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DEENT Exam 4 > Acne Vulgaris Therapy > Flashcards

Acne Vulgaris Therapy Flashcards

(44 cards)

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1
Q

Grade I (mild) acne

A

Mainly comedones
Occasional papules
No nodules, no scarring
Mostly non-inflammatory

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2
Q

Grade II (moderate) acne

A

Comedones
more papules and pustules(mainly facial)
Mild scarring
Inflammatory lesions

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3
Q

Grade III (Moderate) acne

A

Numerous and extensive comedomes, papules, pustules, and nodules
(facial with spread to back, chest, shoulders)
Occasional cyst or nodule
Moderate scarring

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4
Q

Grade IV (Severe) acne

A

Numerous large cysts or nodules on the face, neck and upper trunk
Severe scarring
Persistant pustulocystic
Recalcitrant cystic

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5
Q

Assessment of severity

A

Garde 1, II, III, and IV

Guides whether or not patient can be a candidate for self treatment and what treatment strategies will be necessary or work best for them.

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6
Q

Approach to acne treatment

A
  • Identify/limit exposure to exacerbating factors
  • Alleviate discomfort
  • Control lesions
  • Prevent pitting/scarring
  • Prevent new lesions
  • Minimize adverse drug reactions
  • Address as many pathogenic factors for acne development as possible by:
  • Reducing sebum production
  • Suppress P. acnes
  • Reducing inflammatory process to prevent scarring
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7
Q

Non-pharmacologic therapy for acne

A
  • Eliminate exacerbating factors
  • Counsel patient on importance of adherence
  • Cleanse skin with mild soap or non-soap cleanser twice a day
  • Avoid using abrasive products and excessive cleansing
  • Stay well hydrated
  • Do not pop, squeeze or pick acne
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8
Q

Non-prescription topical products

A 
Benzoyl Peroxide:
Bacetricidial
Slightly Keratolytic
Comes in wash, liquid, cream, and gel
Adverse: bleach hair & clothes, drying, photosensitivity

Salicylic Acid:
Keratolytic
Comedolytic (lyses comedones)
Comes in pads, cream, gel
Adverse: Potent keratolytic at high concentration, drying, photosensitivity

Sulfur:
Bactericidal
Keratolytic
Comedolytic
Comes in cream & lotion
Adverse: color, malodorous, drying
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9
Q

Topical product selection for oily to normal skin

A

Gels, solutions, and lotions

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10
Q

Topical product selection for normal skin

A

Gels, solutions, lotions, and creams

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11
Q

Topical product selection for normal to dry skin “sensitive skin”

A

Lotions and creams

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12
Q

Ointments and bars

A

not usually recommended for any skin type

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13
Q

Benzoyl Peroxide

A

Most common topical OTC product for acne

Recognized by FDA as safe and effective

Used alone or in combination with oral/topical antibiotics

Prevents development of P. acnes resistance

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14
Q

Benzoyl Peroxide OTC Formulations

A

2.5% to 10% concentration

Prescription strength up to 20%

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15
Q

Benzoyl Peroxide Side Effects

A

Most common: skin irritation (more likely in higher strengths)
Side effects will stabilize within 1-2 weeks

Photosensitivity

Bleached hair/clothing

Allergic reaction

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16
Q

Salicylic Acid

A

FDA-approved topical product available OTC

Comedolytic and keratolytic

Efficacious in treatment of acne, though less than benzoyl peroxide

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17
Q

Salicylic Acid Formulations

A

Non-prescription strengths: 0.5 to 2%

Prescription strengths up to 30%

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18
Q

Salicylic Acid Side Effects

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A

Potent keratolytic
Drying
Photosensitivity

19
Q

Sulfur

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A

FDA-approved for OTC treatment of acne

Keratolytic and antibacterial

Useful for existing comedones but may promote comedone development with long-term use

20
Q

Sulfur Formulation

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A

Can be combined with resorcinol

  • Enhances sulfur effect
  • Can produce a reversible, dark brown pigment in darker-skinned patients
21
Q

Sulfur Side Effects

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A

Dry skin, noticeable odor

22
Q

Complementary Therapy for Acne

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A 
Tea Tree Oil:
Essential oil
May have antiseptic properties
Has been shown to reduce lesions but slower onset of action
May be irritating if applied directly
Add to a moisturizing or gel vehicle
23
Q

Alpha Hydroxy Acids

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A
  • Glycolic acid; Lactic acid; Citric acid
  • Exfoliates
  • In high concentrations, can be used as a chemical peel to reduce acne scarring
  • Need to use sunscreen due to increased photosensitivity
24
Q

