Acne and Related Disorders — MCQs

An 18-year-old man has facial and upper back lesions that have waxed and waned for the past 6 years. On physical examination, there are 0.3- to 0.9-cm comedones, erythematous papules, nodules, and pustules most numerous on the lower face and posterior upper trunk. Other family members have been affected by this condition at a similar age. The lesions worsen during a 5-day cruise to the Adriatic. Which of the following organisms is most likely to play a key role in the pathogenesis of these lesions?

Acne and Related Disorders Indian Medical PG Practice Questions and MCQs

Question 71: Skin manifestations of PCOS are all except

A. Alopecia
B. Seborrheic dermatitis (Correct Answer)
C. Acne
D. Hirsutism

Explanation: ***Seborrheic dermatitis*** - While general skin health can be affected by hormonal imbalances, **seborrheic dermatitis** is primarily linked to an inflammatory response to the yeast *Malassezia* and is not a direct or common skin manifestation of **PCOS**. - Its presence is more coincidental than directly causal in the context of PCOS. *Alopecia* - **Androgenetic alopecia** (female pattern hair loss) is a common manifestation of **PCOS** due to elevated **androgen levels**, leading to thinning hair on the scalp. - This symptom is directly linked to the hormonal dysregulation characteristic of the syndrome. *Acne* - **Acne vulgaris** is frequently seen in **PCOS** patients due to increased **androgen production**, stimulating sebaceous glands and leading to oily skin and breakouts. - It is a prominent dermatological sign of hyperandrogenism in PCOS. *Hirsutism* - **Hirsutism**, defined as excessive growth of coarse, dark hair in a male-like pattern, is a hallmark clinical sign of **hyperandrogenism** in **PCOS**. - It results from increased sensitivity of hair follicles to androgens or elevated androgen levels.

Question 72: Adapalene is used in treatment of:

A. Atopic dermatitis
B. Psoriasis
C. Acne vulgaris (Correct Answer)
D. All of the options

Explanation: **Acne vulgaris** - **Adapalene** is a **topical retinoid** primarily used for the treatment of **acne vulgaris**. - It works by modulating **cell differentiation**, **keratinization**, and **inflammatory processes** in the skin, which helps prevent the formation of **comedones**. *Atopic dermatitis* - Treatment for **atopic dermatitis** typically involves **topical corticosteroids**, **calcineurin inhibitors**, and **emollients** to reduce inflammation and itching. - **Adapalene** is not a primary treatment for atopic dermatitis and may even cause skin irritation in patients with compromised skin barriers. *Psoriasis* - **Psoriasis** treatment often includes **topical corticosteroids**, **vitamin D analogs** (e.g., calcipotriene), and sometimes **systemic therapies** or **biologics**. - While other retinoids (e.g., **tazarotene**) can be used for psoriasis, adapalene is not a first-line treatment for this condition. *All of the options* - This option is incorrect because adapalene is specifically indicated for **acne vulgaris** and is not a primary or recommended treatment for **atopic dermatitis** or **psoriasis**. - The distinct mechanisms and conditions for which these skin diseases are treated make it unlikely for one drug to be indicated for all three.

Question 73: Which is the most commonly prescribed first-line oral antibiotic for moderate to severe acne vulgaris?

A. Co-triamoxazole
B. Penicillin
C. Tetracycline
D. Minocycline (Correct Answer)

Explanation: ***Minocycline*** - **Minocycline** is a **tetracycline derivative** and is frequently used as a first-line oral antibiotic for moderate to severe acne due to its **lipophilicity** and good tissue penetration. - It exhibits **anti-inflammatory** properties in addition to its direct antibacterial effects against *Cutibacterium acnes* (formerly *Propionibacterium acnes*). *Co-triamoxazole* - **Co-triamoxazole** (trimethoprim/sulfamethoxazole) is an antibiotic combination generally reserved for acne that has been unresponsive to other treatments due to concerns about **adverse effects** and development of resistance. - It is not typically considered a **first-line agent** for acne vulgaris due to its broader spectrum of activity and potential for significant side effects like **Stevens-Johnson syndrome**. *Penicillin* - **Penicillin** is effective against many bacterial infections, but it has **limited efficacy** against *Cutibacterium acnes*, the primary bacterium implicated in acne vulgaris. - It is not routinely used for the treatment of **acne vulgaris** due to its poor targeting of the causative organisms and the availability of more effective antibiotics. *Tetracycline* - While **tetracycline** is an older antibiotic that was widely used for acne, its efficacy is often less than newer tetracycline derivatives like minocycline and doxycycline. - It requires **dosing precautions** such as taking it on an empty stomach and avoiding dairy, which can affect patient adherence compared to newer options.

