thickening of the skin on the nose. - This condition arises from long-standing inflammation and vascular changes typical of advanced rosacea. *Psoriasis* - **Psoriasis** is a chronic inflammatory skin condition characterized by **silvery scales** on erythematous plaques, not sebaceous gland hypertrophy. - It typically affects extensor surfaces and can be associated with joint disease, not rhinophyma. *Pemphigus* - **Pemphigus** is an autoimmune blistering disorder affecting the skin and mucous membranes, not sebaceous glands. - It is characterized by the formation of **flaccid bullae** due to autoantibodies against desmogleins. *Acne vulgaris* - **Acne vulgaris** is a common skin condition involving hair follicles and sebaceous glands, characterized by **comedones**, papules, pustules, and cysts. - While it affects sebaceous glands, it does not typically lead to the severe hypertrophic changes seen in rhinophyma, which is specific to rosacea.

Question 70: A 40 year old woman presents with a 2 year history of erythematous papulopustular lesions on convexities of the face. There is a background of erythema & telangiectasia. The most likely diagnosis is –

A. Polymorphic light eruption
B. Acne vulgaris
C. Acne rosacea (Correct Answer)
D. SLE

Explanation: ***Acne rosacea*** - This condition presents with **erythematous papulopustular lesions**, background **erythema**, and **telangiectasias** predominantly on the convexities of the face, which is a classic presentation for rosacea. - The absence of **comedones** (blackheads/whiteheads) helps differentiate it from acne vulgaris. *Polymorphic light eruption* - This is a recurring skin rash triggered by **sun exposure**, presenting as itchy papules, plaques, or vesicles, usually appearing a few hours after exposure. - Unlike rosacea, it does not typically feature permanent facial erythema or telangiectasias and is more directly linked to UV exposure episodes. *Acne vulgaris* - While it features papules and pustules, **acne vulgaris** is characterized by the presence of **comedones** (blackheads and whiteheads), which are not described in the patient's presentation. - It also does not typically involve the prominent background erythema and telangiectasias seen in rosacea. *SLE* - Systemic lupus erythematosus (SLE) can cause a **malar or 'butterfly' rash** across the nose and cheeks, but it is typically a fixed erythema, sometimes with scaling, and does not usually involve papulopustular lesions or telangiectasias as a primary feature. - SLE often has systemic symptoms (e.g., joint pain, fatigue) that are not mentioned, and skin lesions can be photosensitive but are not typically pustular.

Practice by Chapter

Acne Vulgaris: Pathophysiology

Practice Questions

Acne Vulgaris: Clinical Types

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Acne Vulgaris: Management

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Acne in Special Populations

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Rosacea

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Perioral Dermatitis

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Hidradenitis Suppurativa

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Acne Keloidalis Nuchae

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Acne Scarring and Its Management

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Psychological Aspects of Acne

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Diet and Acne

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Newer Therapies in Acne Management

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