Therapeutics - Acne Flashcards by amanda kastel

true or false

acne can be inflammatory or non inflammatory

true

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true or false

acne is self limiting

true

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true or false

there is mortality associated with acne

false - there’s not

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differentiate between inflammatory acne lesions vs noninflammatory acne lesions

noninflammatory are open (blackheads) and closed (comedones)

inflammatory are papules/pustules/nodules (cysts)

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there is NO universal grading system in place for acne

that being said, what’s the closes system we have

basing on the number and type of lesions, extent, regions, quality of life, severity (0-4 with 0 being clear)

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what is the 5 point ordinal scale to quantify the severity of acne

0 is clear

4 is severe

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true or false

in general, oral therapies are first line in mild and moderate acne

FALSE

topical is first line for mild-moderate

oral therapies reserved for moderate -severe (oral=systemic)

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differentiate between papules vs pustules vs nodules

papules are raised regions with no pus

pustules have pus

nodular can cause scarring without even any manipulation (touching)

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when picking the VEHICLE for topical acne treatment - what is a very important consideration

SKIN TYPE

dry oily or normal?

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true or false

when choosing an acne product, we should only be considering the product

FALSE

product and vehicle

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what is an issue with some OTC things for acne

abrasive soaps for example are irritating and can limit ability to tolerate other therapies

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name a drug that can INDUCE acne lesions

topical or oral corticosteroids

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name 4 drugs that can WORSEN acne

lithium
isonaizid
hydantoin
rifampin

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cosmetics containing ___ or ___ may worsen acne

lanolin or oil

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for women, what is a likely determinant that the acne is hormone related

oligomenorrhea or hirstuism + acne may be caused by polycystic ovarian disease or late-onset adrenal hyperplasia — increased androgen production

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true or false

certain hormonal contraceptives can worsen acne

TRUE

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name 2 physical complications of acne

scarring and hyperpigmentation

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is acne considered chronic?

yes

even tho most ppl outgrow it, especially if hormonal

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TRUE OR FALSE

cleaning the face as much as possible throughout the day can help to reduce acne

FALSE

over cleaning can cause irritation to the face

the SURFACE sebum and bacteria do not cause acne – only if they get inside it can cause complications

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what does “noncomedogenic” mean

water-based cosmetics that don’t clog the pores

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in choosing a soap for acne, avoid ones with high ____ content

oil

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true or false

medicated and antibacterial soaps and astringents have no benefit in acne

true

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explain the preferred methods of cleansing for inflammatory acne vs noninflammatory acne

for non-inflammatory, a mildly abrasive cleaner is okay - but nothing too crazy

for inflammatory - use GENTLE SOAPS

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which 2 vehicles are good for use in the winter and why

creams and lotions bc of their moisturizing nature

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which 2 vehicles are good for ANY skin type explain why

washes and soap they don't stay on the skin for a long time and don't affect the oilyness or dryness

***which vehicle should NEVER be used in acne patients

OIL too occlusive and does the opposite of what we want

skin type for creams vs lotions

creams - normal lotion - normal-dry

which vehicle is most convenient to use

soaps

skin type for gels

oily-normal has drying effects

name 2 vehicles that are best for pts with sensitive skin

washes and lotions

skin type for foams

oily-normal also drying like gels

name the 2 classes of topical therapy used in acne

antimicrobial comedolytics

is the main action of benzoyl peroxide as an antimicrobial or comedolytic

mainly antimicrobial

for ALL acne, what is 1st line treatment

topical retinoids/benzoyl peroxide are equally considered 1st line as MONOtherapy if doesnt work, add the one not used at 1st

true or false topical antibiotics are 1st line for mild acne

not really Bp and retinoids are preferred and should be tried 1st

name the 3 strongly recommended "fixed dose" topical combinations

topical AB and retinoid topical retinoid and BP topical retinoid and topica; antibiotic

name 3 topical agents that are only conditionally recommended

clascoterone salicylic acid azelaic acid

only treatment for acne conditionally recommended against

pneumatic broadband light added to adapalene

what is the concern with systemic antibiotics used for acne and what do we recommend to combat this