Prescription Products for Acne

Study These Flashcards
A 
Topical Retinoids
Topical Antibiotics
Topical Antimicrobials
Oral Antibiotics
Oral Antiandrogen
Oral retinoid
Other Topicals
25
Topical Retinoid examples
Tretinoin Adapalene Tazarotene
26
Topical Antibiotic examples
Clindamycin | Erythromycin
27
Topical Antimicrobial examples
Erythromycin | Clindamycin
28
Oral Antibiotic Examples
``` Tetracycline Minocycline Erythromycin Doxycycline Clindamycin ```
29
Oral Antiandrogen Examples
Spironolactone Drospirenone Flutamide Oral contraceptives
30
Oral retinoid examples
Isotretinoin
31
Other topical examples
Benzoyl Peroxide Azelaic Acid Salicylic Acid Corticosteroids
32
Topical retionds
``` Vitamin A derivatives Tretinoin (Retin-A ®) Adapalene (Differin ®) Tazarotene (Tazorac® or Fabior ® foam) Most powerful peeling agents available ``` Reduce inflammation, normalize keratinocyte differentiation, and increase keratinocyte proliferation/migration Apply to clean, dry skin (avoid eyes, mucous membranes, abrasions) Photosensitivity/photoirritants
33
Topical antibiotics
Antibiotic and anti-inflammatory effects Erythromycin Clindamycin Foam: apply daily; use gloves to apply and wash hands thoroughly afterward Apply to dry, clean skin BID Wait 30 minutes to shave area or apply makeup Adding benzoyl peroxide or topical retinoids can prevent/overcome bacterial resistance
34
Systemic Retinoids
Isoretinoin (Accutane®)--Oral Treatment for: Severe recalcitrant acne Treatment resistant acne Acne causing significant physiological/psychological scarring Weigh benefits of use against risk of adverse effects: Dry nose, eyes, mouth, inflammation of the lips Musculoskeletal, ophthalmic effects, headache, CNS effects Mood disorders, depression, suicidal ideation Lab monitoring: triglycerides, cholesterol, LFTs, and CBC Potent teratogen—iPledge program for child-bearing aged female patients
35
Systemic Antibiotics
Moderate to severe acne Minocycline Doxycycline Erythromycin (bacterial resistance) Trimethoprim-sulfamethoxazole Bacterial resistance for antibiotics increasing problem If using tetracycline, separate from dairy products by 1-2 hours and use sunscreen to avoid toxicity
36
Hormonal Agents
Estrogen containing oral contraceptives for some women Oral anti-androgenic agents—spironolactone and cyproterone acetate Side effect of spironolactone—hyperkalemia Oral corticosteroids—limited data May be beneficial for patients with highly inflammatory disease
37
Treatment Strategies: | Pediatric mild treatment
``` Initial: benzoyl Peroxide or topical retinoid OR Combination Therapy BP+antibiotic, BP+retinoid BP+retinoid+antibiotic ``` Inadequate Response: -Add BP or Retinoid (if not already prescribed). -Change Retinoid Concentration, Type, and/or formulation OR -Change topical combination therapy
38
Pediatric Moderate Treatment
``` Initial: Topical Combo BP+ Retinoid OR Retinoid+(BP+antibiotic) OR (Retinoid+Antibiotic)+BP ``` OR Oral antibiotic+topical retinoid+BP OR Topical Retinoid+Antibiotic+Bp Inadequate: -Change Retinoid Concentration, Type, and/or formulation OR -Change topical combination therapy AND/OR Change oral antibiotic Female:consider hormone therapy OR Consider oral isotretinoin
39
Pediatric Severe Treatment
Initial: Combo therapy Oral antibiotic +/- topical antibiotic+BP+topical retinoid Inadequate: Change oral antibiotic+consider oral isotretinoin Female:consider hormone therapy
40
Acne Patient Conseling
It may take 8 weeks or more to see visible benefits of treatment Acne is a condition that will get worse before it gets better Peeling of the skin when first using topical agents may occur
41
Case 1: 16 year old girl acne on face, no inflammatory lesions; wearing heavy makeup
Classify her acne – mild First line of medications to suggest – Benzoyl peroxide Non-pharm advice – hydration
42
Case 2: 18 year old boy; acne is on his forehead and cheeks, and that he also gets lesions and papules on his shoulders. There is some mild scarring. He does not take any medications on a regular basis, though he admits to trying topical benzoyl peroxide 10% twice a day for the past few weeks. He just moved away from home to go to college and reveals his diet consists of primarily sugary drinks and fast food. He complains that his skin on his face is oily.
Classify his acne – moderate mixed Topical preparation type – gel Add to current regimen – topical retinoid
43
Case 3: A 27 year old women with moderate acne is complaining of acne despite being prescribed oral doxycycline, topical retinoids and benzoyl peroxide for 8 months She takes loratidine 10 mg daily for allergic rhinitis and has no drug allergies She has comedones on her forehead, nose and chin, as well as papules on her nose and two cysts below her chin. She states that she also has some cystic lesions on her upper back and shoulders She is also complaining of irregular periods. She is not sexually active nor planning a pregnancy in the near future.
Next treatment step: oral contraceptives Oral contraceptives do not work, wants to start oral retinoids, what counseling points? iPledge, teratogenic, side effects – mood
44
Suggesting Regimen
Determine outcomes for that patient Use non-pharmacologic, first Then, add lowest strength medications – Topical then oral Monitor response over 6 weeks or more Reduce therapies, when possible Add or change therapies, as indicated Remember to check on drug interactions, side effects – sunscreen, moisturizer, etc

DEENT Exam 4 (6 decks)

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