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OTC II > Acne EXAM III > Flashcards

Acne EXAM III Flashcards

1
Q

QUEST Process

A

QU: Ask questions about Symptoms, Onset, History, characteristics, Location, Aggravating and Remitting factors, Medication, Allergies

E: Establish if the patient is a candidate for self-care
S: Suggest appropriate treatment
T: Teach the patient

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2
Q

Where are most of the sebaceous glands found?

A

Epidermis on hair folicles, oily preventing drying
Around the mouth
Back

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3
Q

What are the causes of acne?

A

Androgen-stimulated
2. 1. Increases sebum production
2. Follicular hyperkeratinization
3. Colonization of Propionibacterium acnes
4. Release of inflammatory mediators

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4
Q

What is a follicular occlusion within the pilosubecous unit?

A

Microcomedone

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5
Q

How are non-inflammatory and inflammatory acne classified?

A

Non-Inflammatory: Comedones
Open (blackhead)
Closed (whitehead)

Inflammatory:
Papules
Pustules
Nodules
Cysts

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6
Q

How is mild acne classified?

A

Mild: Open (blackhead) and closed (whitehead) Comedones and a few papules and pustules

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7
Q

How is Moderate acne classified?

A

Comedones, more papules and pustules, minimal scarring
mainly comedonal or mainly inflammatory acne

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8
Q

How is severe acne classified?

A

Comedones, even more papules and pustules + nodular abscesses - more excessive scarring

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9
Q

What does scarring indicate?

A

Previous episodes of severe acne
-> may need more aggressive treatment

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10
Q

When to refer a patient?

A

inflammatory acne (papules, pustules) with a risk of scarring

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11
Q

Meaning of Keratolytic and Comedolytic

A

Keratolytic: too much keratin -> agents that soften the skin by loosening keratin and helping with exfoliation (removal of dead skin)

Comedolytic: breaks down power blockage by causing skin cells to slough away faster -> addresses RETENTION HYPERKERATOSIS

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12
Q

Non-pharmacological treatment

A

-Shampoo, balanced diet, hydration, exercise (more blood flow, wash with warm water twice a day)

-not effective alone -> combine with pharmacological treatment

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13
Q

What is the most effective pharmacologic treatment approach for acne?

A

Benzoyl Peroxide (topical antimicrobial)
-2.5-10% gel
-lotion
-creams
-pads, masks, cleansers

AE: Contact dermatitis, skin irritation, bleaching on clothing
AE often bc not the appropriate dose or formulation -> CHANGE

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14
Q

Available doses for Benzoyl Peroxide

A

2.5% - 10%
10% (Rx)

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15
Q

AE of Benzoyl Peroxide

A

AE: Contact dermatitis, skin irritation, bleaching on clothing
AE often bc not the appropriate dose or formulation -> CHANGE
-mild erythema and scaling but should subside in 1-2 weeks

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16
Q

What patients should expect when using Benzoyl Peroxide?

A

-Frequency depends on mild peeling
-may experience mild erythema and scaling in the first 1-2 weeks
-allergic reaction with Rx: sudden erythema and vesiculation /vesicles filled with fluid)

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17
Q

Direction Benzoyl Peroxide

A

-Do not apply for 15-20min after washing
-Apply 1-2 times daily at 2.5%
-Leave initial application on for only 15min then wash off and slowly increase
-Once product can be tolerated for 2 hours then can leave on overnight

-After 1-2 weeks can increase to 2-3x/day

18
Q

Counseling points for Benzoyl Peroxide

A

-avoid contact with clothes
-use sunscreen SP15
-expect it to work within 8 weeks - sebaceous glands turn over every other month -> so it takes time to unblock
-acne can get worse before it gets better! (pt may stop treatment - so warn them)
-Continue treatment after lesions have
cleared

19
Q

MOA for Beta-hydroxy acids (salicylic acid)

A

Keratolytic and comedolytic

-Contraindicated in diabetes and pts with poor circulation

dose: 0.5% to 5%

20
Q

Signs of toxicity for Beta-hydroxy acids

A

-N/V, dizziness, diarrhea
-loss of hearing, tinnitus
-lethargy (lack of energy)
-hyperpnea (breathing faster)
-psychic disturbances

