Follicle-centered erythematous papules with central pustules on the face - USMLE Forums
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  #1  
Old 12-07-2011
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Skin Follicle-centered erythematous papules with central pustules on the face

A 28-year-old man comes to your office complaining of a severe outbreak of pimples that started a week earlier. You have been treating him for acne for the past several months with a combination of oral Doxycycline, topical Clindamycin, and a Salicylic acid cleanser. He was doing well, with a reduction in inflammatory lesions at his most recent visit three weeks earlier. The patient tells you that he had stopped taking the Doxycycline because he was doing so well, and within days, developed hundreds of new lesions. He has no other complaints and is in good health. His current medications are topical Clindamycin and a multivitamin. On physical examination, the patient is in no acute distress, and his vital signs are normal. Inspection of the skin reveals hundreds of uniform, follicle-centered erythematous papules with central pustules on the face, neck, chest, back, and shoulders. Which of the following pathogens is most likely responsible for this patient's skin lesions?

A. Demodex folliculorum
B. Escherichia coli
C. Pityrosporum ovale
D. Propionibacterium acnes
E. Staphylococcus aureus
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Old 12-07-2011
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propionebacterium acne
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Old 12-07-2011
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D. Propionibacterium acnes
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Old 12-08-2011
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D. Propionibacterium acnes
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Old 12-08-2011
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D. Propionibacterium acnes
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Old 12-08-2011
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Cannot be Propionibacterium acnes, because he was using oral Doxycycline (Propionibacterium should be gone by now)...should be a new organism (flora)...but I dont know if the answer is A or B
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Old 12-08-2011
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The answer is B.

This patient has developed gram-negative folliculitis, an infectious complication that develops in patients with acne vulgaris or rosacea treated with` systemic antibiotics for a prolonged time. Gram-negative folliculitis should be considered in patients with acne who have a flare of pustular or cystic lesions or if the acne is resistant to treatment. Systemic antibiotics alter the nasal flora with resultant overgrowth of gram-negative bacteria leading to folliculitis. The gram-negative microorganisms responsible include Escherichia coli, Klebsiella species, Serratia species, Proteus species, and, rarely, Pseudomonas aeruginosa. Treatment of choice is with isotretinoin and systemic antibiotics chosen according to results of culture and sensitivity studies.

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Old 12-08-2011
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The correct answer is B. This patient has developed gram-negative folliculitis, an infectious complication that develops in patients with acne vulgaris or rosacea treated with` systemic antibiotics for a prolonged time. Gram-negative folliculitis should be considered in patients with acne who have a flare of pustular or cystic lesions or if the acne is resistant to treatment. Systemic antibiotics alter the nasal flora with resultant overgrowth of gram-negative bacteria leading to folliculitis. The gram-negative microorganisms responsible include Escherichia coli, Klebsiella species, Serratia species, Proteus species, and, rarely, Pseudomonas aeruginosa. Treatment of choice is with isotretinoin and systemic antibiotics chosen according to results of culture and sensitivity studies.
Demodex folliculorum (choice A) is a mite normally found to inhabit the follicular infundibula of adults. It has been implicated in the pathogenesis of rosacea in the past, but no studies have been able to prove a causal relationship.
Pityrosporum ovale (choice C) is a yeast that is normally present in the scalp of adults. Overgrowth causes the clinical picture of tinea versicolor, where slightly pink, scaly macules and patches appear on the neck, shoulders and back of young adults who sweat profusely.
Propionibacterium acnes (choice D) is a bacterium normally found to inhabit the pilosebaceous follicle of adults. It is important in the pathogenesis of acne because it hydrolyses lipids to free fatty acids, which cause inflammation and rupture of the hair follicle, leading to development of inflammatory lesions.
Staphylococcus aureus (choice E) is a bacterium that commonly causes impetigo of the skin, especially in children. Erythematous, ill-defined patches covered with honey-colored, sticky crusts develop at sites of infection. Autoinoculation with adjacent spread is very common. Diagnosis is based on clinical examination and skin cultures. Treatment is with topical and oral antibiotics.
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Old 12-08-2011
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Quote:
Originally Posted by dr-ahmed View Post
The answer is B.

This patient has developed gram-negative folliculitis, an infectious complication that develops in patients with acne vulgaris or rosacea treated with` systemic antibiotics for a prolonged time. Gram-negative folliculitis should be considered in patients with acne who have a flare of pustular or cystic lesions or if the acne is resistant to treatment. Systemic antibiotics alter the nasal flora with resultant overgrowth of gram-negative bacteria leading to folliculitis. The gram-negative microorganisms responsible include Escherichia coli, Klebsiella species, Serratia species, Proteus species, and, rarely, Pseudomonas aeruginosa. Treatment of choice is with isotretinoin and systemic antibiotics chosen according to results of culture and sensitivity studies.

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I am also preparing for CK and of course, I did not write any of these questions myself. I am just posting some nice questions( by copying- as you say).
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Old 12-08-2011
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Quote:
Originally Posted by drnrpatel View Post
I am also preparing for CK and of course, I did not write any of these questions myself. I am just posting some nice questions( by copying- as you say).
Hey I didn't mean to offend you ,, All I meant is that here's the answer

and that the copy rights are reserved to the mentioned website ,,
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