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  #1  
Old 01-24-2013
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Question dermat question

Q) a 25 yr old caucasian women presented to the physician for evaluation of severe outbreak of pimples she got last week.the physician has been treating her acne for the past several months with combination of oral doxycycline , topical minocycline and a fusidic acid cleanser.she has quite improvement since the treatment has began till 3 weeks earlier.she tells you she stopped the doxycycline because she was feeling quite well and within days she developed numerous pimples.she has no other problems with regular menstrual cycles .on p/e the pt. is normal with no acute distress.inspection of skin reveals numerous uniform,follicle centered erythematous papules with central pustules on face and neck..which of the following organism is most likely responsible for this outbreak of acne..?

a) pityrosporum orbiculare
b) demodex folliculorum
c) serratia marcesans
d) propionibactrium acnes
e) pseudomonas aeruginosa..
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  #2  
Old 01-24-2013
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I ill go with D
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  #3  
Old 01-24-2013
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d) propionibactrium acnes
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  #4  
Old 01-25-2013
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Post c

i also thought it as propionibacterium acnes but the right one turns out to be serratia marcesans....(that's the reason i asked here..)

the above pt. suffers from gram -ve folliculitis....gram -ve folliculitis is a potential complication that develops in pts with acne or rosacea treated with antibiotics for certain time(from months to years)..it must be considered in pts who have sudden flare of pustular or cystic lesions just after stopping antibiotic medication use..systemic antibiotics alter the nasal flora with resultant overgrowth of gram -ve bacteria leading to folliculitis.....out of the bacteria E.coli is most common..
e.coli>>>klebsiella>>serratia,proteus>>>>>>pseudom onas(rare)

treatment of choice is --isotretinoin(2 pregnancy tests must be done before starting of medication)...



propionibacterium acnes---is important in pathogenesis of acne..it hydrolyses lipids to ffa which cause inflammation and rupture of hair follicle(no folliculitis)..


demodex---implicated in rosacea

pityrosporum orbiculare/ovale----implicated in tinea versicolor....


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Old 01-27-2013
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Default d

i go with d
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