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PHAR153 > Acne > Flashcards

Acne Flashcards

(90 cards)

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1
Q

What is critical in each case of acne?

A

simple skin care
handling patient expectations

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2
Q

Amongst those who seek advice for acne, what is the % for pharmacists compared to MDs?

A

10% seek a pharmacist
90% seek an MD

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3
Q

What is the etiology for acne?

A

follicular changes (follicular wall becomes sticky, stuff plugs up)
increased sebum (due to puberty)
P. acnes (bacteria)
inflammation (redness and zits are inflammatory processes)

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4
Q

What is the difference between a blackhead and a whitehead?

A

blackhead:
-open comedo
-does not lead to more acne/inflammation
-mainly a cosmetic issue
whitehead:
-closed comedo
-due to sticky follicular wall
-can become worse

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5
Q

What are predisposing factors for acne?

A

puberty for boys and girls
pre-menstrual flares (acne especially on the jawline)
skin hydration (sweat clogs pores)
cosmetics
irritation and occlusion
dietary aspects
stress
occupation
hereditary

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6
Q

What are some of the symptoms of polycystic ovary syndrome (PCOS)? What should you do?

A

acne, hair loss, male pattern baldness
refer

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7
Q

What is PCOS?

A

hormonal disorder that causes enlarged ovaries, small cysts may form on the outer edges, can affect fertility

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8
Q

True or false: acne is common during pregnancy

A

true
more than one out of every two pregnant women can develop acne

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9
Q

How does diet contribute to acne?

A

diet high in sugar–>more insulin–>more oils

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10
Q

How does stress contribute to acne?

A

stress induces body steroid levels to rise–>stimulates more sebum production

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11
Q

What kind of jobs are more prone to acne?

A

fast-food workers (“McDonalds acne”)

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12
Q

Which type of adult acne are we not involved in?

A

adult-onset cases should be immediate referral

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13
Q

Where are some typical locations for acne to appear?

A

face
neck
chest
upper back
upper arms

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14
Q

Which acne lesions tend to be inflammatory?

A

papules
pustules
nodules
cysts

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15
Q

What is the definition of mild acne?

A

<20 comedones or <15 inflammatory lesions or <30 total lesions

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16
Q

True or false: pharmacists only deal with moderate acne

A

false
pharmacists only deal with mild acne

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17
Q

Which drugs can cause drug-induced acne?

A

topical steroids (improper use)
some birth control pills (most are helpful)

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18
Q

What % of adult acne cases are continuing from teenage years? What about adult onset cases?

A

80% are cases that continue from teenage years
20% are adult-onset cases

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19
Q

What is milia?

A

“baby acne”
not true acne
appears in the first few days of life and disappears in a few weeks without any treatment

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20
Q

What is rosacea?

A

a skin condition that affects the central face
no comedones
there can be ocular symptoms
transient flushing and warmth
blood vessels appear on skin
comes and goes

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21
Q

What triggers rosacea?

A

nobody really knows the exact cause

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22
Q

Which group of people are typically affected by rosacea?

A

usually people older than 30
rarely in kids

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23
Q

What is the treatment for rosacea?

A

topical agents

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24
Q

Are there any products in the OTC aisle to help with rosacea?