Question 74: A girl about to marry has comedonal acne. Drug to treat such a case is:

A. Topical antibiotic
B. Retinoids (Correct Answer)
C. Estrogen
D. Benzoyl peroxide

Explanation: ***Retinoids*** - **Topical retinoids** (e.g., tretinoin, adapalene) are the gold standard for comedonal acne as they normalize **follicular keratinization** and prevent microcomedone formation. - Being **Category C in pregnancy**, topical retinoids require **contraception counseling** for women of childbearing age but are still first-line treatment with proper precautions. *Benzoyl peroxide* - **Benzoyl peroxide** has mild comedolytic properties but is primarily effective for **inflammatory acne** due to its antimicrobial action against *Cutibacterium acnes*. - Less effective than retinoids for purely **comedonal acne** as it doesn't address the core pathology of abnormal keratinization. *Estrogen* - **Hormonal therapy** with estrogen-containing contraceptives reduces sebum production by suppressing androgens but takes **3-6 months** to show effects. - More suitable for **hormonal acne** with inflammatory lesions rather than purely comedonal acne, and not first-line for this presentation. *Topical antibiotic* - **Topical antibiotics** (clindamycin, erythromycin) target bacterial overgrowth and inflammation but have limited efficacy in **non-inflammatory comedonal acne**. - Risk of **bacterial resistance** when used alone, and they don't address the underlying hyperkeratinization that causes comedone formation.

Question 75: Rhinophyma is a condition characterised by which of the following?

A. Hyperplasia of sebaceous glands (Correct Answer)
B. Perioral dermatitis
C. Sweat gland hypertrophy
D. Butterfly rash on the nose

Explanation: ***Hyperplasia of sebaceous glands*** - **Rhinophyma** is a severe form of rosacea primarily affecting the nose, characterized by **marked sebaceous gland hyperplasia** and connective tissue overgrowth. - This leads to the classic appearance of a large, red, bulbous nose with thickened skin and prominent pores. *Perioral dermatitis* - This condition presents as small, red papules and pustules around the mouth, not typically involving the nose in a generalized, hypertrophic manner. - It is often associated with topical corticosteroid use or irritants, which is distinct from the pathophysiology of rhinophyma. *Sweat gland hypertrophy* - While skin conditions can involve various glands, rhinophyma specifically affects **sebaceous glands**, not sweat glands (eccrine or apocrine). - Sweat gland hypertrophy is not a characteristic feature of rhinophyma and would not result in the distinct nasal enlargement seen. *Butterfly rash on the nose* - A **butterfly rash** (malar rash) is typically associated with conditions like **Systemic Lupus Erythematosus (SLE)**, affecting the cheeks and bridge of the nose symmetrically. - This rash is generally flat or slightly raised and erythematous, not characterized by the nodular hyperplasia and tissue thickening seen in rhinophyma.

Question 76: Which of the following are treatment options for acne vulgaris?

A. Isotretinoin
B. All of the options (Correct Answer)
C. Topical erythromycin
D. Oral Minocycline

Explanation: ***All of the options*** - All listed options (Isotretinoin, Topical erythromycin, and Oral Minocycline) are well-established and commonly used **treatment options for acne vulgaris**, depending on the severity and type of acne. - The choice of treatment often follows a stepped approach, starting with topical agents for mild to moderate acne and progressing to oral medications like antibiotics or isotretinoin for more severe or resistant cases. *Isotretinoin* - **Isotretinoin** is a powerful oral retinoid primarily used for **severe, recalcitrant nodular acne** that has not responded to other treatments. - It works by reducing sebum production, follicular hyperkeratinization, inflammation, and the growth of *P. acnes*. *Topical erythromycin* - **Topical erythromycin** is an **antibiotic** used to treat mild to moderate inflammatory acne by reducing the growth of *Cutibacterium acnes* (formerly *Propionibacterium acnes*) and decreasing inflammation. - It is often combined with other topical agents like benzoyl peroxide to minimize the development of **antibiotic resistance**. *Oral Minocycline* - **Oral minocycline** is a **tetracycline antibiotic** used for moderate to severe inflammatory acne. - It reduces bacterial populations on the skin and exhibits **anti-inflammatory properties**, making it effective for widespread or deeper lesions.

Question 77: Which of the following best describes the current understanding of rosacea pathogenesis?

A. Primarily caused by increased sebum production similar to acne vulgaris
B. Solely due to increased reactivity of cutaneous blood vessels to vasodilators
C. Multifactorial etiology with no single definitive cause established (Correct Answer)
D. Results from bacterial infection affecting the entire face and back

Explanation: ***Multifactorial etiology with no single definitive cause established*** - Rosacea is understood to arise from complex interactions between **genetic predisposition**, **environmental triggers**, **immune dysregulation**, and **neurovascular dysfunction**. - No single factor fully explains its development; rather, it's a **synergistic interplay** of multiple pathways. *Primarily caused by increased sebum production similar to acne vulgaris* - While sebaceous glands can be affected in phymatous rosacea, **increased sebum production** is the primary driver of **acne vulgaris**, not rosacea. - Rosacea is fundamentally a disorder of **neurovascular and immune dysregulation**, not primarily of follicular obstruction or sebum overproduction. *Solely due to increased reactivity of cutaneous blood vessels to vasodilators* - While **vascular dysfunction** and increased reactivity to vasodilators are significant components of rosacea, they are not the sole causative factor. - **Inflammation**, genetic factors, and immune system involvement also play crucial roles. *Results from bacterial infection affecting the entire face and back* - Rosacea is not solely caused by a **bacterial infection**, although the **skin microbiome** (e.g., *Demodex mites*, *Bacillus oleronius*) may contribute to inflammation in some cases. - Unlike conditions like **acne**, which is linked to *Cutibacterium acnes*, rosacea is not considered a primary bacterial infection.

