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PDAT1 > 11 - Acne > Flashcards

11 - Acne Flashcards

1
Q

Benzoyl Peroxide

MoA / Efficacy

A
  • *ANTIMICROBIAL**
  • MILD* keratolytic / Comedolytic effects

Efficacy:

  • *2.5%** is just as effective as 5% / 10%
  • LOWER CONC are BETTER TOLERATED*

VEHICLE = determines the efficacy
Gels = MOST EFFECTIVE, BUT Most Drying
lotions / creams = intermediate
washes / cleaners = related to the contact time w/ skin
10-15 minutes

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2
Q

Inflammatory Acne

A

Papules
red bumps

Pustules
contains pus

Cysts /Nodules
deeper

after the obstruction of sebaceous gland
Increased proliferation of propionibacterium acnes
(NORMAL FLORA, body is responding to the oils)
producing chemotactic factors + proinflammatory mediators

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3
Q

Adapalene
Class / MoA / Efficacy

A

Retinoid

  • *Strong Keratolytic / Comedoltic** effects
  • MILD* anti-inflammatory effect

Highly Effective - non-inflammatory acne
still good for inflammatory acne - in combo w/ oral/topical anti-microbial

(both RX & Only OTC Retinoid - 0.1% gel)

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4
Q

NON-Pharmacologic TX
of ACNE

A

HYGIENE​

Wash BID
Mildly drying soap / GENTLE abrasive washcloth
no evidence that frequency is more beneficial
unless in dirty environment

Shampoo DAILY if hair is oily

Limit TOUCHing Face

DO NOT POP/PICK lesions

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5
Q

ORAL Antibiotics
RX Agents for Acne

A

Doxycycline / Tetracycline / MinoCycline / Erythromycin

Moderate to SEVERE Inflammatory/Nodulocysitic Acne
or for EXTENSIVE acne –> on the back / hard to reach

  • *Antimicrobial + Anti-Inflammatory**
  • DECREASE* Free Fatty Acids on skin

Concern = ABx Resistance
use in a _limited time_ in combination w/ BPO or topical retinoids

ADR = Yeast infections in women
do NOT combine with ORAL & TOPICAL Abx

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6
Q

ISOTRETINOIN

iPLEDGE Program

A

TERATOGENIC = Preg CAT X

ALL Isotretinoin patients MUST ENROLL
Males + Females

Prescriber = document patient consent / education / monitoring

Pharmacy = Verify online eligibility/dispensing requirements
NOT Refilable

Do NOT share medication / DO NOT DONATE BLOOD
2 types of Contraception + MONTHLY Pregnancy test

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7
Q

Hormones + Hormone Modifiers

for Acne

A
  • DECREASE*
  • *Androgen-Induced Sebum** preduction

Combination Oral Contraceptives
Estrogens = IMPROVE
progestins = worsen
generally OCP’s IMPROVE, but MAY exacerbate acne

Spironolactone
Anti-Adrogenic: blocks androgen receptor
commonly used in WOMEN

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8
Q

Pathophysiology of ACNE

A

Puberty = Onset of Androgen production

Effect on PiloSEBEACEOUS GLAND
produce MORE Sebum + Keratinized
–> obstruction of sebaceous gland (micromedone)

Can lead to:
Non-Inflammatory (white+blackheads)
or
Inflammatory Acne
(from bacteria & pro-inflammatory mediators)

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9
Q

Benzoyl Peroxide = BPO

A

Considered the MOST effective OTC agent for:
INFLAMMATORY ACNE
some products are RX only, chosen by manufacturer

2.5% - 10%

NOT approved for those < 12 y/o

often used with antimicrobials because it limits ABx Resistance

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10
Q

Topical Retinoids / Prodrugs / Retinoid-Like-Drugs
RX Agents for Acne

A

Tretinoin / Adapalene RX / Tazarotene / Azelaic Acid

Mild-Moderate Inflammatory Acne & Non-Inflammatory

Comedolytic + Antiinflammatory

SLOW onset of efficacy –> can be WORSE first

ADR:
skin irritation / DRYING / erythema
Photosensitivity = use Sunscreen
choice of VEHICLE matters

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11
Q

Treatment Approach for Acne Vulgaris

Mild
Comedonal
White + blackheads

<10 Papules/Pustules

No Scarring

A

TOPICAL RETINOID

Adapalene
Tretinoin / Tazarotene

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12
Q

Patient Assessment QUESTIONS
for ACNE

A

How old are you?