A

no
refer if you think the patient has rosacea

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25
What is perioral dermatitis? What does it look like?
it is a facial rash that tends to occur around the mouth appears red and slightly scaly or bumping, burning or itching is mild NO BLACKHEADS
26
What is the treatment for perioral dermatitis?
oral/topical antibiotics MD care
27
What are the non-medical measures for acne treatment?
basic skin care: -washing face BID -do not scrub -minimize picking eczema grade soaps no need for astringents acne cleansing pads are fine
28
True or false: over cleaning can increase sebum levels on the skin
true BID washing is fine
29
What are the cornerstones of acne therapy?
BP and/or retinoids
30
How long should an acne patient expect to undergo therapy?
2-4 years
31
If parents had acne, then what could be a good move for their kid?
start treatment early to prevent mild acne from getting moderate or severe
32
How does salicylic acid work?
keratolytic -dries out oils on the face -reduces plugging on the surface
33
What strengths does salicylic acid typically come in?
0.5% or 2%
34
What is the active ingredient in oxy wipes?
salicylic acid
35
What is the main reason that salicylic acid is added to products?
allows the manufacturer to advertise their product as medicated
36
Other than our cornerstone acne treatments, what are some other therapies?
sulfur (antibacterial) resorcinol (exfoliant, antibacterial) tea tree oil (antibacterial) topical nicotinamide (might be doing something)
37
Which strengths of BP are OTC? Which strength is Rx?
OTC: 2.5% (uncommon) and 5% (good starting point) Rx: 10%
38
When should BP be used as a solo product? When should it be used as a combo product?
solo: mild acne combo: moderate acne
39
What are the side effects of BP?
redness, peeling, dryness, burning, bleaches clothes
40
What is the mechanism of action of BP?
antibacterial (not an antibiotic) -hits P acnes with a blast of O2 exfoliant action
41
True or false: it is necessary to use sunscreen while on BP
false not as sun-sensitive as retinoids
42
Which vehicles are more valuable for BP? Which vehicles are less valuable for BP?
lotions and gel (acetone>alcohol>aqueous) are better soaps/washes are less valuable due to concerns of contact time
43
True or false: gels are stronger than lotions but it is not a massive jump in therapy
true
44
If a patient has oily skin which vehicle should you go for? What about if the patient has sensitive skin?
oily skin go for a gel because it can dry it out sensitive skin go for a lotion
45
How much BP should be applied to an affected area?
smaller than an FTU (pea-sized) more is not better
46
What are the directions for use of BP?
start slowly -ex: apply for 1-2hrs then wipe off for a few days and then apply for 3-4hrs for a few days before moving to a full night of contact
47
What is a good way to verbalize the "start slowly" directions?
"This will eventually be left on overnight. Now, how you get there is this way..."
48
True or false: we should resist the temptation to spot treat with BP
true
49
What can be done for overly dry skin that is the result of BP?
add dry skin lotion (non-cometogenic) go slower change % or formulation base
50
As a pharmacist, what is critical during an OTC consult with regards to acne?
expectations in regards to improvement
51
Explain the once-a-day regimen for BP.
wash face in the morning wash face in the evening let skin dry apply BP (thus contact time is 8-10hrs)
52
Explain the BID regimen for BP.
wash face in the morning let skin dry apply BP around 8pm, wash face let skin dry apply BP (thus contact time is ~24hrs)
53
What is the mechanism of action of topical retinoids?
they decrease the cohesiveness of the follicular wall they increase the penetration of other agents like BP
54
Which vitamin are topical retinoids a derivative of?
vit A
55
What are the dosing and formulations for tretinoin?
0.01% cream and 0.025% cream 0.025% gel and 0.05% gel
56
What are the side effects of tretinoin?
erythema or irritation
57
What are the directions for use of tretinoin?
skin needs to be dry before application pea-sized amount start slowly (start with low strength aka cream and then re-asses) apply at night
58
Why should topical retinoids be applied at night?
tretinoin is a sun sensitive agent if applied at night, it should all be gone by the morning
59
Why might your acne worsen upon initial usage of topical retinoids?
retinoids bring "soon to be" acne up to the surface
60
What are the choices of topical retinoids?
adapalene (least irritating) tretinoin (most photosensitizing) tazarotene (most potent)
61