Question 78: Comedones are characteristics of:

A. Acne vulgaris (Correct Answer)
B. Acne rosacea
C. Adenoma sebaceum
D. SLE

Explanation: ***Acne vulgaris*** - **Comedones** are the hallmark lesions of acne vulgaris, resulting from the obstruction of hair follicles by sebum and keratinocytes. - These can be **open comedones (blackheads)** or **closed comedones (whiteheads)**. *Acne rosacea* - Characterized by **erythema**, **telangiectasias**, papules, and pustules, primarily on the central face. - **Comedones are notably absent** in acne rosacea, which helps differentiate it from acne vulgaris. *Adenoma sebaceum* - This term is a misnomer for **facial angiofibromas**, which are small, red-brown papules, typically found on the nose and cheeks. - These lesions are a characteristic feature of **tuberous sclerosis** and are not comedones. *SLE* - Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse dermatologic manifestations such as the **malar rash (butterfly rash)**, photosensitivity, and discoid lesions. - **Comedones are not a typical feature** of cutaneous manifestations of SLE.

Question 79: Recalcitrant acne is treated by:

A. Steroids
B. Retinoids (Correct Answer)
C. Oral erythromycin
D. Oral tetracycline

Explanation: ***Retinoids*** - **Oral retinoids**, particularly **isotretinoin**, are highly effective for **recalcitrant, severe acne** that has not responded to conventional therapies. - They work by reducing **sebum production**, inhibiting **Propionibacterium acnes**, normalizing **follicular keratinization**, and possessing **anti-inflammatory** properties. *Steroids* - **Systemic steroids** are generally not used for long-term acne treatment due to significant side effects and the potential for **steroid-induced acne**. - They may be used short-term for **severe nodulocystic acne** with significant inflammation, but not as a primary treatment for recalcitrance. *Oral erythromycin* - **Oral erythromycin** is an antibiotic sometimes used for acne, but resistance is common, limiting its effectiveness, especially in **recalcitrant cases**. - It primarily targets **Propionibacterium acnes** and has some **anti-inflammatory** effects, but is less potent than retinoids for severe, persistent acne. *Oral tetracycline* - **Oral tetracyclines** (e.g., doxycycline, minocycline) are commonly used for moderate to severe acne, but if acne is **recalcitrant**, it indicates a lack of response to these antibiotics. - Their mechanism involves reducing **bacterial growth** and inflammation, but they do not address the underlying pathogenesis of severe acne as comprehensively as retinoids.

Question 80: An 18-year-old man has facial and upper back lesions that have waxed and waned for the past 6 years. On physical examination, there are 0.3- to 0.9-cm comedones, erythematous papules, nodules, and pustules most numerous on the lower face and posterior upper trunk. Other family members have been affected by this condition at a similar age. The lesions worsen during a 5-day cruise to the Adriatic. Which of the following organisms is most likely to play a key role in the pathogenesis of these lesions?

A. Propionibacterium acnes (Correct Answer)
B. Herpes simplex virus type 1
C. Group A β-hemolytic streptococcus
D. Mycobacterium leprae

Explanation: ***Propionibacterium acnes*** (now *Cutibacterium acnes*) - The presence of **comedones, papules, nodules, and pustules** on the face and upper back in an 18-year-old is classic for **acne vulgaris**. - **_P. acnes_** is a commensal bacterium that proliferates in clogged hair follicles, contributing to inflammation and lesion formation in acne due to its lipolytic activity and immune-activating properties. *Herpes simplex virus type 1* - **HSV-1** typically causes **oral herpes (cold sores)** or **genital herpes**, characterized by painful vesicles and ulcers. - The described lesions (comedones, papules, nodules, pustules) are not characteristic of HSV-1 infection. *Group A β-hemolytic streptococcus* - **Group A Strep** causes infections like **pharyngitis (strep throat)**, **impetigo**, or **cellulitis**, which are typically acute and rapidly spreading. - Its presence is not associated with chronic, polymorphic lesions characteristic of acne. *Mycobacterium leprae* - **_M. leprae_** is the causative agent of **leprosy**, presenting with skin lesions, nerve damage, and other systemic effects. - The skin lesions of leprosy are typically macules, papules, or nodules with sensory loss, not the comedones and pustules seen in acne.

Practice by Chapter

Acne Vulgaris: Pathophysiology

Practice Questions

Acne Vulgaris: Clinical Types

Practice Questions

Acne Vulgaris: Management

Practice Questions

Acne in Special Populations

Practice Questions

Rosacea

Practice Questions

Perioral Dermatitis

Practice Questions

Hidradenitis Suppurativa

Practice Questions

Acne Keloidalis Nuchae

Practice Questions

Acne Scarring and Its Management

Practice Questions

Psychological Aspects of Acne

Practice Questions

Diet and Acne

Practice Questions

Newer Therapies in Acne Management

Practice Questions

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