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604 > Acne > Flashcards

Acne Flashcards

1
Q

Patho of acne

A

Skin cells tick together due to excess keratin + excess oil from sebaceous glands = blockage of hair follicle
Bacteria grows = WBC, inflammation,

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2
Q

Signs and symptoms of acne

A

white head-black head- papule- cyst- module- pustule

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3
Q

Onset of acne

A

at puberty
M>F
Lower incidence in AA and asians
genetic predispositions

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4
Q

Drug induced “acneiform” lesions

A

LVP (lithium, valproic, phenytoin)
OC, androgens, GC
Cyclosporine, AZA
Disulfiram
Phentermine
Iodides, bromides
Danazol
High dose B or D vitamins

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5
Q

Environmental factors for acne

A

CRH - emotional stress
pH = repetitive stress
occlusion, pressure
heat, humidity
occupational “chloracne”
Food

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6
Q

pH of healthy skin

A

4.7-5.7

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7
Q

Staging acne

A

Mild: <10 papules, no nodules
Mod: many papules, nodules+comedomes
Severe: extensive pustules/modules

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8
Q

Mild acne tx

A

Topical
BP or retinoid
Topical combo:
BP + abx and or retinoid

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9
Q

Moderate acne tx

A

Oral abx + topical therapy
Oral abx + topical combo therapy

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10
Q

Severe acne tx

A

Oral abx + topical combo therapy
Oral ISOTRETINOIN ONLY

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11
Q

Goals of acne treatment

A

decrease inflammation, sebum, scarring
remove keratin plug

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12
Q

Exclusions to acne self care

A

comedogenic drug use
mod-severe acne
pregnancy
treatment failure

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13
Q

Targeted treatment factors

A
  1. follicular hyperproliferation
  2. increased sebum production
  3. C.acnes proliferation
  4. inflammation
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14
Q

Follicular hyper proliferation

A

“RASH”
Retinoids (PO/topical)
Azelaic acid
Salicylic acid
Hormonal therapies

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15
Q

Increased sebum production

A

“CHI”
Clasoterone cream
Hormonal therapies
Isotretinoin

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16
Q

C.acnes proliferation

A

“BAAD”
Benzyol peroxide
Abx
Azelaic acid
Dapsone

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17
Q

Inflammation

A

“TRACD”
Tetracycline
Retinol (PO/Topical)
Azelaic acid
Clasterone cream
Dapsone

18
Q

Topical retinoids

A

decrease cohesiveness of follicular epithelial cells (increase turnover)
Start low go slow
8-12 weeks for improvement

19
Q

Most irritating retinoid

A

Tazarotene

20
Q

Least irritating retinoid

A

adapalene

21
Q

Tazarotene precaution

A

avoid in pregnancy

22
Q

Microtretinoin allergy precaution

A

fish protein

23
Q

Tretinoin DDI

A

Benzyoyl peroxide will decrease stability
Clindamycin will enhance

24
Q

Adapalene DDI

A

Benzyoyl peroxide will enhance activity

25
Q

Azaleic acid

A

limits melanin
inhibits tyrosinase

26
Q

Drugs for treating hyperpigmentation

A

Azaleic acid, topical retinoids, alpha hydroxy acids (glycolic, lactic), hydroquinone

27
Q

Drug-induced hyperpigmentation

A

Sulfonamides
tetracycline
silver
mercury
antimalarials (hydroquinone)
Amiodarone

28
Q

Clascoterone cream

A

decreases sebum and inflammation
REFRIGERATE
STORE AT RT ONCE DISPENSED

29
Q

CLASCOTERONE CREAM ADR

A

IF OCCLUSIVE DRESSING = MAY CAUSE HPA SUPRESSION

30
Q

Hormonal agents

A

use with topical retinoids for mod-severe acne
K sparing and EE COCs

31
Q

K sparing monitoring

A

Serum potassium at first cycle, baseline, 4-6 weeks

32
Q

Oral isotretinoin

A

shrinks sevaceous glands
decreases sebum
INDIRECT action on c.acnes
normalize desquamation (prevent keratin)
mod-severe recalcitrant nodular acne
reduces inflammation

33
Q

isotretinoin use ADR

A

C/I pregnancy
Underlying psych conditions
Tetracyclines = pseudotumor cerebri (BP)
Avoid vitamin A supplement
Avoid skin procedures (don’t wax ur brows)

34
Q

Isotretinoin monitoring

A

Baseline LFT/FLP
- if normal, get again in 2 months
- if abnormal, periodically monitor
- if ALT/ST x3 uln = d/c drug

CK: if joint pain or muscle pain (15-50% elevation)

35
Q

Isotretinoin ADR

A

Liver damage (high TG, thin hair)
IBS (want to decrease PM dose)
Night blindness
Dry eye
Growth stunt
muscle pain (CK)
Bone marrow impression
Calcification of ligament/tendons
Skin photosensitivity
eczema-like rash
dry lips, cheilitis

36
Q

Acne conglobate

A

Isotretinoin
systemic abx
or intralesional steroids

37
Q

Acne fulminans

A

May occur due to isotretinoin (d/c if so)
Systemic = PO GC x 4 weeks then iso
not sys = PO GC x 2 weeks then Iso

38
Q

Ipledge pregnacy test #

A

N+4

39
Q

Calculating the duration of Isotretinoin therapy

A

Cumulative dose
120-150 mg/kg

40
Q

Daily dose isotretinoin

A

0.5-1mg/kg/day

41
Q

micronized dosing

A

multiply by 0.8

42
Q

Isotretinoin counseling

A

take with food
avoid the sun
dont get pregnant

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