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Acne Flashcards

1
Q

key factors in acne pathogenesis

A

follicular keratization
androgens/sebum formation
cutibacterium acnes
inflammation

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2
Q

acne vulgaris

causes

A 
emotional stress
rpetitive stress
occlusoin and pressure
heat and humidity
occupational acne
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3
Q

drugs that casue acne-like acneiform lesions

A 
Lithium
valproic acid
isoniazid GCs
po contracept. 
cyclosporine
azathioprine
disulfuram
phentermine
iodides, bromides
danazol
high dose vitamin B and D
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4
Q

mild acne definitition

A

few to several papules/pustules (<10) and no nodules

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5
Q

moderate acne definition

A

10-40 papules/pustules along with 10-40 comedomes and few to several nodules

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6
Q

severe acne definition

A

numerous or exensive papules/pustules and many nodules

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7
Q

exclusions to self tx

A

comedogenic drugs
mod-severe acne
pregnancy
when tx does not work

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8
Q

mild acne 1st line tx options

alternative?

A

BP or TR

OR

TCT (BP + ABX), (BP + R), (BP + ABX + R)

Alt? add topical R or BP or consider diff retinoid or consider topical dapsone

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9
Q

goals of acne tx

A

remove keratin plug
reduce bacterial inflammation
reduce sebum production
reduce/eliminate scarring

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10
Q

acne home care

A 
gentle synthetic cleansers BID
wash with fingers
avoid scrubs
water-based lotions
dont pick at lesions
skin should be dry before applying topicals
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11
Q 
dry skin =
oily skin = 
hairy areas = 
solutions =
pledgets
A 
dry skin use lotions or creams
oily skin use gels or foams
hairy area use foams
solns are drying but cover large areas
pledgets cover large areas
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12
Q

tx that target follicular hyperproliferation

A

oral/topical retinoids
azelaic acid
salicylic acid
hormonal therapies

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13
Q

tx that target inc sebum production

A

po retinoids
hormonal tx
clascoterone cream

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14
Q

tx targeting c. acnes prolif

A

benzoyl peroxide (BP)
ABX
Azelaic acid
dapsone topical

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15
Q

tx for inflammation

A 
po/topicla retinoids
po TTCs
azelaic acid
clascoterone cream
dapsone topical
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16
Q

topical retinoids
use
onset

A 
initial management in most patients
monotherapy w comedonal acne
normalize follicular hyperkeratosis
prevent formation of microcomedo
may improve inflammatory acne
maytake 8-12 weeks to work
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17
Q

clascoterone cream
moa
storeage

A

androgen receptor inhibitor
HPA suppression has been reported
store at 2-8C before dispensing, patient cans tore at room temp, discard 180 days after dispensing, 30d once opened

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18
Q

topical retinoids for acne treatment

A 
tretinoin (Atralin, Renova)
Adapaline (Differin)
Tazarotene (Tazorac, Fabior foam, Avage)
TWYNEO (tretinoin/BP)
Trifarotene (Aklief)
Epiduo Forte (Adapalene and BP)
VELTIN
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19
Q

topical retinoids
admin
with BP?

A

gently clean area, pat dry, apply retinoid and then moisturizer

thin layer, qd hs, no not apply tretinoin the same time as BP, applied to entire effected area

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20
Q

topical retinoids AE

A

irritation, dryness, flaking of skin, transient worsening of acne, photosensitivity, titrate up frequency
avoid use in preggo

21
Q

Moderate acne 1st line tx

Alternative?

A

TCT (BP + ABX), (BP + R), (BP + ABX + R)

OR
(BP + po ABX + R)

OR
(BP + po ABX + topical ABX + R)

Alternative:
consider alt combo tx or consider diff po ABX or add COC or po Spironolactone (female) or consider po isotretinoin

22
Q

Severe acne 1st line

Alternative?

A

po ABX + TCT (BP + ABX), (BP + R), (BP + ABX + R)

OR
po isotretinoin

Alternative: consider diff po ABX or add COC or po Spironolactone (female) or consider po isotretinoin

