Chapter 78 - Acne Vulgaris

Question 1

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

First line
Mild
Comedonal

Answer 1

Topical retinoid or combination

Combination
- BPO + erythromycin
- BPO + clindamycin
- Adapalene + BPO
- Tretinoin + clindamycin

Question 2

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

First line
Moderate
Papular or Pustular

Answer 2

Topical retinoid + topical antimicrobial or combination

Combination
- BPO + erythromycin
- BPO + clindamycin
- Adapalene + BPO
- Tretinoin + clindamycin

Question 3

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

First line
Severe
Papular or Pustular

Answer 3

Oral antibiotic +
topical retinoid ±
BPO or combination

Combination
- BPO + erythromycin
- BPO + clindamycin
- Adapalene + BPO
- Tretinoin + clindamycin

Question 4

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

First line
Nodular

Answer 4

Oral antibiotic + topical retinoid ± BPO

Question 5

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

First line
Conglobata or Fulminans

Answer 5

Oral isotretinoin ± oral corticosteroids

Question 6

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Second line
Mild
Comedonal

Answer 6

Topical dapsone or azelaic acid or salicylic acid

Question 7

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Second line
Moderate
Papular or Pustular

Answer 7

Topical dapsone or azelaic acid or salicylic acid

Question 8

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Second line
Severe
Papular or Pustular

Answer 8

Oral antibiotic +
topical retinoid ±
BPO or combination

Combination
- BPO + erythromycin
- BPO + clindamycin
- Adapalene + BPO
- Tretinoin + clindamycin

Question 9

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Second line
Nodular

Answer 9

Oral isotretinoin or oral antibiotic +
topical retinoid ±
BPO–azelaic acid or combination

Combination
- BPO + erythromycin
- BPO + clindamycin
- Adapalene + BPO
- Tretinoin + clindamycin

Question 10

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Second line
Conglobata or Fulminans

Answer 10

High-dose oral antibiotic +
topical retinoid +
BPO or combination

Combination
- BPO + erythromycin
- BPO + clindamycin
- Adapalene + BPO
- Tretinoin + clindamycin

Question 11

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Additional for female patients
Severe
Papular or Pustular

Answer 11

+ Oral contraceptive–antiandrogen

Question 12

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Additional for female patients
Nodular

Answer 12

+ Oral contraceptive–antiandrogen

Question 13

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Additional for female patients
Conglobata or Fulminans

Answer 13

+ Oral contraceptive–antiandrogen

Question 14

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Additional options
Mild
Comedonal

Answer 14

Comedone extraction

Question 15

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Additional options
Moderate
Papular or Pustular

Answer 15

Comedone extraction, laser or light therapy, photodynamic therapy

Question 16

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Additional options
Severe
Papular or Pustular

Answer 16

Comedone extraction, laser or light therapy, photodynamic therapy

Question 17

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Additional options
Nodular

Answer 17

Comedone extraction; intralesional corticosteroid, laser or light therapy, photodynamic therapy

Question 18

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Additional options
Conglobata or Fulminans

Answer 18

Intralesional corticosteroid, laser or light therapy, photodynamic therapy

Question 19

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Refractory to treatment
Mild
Comedonal

Answer 19

Check compliance

Question 20

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Refractory to treatment
Moderate
Papular or Pustular

Answer 20

Check compliance
Exclude gram-negative folliculitis
Females: exclude PCOS, adrenal or ovarian tumors, CAH
Males: exclude ECAH

Question 21

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Maintenance
Mild
Comedonal

Answer 21

Topical retinoid ± BPO, or combination

Combination
- BPO + erythromycin
- BPO + clindamycin
- Adapalene + BPO
- Tretinoin + clindamycin

Question 22

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Maintenance
Moderate
Papular or Pustular

Answer 22

Topical retinoid ± BPO, or combination

Combination
- BPO + erythromycin
- BPO + clindamycin
- Adapalene + BPO
- Tretinoin + clindamycin

Question 23

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Maintenance
Severe
Papular or Pustular

Answer 23

Topical retinoid ± BPO, or combination

Combination
- BPO + erythromycin
- BPO + clindamycin
- Adapalene + BPO
- Tretinoin + clindamycin

Question 24

TABLE 78-2
Treatment Algorithm for Acne Vulgaris

Maintenance
Nodular

Answer 24

Topical retinoid ± BPO, or combination

Combination
- BPO + erythromycin
- BPO + clindamycin
- Adapalene + BPO
- Tretinoin + clindamycin

Question 25

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Topical Therapies Azelaic acid

Answer 25

B

Question 26

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Topical Therapies Clindamycin

Answer 26

B

Question 27

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Topical Therapies Erythromycin

Answer 27

B

Question 28

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Topical Therapies Metronidazole

Answer 28

B

Question 29

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Topical Therapies Adapalene

Answer 29

C

Question 30

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Topical Therapies Benzoyl peroxide

Answer 30

C

Question 31

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Topical Therapies Dapsone

Answer 31

C

Question 32

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Topical Therapies Salicylic acid

Answer 32

C

Question 33

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Topical Therapies Sodium sulfacetamide

Answer 33

C

Question 34

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Topical Therapies Tretinoin

Answer 34

C

Question 35

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Topical Therapies Tazarotene

Answer 35

X

Question 36

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Oral Therapies Amoxicillin

Answer 36

B

Question 37

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Oral Therapies Azithromycin

Answer 37

B

Question 38

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Oral Therapies Cephalexin

Answer 38

B

Question 39

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Oral Therapies Erythromycin

Answer 39

B

Question 40

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Oral Therapies Cotrimoxazole

Answer 40

C

Question 41

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Oral Therapies Levofloxacin

Answer 41

C

Question 42

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Oral Therapies Spironolactone

Answer 42

C

Question 43

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Oral Therapies Tetracyclines

Answer 43

D

Question 44

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Oral Therapies Isotretinoin

Answer 44

X

Question 45

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Oral Therapies Oral contraceptive pills

Answer 45

X

Question 46

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Physical Modalities ALA: photodynamic therapy

Answer 46

C

Question 47

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Physical Modalities Glycolic acid peels

Answer 47

N

Question 48

TABLE 78-5 Safety Ratings of Acne Medications in Pregnancy Physical Modalities Blue-red light phototherapy

Answer 48

N