Acne therapeutics part 2 Flashcards by amanda kastel

true or false

benzoyl peroxide can be used as monotherapy in mild acne

true - but often used in combination

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what strengths is benzoyl peroxide available

2.5-10%, but therapeutic efficacy has been shown to max out at 2.5%

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what is the only benzoyl peroxide dosage form that is exclusively available as RX

gel

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in what patients should benzoyl peroxide be avoided in

sensitive skin

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true or false

benzoyl peroxide causes c. acnes resistance

FALSE - DOES NOT

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If a patient experiences redness, burning, itching, peeling, or swelling from benzoyl peroxide, what should be done?

if mild, apply less frequently or reduce concentration

if severe, discontinue

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how long does it take to observe results after using benzoyl peroxide

as soon as 5 days

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concern with benzoyl peroxide

may bleach hair or fabrics

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when using benzoyl peroxide, avoid contact with….

eyes, lips, mouth

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name a topical hormone used for acne

clascoterone

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what kind of acne is clascoterone used for

how does it work

HORMONAL ACNE

inhibits androgen receptors, which helps to reduce oil production and inflammation

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true or false

clasterone is only indicated for men

what age?

FALSE

men and women 12 and older

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explain how clasterone should NOT be applied

do not apply under occlusive things - risk of being systemically absorbed

so not apply over large surface areas of use for prolonged period of time

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common vs more rare adverse events from using clascoterone

common - redness,dry, itchy

more rare – HPA suppression (hypothalmic-pituitary-adrenal)

LONG TERM SAFETY IS LACKING

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since clascoterone has the potential to cause HPA suppression, what is an important consideration

have to taper down if stopping

do not stop abruptly (like steroids)

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true or false

clascoterone is the only hormonal acne agent used in men (topically)

true

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*****very important consideration when using antibiotics for acne - whether topical or systemic

DO NOT USE ALONE

use other agent with it

increased risk of resistance if you dont

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which topical antibiotic is a SULFONE and what is the concern

DAPSONE

should not be used in pts with sulfa allergies

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what is the newest topical antibiotic

minocycline

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how does minocycline come?

what about dapsone?

minocycline - comes as FOAM

dapsone - comes as 5% and 7.5% gel

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is minocycline topical foam expensive?

YES

more costly than erythromycin and clindamycin, but no evidence that it works better than clindamycib

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dapsone is used in ______ acne….

inflammatory acne

and for comodomal (noninflammatory acne) in combination with a topical retinoid or benzoyl peroxide

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name something that can happen when dapsone is applied

if used with benzoyl peroxide, it may be oxidized and turn an orange-brown, but it’s not a big deal because it can be brushed away

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true or false

dapsone has been shown to benefit males more than females

FALSE

females more than males

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what is a consideration if wanting to start a fixed-dose topical combination

if they've never used either before, may want to just start with 1 to see how their skin reacts and how they respond

concomitant BP use us recommended with combined ____ and _____ to prevent the development of antibiotic resistance

topical retinoid and topical antibiotic

place in therapy for oral (systemic) antibiotics

moderate-severe INFLAMMATORY acne in conjunction with topical benzoyl peroxide and retinoid

how long should someone be on oral antibiotics for acne? explain

usually stopped in around 12 weeks within 12 weeks, the appearance of new inflamm. lesions is reduced, and should start tapering down if a flare up happens while tapering, increase the dose back up. while all this is happening, TOPICAL THERAPY IS STILL BEING USED

The goal with using oral antibiotics is to....

discontinue the oral antibiotics and be able to maintain control with topicla therapy

true or false topical antibiotics and oral antibiotics should not be used together

TRUE BREEDS RESISTANCE

there is no evidence to use oral antibiotics past....