Which product is advertised as being for truncal acne? Would agents like retinoids be fine for truncal acne?
Aklief, it just a marketing move yes they would
62
What do we do in regards to topical retinoids and pregancy?
referral vit A in as retinoids can be teratogenic for unborn kids adapalene: Category C (caution) tazarotene: Category X (contraindication)
63
When are the BP and retinoid combos used?
moderate acne
64
What is starting to become the recommended first line approach in most acne cases?
combination therapy
65
Should BP and a retinoid be applied at the same time?
no there is a drug interaction BP oxidizes the retinoid making it almost not useful
66
If a patient is using BP and a retinoid, when should each agent be applied?
BP in the morning retinoid at night
67
Which formulations bypass the BP-retinoid drug interaction, allowing for BP and the retinoid to both be used at night?
micronized tretinoin gel adapalene+BP
68
If we are really trying to get to the nuances, which situations are BP and retinoids better for as lone agents?
BP: actual pimple formation, inflammation retinoids: prevent white head formation, non-inflammatory
69
Which topical antibiotics are used for acne?
clindamycin (more common) erythromycin
70
Why are topical antibiotics for acne always a combination product?
to prevent resistance
71
In terms of topical antibiotics for acne, what is used for mild-moderate cases? What about severe cases?
mild-moderate: BP+antibiotic or retinoid+antibiotic severe: clindamycin+BP (am) and tretinoin (hs)
72
How do you explain "apply a pea-sized amount"?
apply 1 pea-sized amount of product onto your fingertip and then dot the 1 pea-sized amount onto 6 areas of your face this should be enough to cover your entire face
73
When should topical antibiotics be discontinued?
after resolution of inflammatory symptoms
74
True or false: pharmacists can prescribe for antibiotic and BP combination products as they are indicated for mild acne cases
false antibiotic+BP is for moderate acne we can prescribe clindamycin+tretinoin (indicated for mild acne)
75
What is the mechanism of action of oral antibiotics for inflammation?
antibacterial and anti-inflammatory -killing P.acnes, thus reducing inflammation
76
Which acne cases need oral antibiotics?
moderate to severe cases (alone or in combo) -oral agents must be used with a topical retinoid or BP to increase efficacy and decrease resistance
77
Which oral antibiotics are typically used for acne? List a few things about each of these antibiotics.
tetracycline: -avoid food/dairy -avoid antacids -photosensitive minocycline: -less problems with food -avoid antacids -less photosensitive doxycycline: -give with food -avoid antacids -greater photosensitivity
78
True or false: if oral antibiotics have been used for 3 months and there is no improvement, then we should increase the dose or frequency
false if no improvement, there is no benefit to increase dose and frequency
79
True or false: there is no benefit to using topical and oral antibiotics at the same time
true
80
What is the role in therapy for isotretinoin?
severe acne (very effective agent) -nodular cystic acne
81
What is the action of isotretinoin?
hits all 4 actions
82
What is the dosing for isotretinoin?
0.5-1mg/kg for 12-16 weeks
83
What are the side effects for isotretinoin?
red eyes and dry lips (dries mucous membranes) maybe depression but this might be due to the acne
84
True or false: isotretinoin is not used in pregnancy
true if used, the woman has to sign off a waiver
85
In terms of diet, what might a patient be asked to do in order to help with absorption of isotretinoin?
consume high fat meals -Epuris does not need fat to be absorbed
86
How do oral contraceptives work for acne?
estrogen can have a beneficial effect on acne, progestin is thrown in to help the formulation
87
How can progestins worsen acne? Name some progestins.
due to the androgenic properties norgestimate and levonorgestrel
88
When would an oral contraceptive be a first line acne therapy?
if the girl has acne and wants birth control
89
Differentiate between mild, moderate, and severe acne.
mild: <20 comedones, <15 inflammatory, <30 total moderate: 20-100 comedones, 15-50 inflammatory, 30-125 total severe: >5 pseudocysts, >100 comedones, >50 inflammatory, >125 total
90
What is the role of Diane-35 in acne?
Diane-35 contains a very potent agent against androgenic acne -hormonal based acne or PCOS (severe acne) must be stopped after acne clearing -rarely seen for this reason -can cause cardiovascular damage if used long term -not indicated for contraception

PHAR153 (20 decks)

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