How long have you had acne? What areas are affected?

What treatments/medications have you tried? Have you seen a physician about your acne?

Are you on any medications? What kind of work do you do?

What is your daily hygiene routine?

Do you use cosmetics?

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13
Q

Acne Therapy Pathway Choice

A
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14
Q

Salicylic Acid
Acne Treatment

A

OTC Agent = 0.5 - 2%
Stridex / PROPApH / FOSTEX
for Mild non-inflammatory acne & patients with intolerance

  • *Keratolytic + possibly Antimicrobial**
  • LESS effective than Adapalene*

Once Daily Dosing

local irriaation / systemic absorption

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15
Q

Isotretinoin ADR’s

A
  • *Dermatologic**
  • *Dry skin** / mucus membrane + photosensitivity
  • *Ophthalmogic**
  • *Dry eyes** / conjuctivitis
  • *Musculoskeletal**
  • *Joint + Muscle** Pains –> monitor ESR & Creatinine Kinase
  • *CNS**
  • *HA / Fatigue / Mood**

TERATOGENIC

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16
Q

​Treatment Approach for Acne Vulgaris

Nodular / Conglobate

Multiple Nodules / Cysts

Extensive Scarring

A

ORAL TRETINOIN

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17
Q

Topical Antibiotics
RX Agents for Acne

A

Erythromycin / Clindamycin / Dapsone
use in COMBO with non-ABx to limit RESISTANCE
BPO

Mild - Moderate Inflammatory Acne

Antimicrobial + possible antiinflammatory

very effective, all similar efficacy

  • only local skin irritation*
  • do NOT combine with ORAL & TOPICAL Abx*
18
Q

Resorcinol 2%/3%
acne products

A

Can ONLY be in combination with SULFUR
Clearasil / acnomel / rezamin

Use for mild / non-inflammatory acne

May cause:
Brown Scale on treated areas

19
Q

Treatment Approach for Acne Vulgaris

  • *Mild-Severe**
  • *Nodular = Small nodules** <0.5cm

Few-Moderate Nodules + Cysts

Moderate Scarring

A

ORAL ANTIBIOTIC

BPO

TOPICAL RETINOID

same as moderate treatment

20
Q

ADAPALENE
Acne Treatment

A

Retinoid - Both OTC & RX

1st Line Treatment for NON-INFLAMMATORY ACNE

NOT for use in _children < 12 y/o_

0.1% Gel = OTC now

0.1% cream/soluton/lotion or 0.3% gel or combo with BPO
= RX only

21
Q

Acne Patient Education

A

Drugs Prevent & Treat
do NOT CURE acne

Onset of benefit in 4-12 weeks
continued therapy needed for continued benefit

Drugs will NOT resolve existing scars
but are effective in preventing new scars

If patient has a good response –> TAPER therapy

22
Q

Isotretinoin

LAB ABNORMALITIES

A

Monitor @
baseline/after initiation/dose increases

LIPIDS
INCREASED TG’s

LIVER
INCREASED LFTs

  • *CBC**
  • *Anemia / Thrombocytopenia / leukopenia**
  • if* significant muscle / joint pain
  • *ESR** (Elevated sedimentation rate) + Creatinine Kinase (CK)
23
Q

Non-Inflammatory Acne

A

Whiteheads = CLOSED Comedones

Blackheads = OPEN Comedones

occur after the obstruction of sebaceous gland

24
Q

Classes of Anti-Acne

RX TREATMENTS

A

RX Only

ISOTRETINOIN affects ALL CLASSES

25
Q

Combination Therapy
for Acne

A

Commonly Used!

for Different Mechanisms of action
+
Limits ABx Resistance!

Commercially available or given as 2 seperate agents

26
Q

Acne Distribution

A

Occurs at any site where there are SEBACEOUS GLANDS

FACE

BACK

CHEST

27
Q

Adapalene
Dosing / Adverse Effects

A

ONCE DAILY

ADR:
Skin irritation - drying / erythema

slow onset = can take WEEKS

photosensitivity = use sunscreen

Appears to be better tolerated vs other retinoids

28
Q

Classes of Anti-Acne Medications

OTC TREATMENTS

A

BPO Affects 3 of them

NONE AFFECT SEBUM PRODUCTION

29
Q

What is the FIRST LINE TREATMENT for
NON-INFLAMMATORY ACNE

A

ADAPALENE
only OTC Retinoid = 0.1% gel
Strong keratolyic/comedolytic

not for <12 y/o

30
Q

Treatment Approach for Acne Vulgaris

Mild-Moderate
Mixed & Papular/Pustular

10-25 P/P
On face & trunk
minimal - no scarring

A

Topical Retinoid
Adapalene
+
Topical Antimicrobial
Erythromycin / Clindamycin
dapsone

