Acne

Question 1

Patho of acne

Answer 1

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

Question 2

Signs and symptoms of acne

Answer 2

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

Question 3

Onset of acne

Answer 3

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

Question 4

Drug induced “acneiform” lesions

Answer 4

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

Question 5

Environmental factors for acne

Answer 5

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

Question 6

pH of healthy skin

Answer 6

4.7-5.7

Question 7

Staging acne

Answer 7

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

Question 8

Mild acne tx

Answer 8

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

Question 9

Moderate acne tx

Answer 9

Oral abx + topical therapy
Oral abx + topical combo therapy

Question 10

Severe acne tx

Answer 10

Oral abx + topical combo therapy
Oral ISOTRETINOIN ONLY

Question 11

Goals of acne treatment

Answer 11

decrease inflammation, sebum, scarring
remove keratin plug

Question 12

Exclusions to acne self care

Answer 12

comedogenic drug use
mod-severe acne
pregnancy
treatment failure

Question 13

Targeted treatment factors

Answer 13

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

Question 14

Follicular hyper proliferation

Answer 14

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

Question 15

Increased sebum production

Answer 15

“CHI”
Clasoterone cream
Hormonal therapies
Isotretinoin

Question 16

C.acnes proliferation

Answer 16

“BAAD”
Benzyol peroxide
Abx
Azelaic acid
Dapsone

Question 17

Inflammation

Answer 17

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

Question 18

Topical retinoids

Answer 18

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

Question 19

Most irritating retinoid

Answer 19

Tazarotene

Question 20

Least irritating retinoid

Answer 20

adapalene

Question 21

Tazarotene precaution

Answer 21

avoid in pregnancy

Question 22

Microtretinoin allergy precaution

Answer 22

fish protein

Question 23

Tretinoin DDI

Answer 23

Benzyoyl peroxide will decrease stability
Clindamycin will enhance

Question 24

Adapalene DDI

Answer 24

Benzyoyl peroxide will enhance activity

Question 25

Azaleic acid

Answer 25

limits melanin inhibits tyrosinase

Question 26

Drugs for treating hyperpigmentation

Answer 26

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

Question 27

Drug-induced hyperpigmentation

Answer 27

Sulfonamides tetracycline silver mercury antimalarials (hydroquinone) Amiodarone

Question 28

Clascoterone cream

Answer 28

decreases sebum and inflammation REFRIGERATE STORE AT RT ONCE DISPENSED

Question 29

CLASCOTERONE CREAM ADR

Answer 29

IF OCCLUSIVE DRESSING = MAY CAUSE HPA SUPRESSION

Question 30

Hormonal agents

Answer 30

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

Question 31

K sparing monitoring

Answer 31

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

Question 32

Oral isotretinoin

Answer 32

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

Question 33

isotretinoin use ADR

Answer 33

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

Question 34

Isotretinoin monitoring

Answer 34

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)

Question 35

Isotretinoin ADR

Answer 35

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

Question 36

Acne conglobate

Answer 36

Isotretinoin systemic abx or intralesional steroids

Question 37

Acne fulminans

Answer 37

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

Question 38

Ipledge pregnacy test #

Answer 38

N+4

Question 39

Calculating the duration of Isotretinoin therapy

Answer 39

Cumulative dose 120-150 mg/kg

Question 40

Daily dose isotretinoin

Answer 40

0.5-1mg/kg/day

Question 41

micronized dosing

Answer 41

multiply by 0.8

Question 42

Isotretinoin counseling

Answer 42

take with food avoid the sun dont get pregnant