ANTIBIOTIC RESISTANCE thus - never use as monotherapy. add benzoyl peroxide or some other topical treatment (not another AB)

antibiotics for acne - whether systemic or topical - should NEVER be used alone

true

1st line systemic antibiotic for moderate-severe acne

doxycycline

what is the close 2nd to doxycycline

minocycline

_____ is preferred over azithromycin as a systemic antibiotic for acne

doxycycline

aside from topical treatments, name 3 other categories potentially that can be used for moderate-severe acne

systemic antibiotics hormonal agents isotretinoin

name 3 hormonal agents that can potentially be used for moderate-severe acne

combined oral contraceptives spironolactone intralesional corticosteroids (adjunctive for larger acne papules at risk of scarring)

name 4 potential systemic antibiotics for moderate-severe acne

doxycycline minocycline sarecycline azithromycin (not preferred)

is isotretinoin given with other topical agents

NO once you start this, you come off EVERYTHING ELSE

last line acne treatment

isotretinoin

what is recommended to be monitored when a patient is on isotretinoin

liver function tests and lipids

true or false pts on spironolactone should always monitor their potassium levels

not really - not really useful unless at risk for hyperkalemia like if they're old or have other medical comorbidities or medications that can cause it

patients with ____ or ____ should be considered cnadidates for isotretinoin

psychosocial burden or scarring

which is preferred for isotretinoin - daily dosing or intermittent dosing

daily

sulfur is an OTC topical product marketed for acne is it recommended?

no recommendation - evidence is insufficient

what is the recommendation for salicylic acid

conditionally recommended (not strong)

OTC - topical glycolic acid, sodium sulfacetamide, resorcinol, tea tree oils what is recommendation

no evidence sufficient to develop recommendation

caution with salicylic acid

it is an irritant that may exacerbate inflammatory lesions

if excess irritation occurs while a patient is on a topical sulfur or salicylic acid, what should they do?

discontinue and contact md

true or false topical retinoids are first line treatment for inflammatory AND noninflammatory acne

TRUE

topical retinoids can be used in combo with __ or ___ for mild-moderate acne (both inflamma and non)

BP or topical antibiotic

Retin-A vs Retin-A micro

retin-a micro has a better side effect profile

tretinoin vehicles in order of increasing potency

least potent - liquid creams most potent = gels

aside from tretinoin, name 3 other topical retinoids

adapalene tazarotene tritarotene

explain what does topical retinoids should be started on and why

start at VERY LOW DOSE (0.025%) as cream, micro, or adapalene either every other or every 3rd night progressing as tolerated over 2-3weeks to NIGHTLY APPLICATION (goal) concs can be increased if needed and tolerated exacerbates acne at 1st

patient education with topical retinoids

-will exacerbate at 1st -- resolves in 3-6 weeks mild-severe irritation occurs at 1st redness, dryness, peeling applied ONCE DAILY to completel dry skin at least 30mins after washing (for micro or adapalene - dont need to wait this long) applied at bedtime, and apply sunscreen bc can burn more easily

why is it that patients on topical retinoids burn more easily

the thickness of the stratum corneum is reduced

what time of day should topical retinoids be applied at

bedtime

if someone is using a topical retinoid and benzoyl peroxide, what is a counseling point

their application should be separated (unless it's adapalene)

true or false adapalene can be applied immediately after washing

TRUE this and micro are the only topical retinoids -- all the others have to wait 30mins

tazorotene any benefits over adapalene or tretinoin? anything that's worse?

it may be more efficacious than adapalene and tretinoin, but has more side effects

is adapalene contraindicated in pregnancy

NO - category C -- shown to have adverse effects in animal fetus but not human yet tazarotene IS teratogenic

what is unique about tritarotene

it selectively targets gamma RAR thus, potentially has better efficacy and reduced skin irritation -- but clinical evidence still lacking

what is the most expensive topical retinoid

tritarotene

Therapeutics - Acne Flashcards

(73 cards)