31
Q

Treatment Approach for Acne Vulgaris

A
32
Q

Key notes for
OTC Acne Agents

A

Initial Therapy for Mild / Non-inflammatory Acne
ADAPALENE > Salicylic Acid

Initial therapy for Mild INFLAMMATORY Acne
BPO
use of BPO w/ topical antimicrobials LIMITS resistance

May use in combination w/ RX products
for moderate -> severe acne

33
Q

4 Classes of ANTI-ACNE Medications

A

Reduction in Sebum production

Reduction in Abnormal Desquamation

  • *Keratolytics / Comedolytics**
  • decrease cohesiveness of folicular lining
  • formation of NEW comedones** + LOOSEN formed ones
  • *Anti-Microbial**
  • decrease concentration of* P.Acnes

Anti-Inflammatory

34
Q

Treatment Approach for Acne Vulgaris

  • *Moderate**
  • *Mixed + P/P**

>25 P/P
on face / trunk

Moderate Scarring

A

ORAL ANTIBIOTIC
Doxycycling / tetra cycline / minocycline
WITH OR W/O

BPO
important to prevent resistance of oral antibiotic

+
Topical Retinoid
Adapalene

35
Q

Benzoyl Peroxide = BPO

Dosing

A

Start with 2.5% low dose

FIRST: Test on 1-2 small areas for several days = DAILY
possibility for ADVERSE REACTION
if single agent –> increase frequency to BID as Tolerated

if BID 2.5% is tolerated, but ineffective:
–> 5% strength, generally dont go to 10%

AAA –> 15-30 minutes AFTER cleansing
to allow skin to completely dry, to minimize local irritation

36
Q

BPO
ADR’s

A

2 Types of Skin Reactions

Allergic Contact Dermatitis = 1-3%
this is why we do a TEST/SPOT dose
Redness / itching / hives even with low doses
possible systemic symptoms, DISCONTINUE = Sensitivity

Irritation / Erythema
DOSE RELATED = Can adjust dose
Avoid excessive SUNLIGHT / Use Sunscreen

may BLEACH CLOTHING

37
Q

Isotretinoin = Oral Retinoids
RX Agents for ACNE

A

Targets ALL 4 SITES of Acne Treatment

indicated for:
Severe nodular/cystic acne = FIRST LINE
Mild-Moderate inflammatory acne URESPONSIVE to std treatment = third line

Efficacy: 70% –> prolonged remission may occur

but MANY ADR

38
Q

Acne Pathogenesis

A

Microcomodome
forms from more keratin + excess sebum

  • *Later Comodome**
  • *whitehead** = shedded corneocytes / subum –> PLUG
  • *blackhead** = forms an open comedo
  • *Papule / Pustule**
  • *propinobacterium acnes** proliferiate
  • -> initiating a immune response

Cyst / Nodule
marked inflammatory response & rupture of the follicular wall
–> scarring

39
Q

Sulfur
Acne Treatment

A

OTC Agent - Sulfur 3% - 10%
use for mild / non-inflammatory acne
typically not recommended

  • *KERATOLYTIC**
  • *1-3 times a day**

color / odor
possible comedogenic w/ prolonged use

40
Q

Drugs that can cause ACNE

A

Can induce a inflammatory acne:

CORTICOSTEROIDS
systemic > topical > inhaled
Androgens / Anabolic Steroids / Progestin
contraceptives

  • *CNS Active Drugs**
  • *lithium / risperidone / sertraline**

AntiEpilepticDrugs
carbemazepine / phenytoin / topiramate / gabapentin

Cyclosporin

41
Q

Acne TIME COURSE

A

Starts @ Puberty
may RELAPSE during pregnancy / menopause

NEW onset of acne in 20+ y/o
needs MEDICAL EVALUATION:
might be due to secondary cause / non-vulgaris acne (rosacea)

Acne in newborns
related to maternal hormones
DO NOT TREAT WITH MEDS = will SELF-RESOLVE

PDAT1 (27 decks)

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