23
Q

Topical ABX options

A 
BP
Clinda
Erythro
Dapsone
Minocycline
24
Q

topical BP freq and AE

A

twice daily

local skin irritation, may bleach hair or clothing

25
topical clinda freq and AE
``` twice daily (qd if foam) rare risk of pseudomonas colitis usually prescribed w BP to decrease resistance ```
26
topical erythromycin freq and AE
twice daily | usually prescribed w BP to decrease resistance
27
topical dapsone freq and AE
5% - BID 7.5% - QD yellow-orange skin discoloration when applied at the same time as BP
28
Minocycline freq and AE
QD! 4% foam Headache
29
Azelaic acid MOA use AE
20% cream, 15% gel antimicrobial - limits melanin prod via inhibiting tyrosinase QD burning, itching, redness, hives, anaphylaxis v rare
30
po ABX
``` TTC Doxy Minocycline Sarecycline Erythromycin TMP/SMX Azithro ```
31
TTC po dose and AE
500mg po bid | photosens, GI distress, CI preggo and yoing children
32
Doxy po dose and AE
50-100mg bid | photosens, GI distress, CI preggo and yoing children
33
Minocycline po dose and AE`
50-100mg bid | dizziness, drug-ind skin discoloration, CI preggo and yoing children
34
Sarecycline po dose and AE
``` weight based dosing 33-54 kg = 60mg qd 55-84kg = 100mg qd 85-136kg = 150mg qd photosens, GI distress, CI preggo and yoing children ```
35
Erythro po dosing and AE
500mg bid, GI distress
36
TMP/SMX po dosing and AE
160/800mg po qd-bid, SJS/TEN
37
benzoyl peroxide onset? AE
onset within 3 weeks, max is 12 weeks erythema, acaling, xerosis, stinging/burning, bleaching of hair and clothing, hypersens is rare
38
differen cleanser vs gel
cleanser is BP, gel is adapalene 0.1%
39
salicylic acid MOA with BP?
desquamating agent, lipophilic properties penetrate pilosebaceous follicle to provide comedolytic effects synergistic effects with BP!
40
hormonal agents | for who?
for women with oderate to severe acne who are not trying to become pregnant good in adult women who present w inflammatory acne of lower face/neck with premenopausal flares
41
Hormonal agents? moa products
inhibit androgen actoin in pilosebaceous unit estrogen suppresses ovarian androgen production spironolactone and drosperinone competitively inhibit binding of adnrogens to receptors in pilosebaceous unit Ethinyl Estradiol used to inhibit sebum production **a progestin only contraceptive ineffective for acne
42
``` spironolactone for acne dose pearl onset AE CI ```
50-100mg BID concominant use of birth control is recommended d/t femininization of male fetus AE: menstrual irregularities, breast tenderness, GI upset, orthostatic hypotension, HA, dizziness, fatigue CI: renal or hepatic dysfunction, monitor serum K in first cycle!
43
``` po isotretinoin products MOA use CI dosing ```
Zenatane, Amnesteem, Claravis, Sotret, Absorbica, Absorbica LD is micronized use: mod-severe acne, recalcitrant nidular acne CI: pregnancy, underlying psychiatric conditions, concominant use of TTC ABX MOA: shrinks sebacous glands, normalizes desquamation dose: 0.5-1 mg/kg/day in divided doses WITH FOOD x20 weeks, micronized Absorbica LD is 0.4-0.8mg/kg/day in divided doses 15-20 weeks max; swallow capsule whole with a full glass of water
44
isotretinoin monitoring
take baseline LFT and FLP, if normal take again in 2 months and if normal again no more monitoring CK elevation (joint/muscle pain) Hepatotoxicity : if 3xULN--> D/C recommended
45
po isotretinoin warnings
``` night blindness skin photosensitivity aczema-like rash dry lips and cheilitis dry eyes muscle pain calcification of ligaments and tendons thinning of hair dry nasal passages HA stunted growth bone marrow suppression IBS? ```
46
contraception and isotretinoin pregnancy tests (n) script limitations
at least one primary and one secondary (condom, cervical cap diaphragm or sponge) method of birth control cannot dispense isotret more than 30d after for patients who cannot become preggo, 7d from test for patients who took a pregnancy test no automatic refills no more than 30d supply
47
acne conglobata s/sx tx
inflammatory, acne nodules and cysts that grow together deep below skin, severe scarring tx: isotretinoin systemic ABX Intralesional steroids
48
Acne Fulminans s/sx tx and duration
rare, severe, painful, ulcerating, hemorrhagic +/- fever +/- bone lesions if d/t isotretinoin --> D/C if systemic sx--> po glucocorticoids x4wks then isotretinoin for at least 4wks w/out systemic sx --> po glucocorticoids x2wks then isotretinoin for at least 4wks
49
PIH | tx
post inflammatory inflammation, presence of excess melanin, improves slowly with time tx 1st line = Hydroquinone 2% (avoid spot tx), BID 2nd line = topical retinoids (tretinoin, tazarotene or adapalene), azelaic acid 20%, chemical peels or laser resurfacing (glycolic, salicylic acids)

Derm/Ophth (5 decks)

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