11 - Derm - Acne - Mgmt of Acne

Question 1

1st 2nd and 3rd line?

Answer 1

1 - topical
2 - systemic treatment
3 - systemic retinoids

Question 2

1st line - for what acne? 3 types?

Answer 2

in mild mod acne

top retinoids/antibacterials/antibiotics

Question 3

topical retinoids - eg? mechanism? 4 SE?

Answer 3

isotretinoin
comedolytic
erythema, irritation, photosensitivity, teratogenic

Question 4

topical antibacterials - do 2 things? eg? may cause what SE? how to get?

Answer 4

antibact + anti- inflam
benzoyl peroxide BPO
dryness, irritation
available otc

Question 5

topical ABs - 2 eg? what is a problem? how to limit?

Answer 5

clindamycin, erythromycin
resistance - use for less than 6m
BPO combined reduces resistance

Question 6

2 nd line - what acne? (3 things) a principle of this treatment line? 2 treatments?

Answer 6

in mod/sev - top treatment failure, scarring, back/chest involvement
combine and maintain remission with topical agents

systemic antibiotics and hormonal treatments

Question 7

hormonal tx - esp when? caution if? eg?

Answer 7

OCP
esp if menstrual cycle related
caution if FHx/venous thrombosis risk

Question 8

systemic ABs - dont do what? why? continue for how long?

Answer 8

dont mix ABs, to avoid resistance

6 weeks to assess effectiveness

Question 9

systemic ABs - 3 lines? 1st line contraindications?

Answer 9

1 - clycines - doxy - CI - preg, breast feeding, children <12
2 - erythromycin
3 - trimethoprim

Question 10

syst retinoids - mechanism? when used?

Answer 10

reduces seb gland size, sebum prod, and comedogenesis

used in tx res acne, nodulocystic, scarring, psych problems

Question 11

syst retinoids SE

Answer 11

dry skin, dry eyes, dry mucosa, epistaxis
lipid and LFT disturbance
arthralgia, myalgia, depression

Question 12

syst retinoids - length? relapse rate? teratogenic.. so what monitoring etc?

Answer 12

for 4-6 months
20-30% relapse
OCP req for 1 month either side and monthly preg tests