-Contraindicated in diabetes and pts with poor circulation

21
Q

Dose for Beta-hydroxy acids

A

0.5% to 5%

22
Q

Indication of Beta-hydroxy acids

A

Hyperkeratotic skin

23
Q

Alpha-hydroxy acids

A

-glycolic, lactic, or citric acid
-not often used
-not enough evidence to support use for acne
-may be useful for scarring

24
Q

MOA Salicylic Acid

A

Mild comedolytic and keratolytic
-Unclog pores by causing peeling
-less effective alternative to tretinoin (Rx)
-Wash or cleansing agents used as adjuvant treatment
-dose: 0.5% to 2%

25
Q

What is the Rx alternative to Salicylic Acid considered to be more effective?

A

Tretinoin (Rx)

26
Q

Salicylic Acid
Counseling

A

-If excessive peeling occurs, limit use to once daily or every other day

-May cause sun sensitivity

27
Q

Sulfur

A

-Keratolytic & antibacterial in 3-10%
-Resolution of existing comedones

28
Q

Counseling Sulfur

A

-Color and odor should be considered
-dose: Applied in thin film to affected area 1-3x/day

29
Q

Which drugs can be combined with Sulfur for more efficacy?

A

-Resorcinol: enhances the effect of sulfur (cell turnover)
(May experience dark brown scale with darker skin)
-Sodium Sulfacetamide – destroys para-aminobenzoic acid (essential for bacterial growth)

30
Q

Adapalene Gel 0.1%

A

-Retinoid
-MOA: Modulator of cellular differentiation, keratinization, and anti-inflammatory
-used for mild acne! (moderate acne -> Benzoyl peroxide)
-expect scaling and worsening of acne in the first 2 weeks (let patient KNOW)

31
Q

AE Adapalene Gel 0.1%

A

-the sensation of warmth or slight stinging right after application,
-Burning, skin redness, dryness - dry skin (45%),
-itching, scaling, and worsening of acne within the first 2-4 weeks of treatment

32
Q

Adapalene Gel 0.1%
Counseling points

A

-Onset of 8 weeks
-how to apply: wash the face and wait to dry –> apply on clean, dry skin at bedtime -> wash off in the next morning

-don’t apply on broken skin, lips, ankle of the nose, eyes
-Avoid other alpha hydroxy or glycolic
acid containing products
-Hypersensitivity and Photosensitivity (use sunscreen)

33
Q

Drug class of Adapalene

A

Retinoid

34
Q

Which formulation is the most effective?

A

-Gels are most effective (astringent and stay on skin longer) -> but have a drying effect (EXAM!), non-greasy better for oily skin

-Creams and lotions less irritating
– Counteract drying and peeling
– Alternative to gels -> for dry sensitive skin and in warm weather

-AVOID ointments, it is occlusive and makes acne worse
-start from low dose and increase if needed

35
Q

How is acne treated in people of color?

A
36
Q

How does pregnancy contribute to acne?

A

-high contribution due to hormonal change
-acne medication should be stopped - it should resolve after pregnancy
-the OTC products for acne are Category C (safe) but should be cautious when treating

37
Q

How to treat acne in neonates?

A

-in 20% of newborns, caused by mother’s hormones
-males > females
-Begins at 6 weeks and clears at 4-6 months of age
-Clean fingertips or soft washcloth with mild soap and water twice daily

38
Q

CAM Therapy (alternative medicine)

A

-Tea tree oil: antibacterial (staph aureus), one trial: as effective as benzoyl peroxide, slower onset

-Oral Zinc: Alternative to tetracyclines, No phototoxicity

39
Q

Products for mild, moderate, and severe acne

A

mild: Adapalene (decreases formation of comedones, and inflammatory and noninflammatory acne lesions)

moderate: Adapalene, Benzoyl peroxide

severe: Tretinoin Rx, consider REFERRAL

40
Q

Products that also need sunscreen use

A

-Benzoyl peroxide
-Salicylic acid
-Adapalene

41
Q

Products to expect worsening before improvement

A

-Benzoyl peroxide
-Adapalene

OTC II (17 decks)

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