3-4 months

how long to notice clinical improvement after starting oral antibiotics

6-8 weeks very long time if nothing happens at this point, consider stopping (TAPER)

true or false oral antibiotics should not be used long term for acne

true if they do well on them but flare up after taking off and keep needing to be put back on --- consider alternate therapy

initial dose minocycline for acne

50mg BID

TRUE OR FALSE minocycline is clinically less efficacious than the other oral ABX for acne

FALSE - actually more effective this is because it's more lipophilic than tetracycline and doxycycline --- more can accumulate in the hair follicles to produce effefcts

dose of doxy for acne

50-200mg in divided doses

pt education for minocycline

take with food for better absorption (it's lipophilic!) sit upright after taking for less side effects like vertigo

which is more likely to cause nausea and photosensitivity - tetracycline or minocycline?

tetracycline more likely

2 main side effects doxycycline

GI side effects (take w food and sit upright) photosensitivity

what is sarecyckine

an oral antibiotic that can be used for acne. extremely expensive and not 1st or 2nd line

advantages and disadvantages of sarecyckine

has lower GI ADRs because it has less activity against normal GI flora (NARROWER SPECTRUM) very expensive and no improved efficacy or decreased chance of resistance

name 2 systemic hormone therapies for acne

estrogen anti-androgens (androgen receptor blocker)

place in therapy for estrogen therapy

teens and women with mild, moderate, or severe acne IF TOPICALS FAIL!!!!! used as an adjunct with other therapy treatment for women who also want to use as birth control

place in therapy for anti androgens

women with hyperandrogenism bc of PCOS and adrenal hyperactivity (hirsutism and acne)

ideal birth control product (estrogen therapy) for acne control

LOW ANDROGEN activity and LOW DOSE OF ESTROGENS

what particular patients on oral contraceptives are at high risk of a clot

if they smoke/have family history

common side effects of estrogen therapy

nausea, weight gain, spotting, amenorrhea, breast tenderness

is spironolactone used for acne treatment in men

not really, due to undesirable effects of gynecomastia (inc breast tissue) and decreased libido (sex drive)

true or false spironolactone is fairly well tolerated in females

true most side effects occur in men

monitoring in spironolactone

monitor potassium and BP also check androgen levels at baseline and then every 3 months to make sure androgens are being suppressed

with what drugs should spironolactone be avoided

bactrim ARBS ace inhibitors potassium substutues

place in therapy isotretinoin

SEVERE INFLAMMATORY ACNE last line

briefly explain dosing isotretinoin how long is therapy?

WEIGHT BASED start at low dose and gradually increase as tolerated 16-20 weeks, and in rare cases 24-32 weeks

side effects isotretinoin

hair loss (resolves) depression, psychosis suicidal thoughts benign intracranial HTN abnormal labs mucocutaneous side effects (drying) hyperlipidemia

is isotretinoin taken with or without food

empty stomach for isotretinoin with lidose with food for norm

explain in further detail how isotretinoin dries you out

dry skin, eyes, nose, and mouth

resolution for dry skin and eyes caused by isotretinoin

skin - moisturize eyes - artificial tears (may not be able to tolerate contacts)

resolution for dry nose and mouth caused by isotretinoin

nose - petrolatum (vaseline) possibly an antibiotic ointment like bacitractin for colonization of staph aureus mouth - hard candies

MAIN lab values that isotretinoin effects

hyperlipidemia and increased hepatic enzymes (ALT, AST)

normal triglyceride value

less than 150

as mentioned, isotretinoin causes hyperlipidemia - increased triglycerides what is the biggest concern with this

can cause pancreatitis therefore, dont give to someone who is already very high at baseline

normal hepatic enzyme value

5-20 if they were at 5 and went all the way to 20, it's still in range but it's a concern bc they quadrupled the value if was at 19 and now 26, not as big a concern

RARE isotret side effects

decreased WBC osteoporosis skeletal abnormalities hypercalicemia

pts on isotretinoin should eat what kind of diet

LOW IN FAT it's gonna cause hyperlipidemia

2 methods of contraception are necessary if on isotretinoin how long

start at 1 month prior to therapy and continue until 1 month after

Acne therapeutics part 2 Flashcards

(66 cards)