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Clinical Pharmacy 1 - Term 1 > 6 - Acne > Flashcards

6 - Acne Flashcards

1
Q

What is required for acne to occur?

A

Pilosebaceous unit (hair follicle)

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2
Q

What are some risk factors for acne?

A
  • Hormones
  • Stress
  • Genetics, family history
  • Environmental factors (oily hair on the face, exposure to aerosolized oil, pollution)
  • Medication
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3
Q

What are the 4 stages of the pathophysiology of acne?

A

1) Increased follicular keratinization
2) Increased sebum production
3) Bacterial (P. acnes) lipolysis of sebum triglycerides to free fatty acids
4) Inflammation

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4
Q

What are the 2 types of non-inflammatory lesions?

A
  • Open comedone (blackhead)

- Closed comedone (whitehead w/ no redness)

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5
Q

What are the types of inflammatory lesions?

A
  • Papules (raised center w/ some inflammation)
  • Pustules (larger b/c contents in hair follicle has ruptured and is spreading; 5 mm or less)
  • Nodules (larger than pustule; 5 mm - 3 cm)
  • Cysts (affects deeper tissue)
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6
Q

What are the 3 types of acne scars?

A

1) Depressed - ice pick, (triangular), boxed (rectangular), hypertrophic (extends above skin)
2) Hypertrophic (also called keloidal)
3) Atrophic

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7
Q

What are the types of acne?

A
  • Drug-induced (same presentation throughout)
  • Neonatal (2-3 months old; self-limiting)
  • Acne conglobata (affects large area)
  • Acne fulminans (severe, can lead to systemic symptoms like sore joints or muscles)
  • Contact (same presentation, can be due to oil-based cosmetics)
  • Endocrine (can be caused by excess glucocorticoids or androgens)
  • Acne mechanica (localized, caused by mechanical reason)
  • Acne excoriee (formed from px manipulating skin)
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8
Q

Which type of acne requires an immediate referral?

A

Endocrine acne

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9
Q

What are the classifications of acne?

A

1) Comedonal
2) Mild - moderate papulopustular
3) Severe papulopustular, moderate nodular
4) Severe nodular, conglobate

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10
Q

What is the presentation of comedonal acne?

A
  • Open and closed comedones

- No more than 1 papule may be present

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11
Q

What is the presentation of mild - moderate papulopustular acne?

A

Numerous comedones, w/ few papules and pustules

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12
Q

What is the presentation of severe papulopustular / moderate nodular acne?

A
  • Numerous comedones
  • Papules and pustules present
  • One nodule may be present
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13
Q

What is the presentation of severe nodular / conglobate acne?

A
  • Numerous comedones, papules, and pustules

- Nodules present

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14
Q

What are some red flags that will cause referral?

A
  • Evidence of scarring
  • Moderate to severe acne
  • Signs and symptoms of infection
  • Drug-induced acne
  • Symptoms consistent w/ endocrionpathy
  • Atypical presentation (ex: rosacea; acne not in the normal peak age of 14-19)
  • Patients who are non-responsive to non-Rx therapy
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15
Q

What kind of acne is self-treatable?

A
  • Comedonal, mild - moderate papulopustular

- Only in onset age btwn 12-25, no scarring or risk of scarring, and presentation is typical

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16
Q

What are the goals of therapy for acne?

A
  • Alleviate symptoms by decreasing # and severity of lesions
  • Slow progression of signs and symptoms
  • Limit duration and reoccurence
  • Prevent long-term disfigurement associated w/ scarring and hyperpigmentation
  • Alleviate psychological distress
  • Avoid factors that exacerbate acne
  • Minimize treatment failure due to poor compliance
  • Educate px w/ emphasis on realistic expectations
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17
Q

What are some non-pharms for acne?

A
  • Wash face w/ mild soap or soapless cleanser no more than twice a day
  • Avoid vigorous scrubbing
  • Be careful when shaving
  • Shampoo hair regularly and keep off face
  • Don’t pop, pick, or manipulate lesions
  • Minimize cosmetic use, or use oil-free products
  • Discontinue or avoid aggravating factors
  • Eat a well-balanced diet and drink lots of water
  • Try to minimize stress
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18
Q

What is the mechanism of action of topical benzoyl peroxide?

A
  • Normalization of follicular keratinization
  • Decrease P acne growth
  • Decrease inflammatory process
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19
Q

What is the mechanism of action of oral isotretinoin?

A
  • Normalization of follicular keratinization
  • Decrease P acne growth
  • Decrease inflammatory process
  • Decrease sebum production
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20
Q

Which Rx treatments work by normalization of follicular keratinization?

A
  • Topical BPO
  • Topical SA/sulfur/resorcinol
  • Topical retinoid and retinoid analogs
  • Oral isotretinoin
  • Oral contraceptive
  • Topical/oral antibiotic
  • Azelaic acid
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21
Q

Which Rx treatments work by decreasing P. acne growth?

A
  • Topical BPO
  • Oral isotretinoin
  • Topical/oral antibiotic
  • Azelaic acid
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22
Q

Which Rx treatments work by decreasing sebum production?

A
  • Oral isotretinoin
  • Oral contraceptives
  • Oral anti-androgens
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23
Q

Which Rx treatments work by decreasing inflammatory process?

A
  • Topical BPO
  • Retinoid analogs
  • Oral isotretinoin
  • Topical/oral antibiotics
  • Azelaic acid
  • Oral anti-androgens
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24
Q

Acetone and alcohol are good for ____ skin

A

Very oily

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25
Q

Water based gels are better for ____ skin

A

Oily, but sensitive

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26
Q

Rank the formulations based on efficacy

A

1) Gels
2) Lotions
3) Creams
4) Bars/washes

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27
Q

Lotions are good for ___ skin types

A

All, especially sensitive

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28
Q

Creams are good for ___ skin

A

Dry

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29
Q

Bars/washes are good for ____ skin types

A

All

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30
Q

What do microspheres do?

A
  • Localized in hair follicle and release medication over time
  • Increase tolerability by decreasing concentration in skin, so less side effects
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31
Q

Microspheres are good for ____ skin

A

Sensitive

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32
Q

What type of acne is salicylic acid used for?

A

Mild acne when BPO is not tolerated

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33
Q

What is the concentration of salicylic acid in OTC products?

A

0.5-2%

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34
Q

What is the dosing of salicylic acid?

A

Once to twice daily

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35
Q

What are the side effects to salicylic acid?

A
  • Redness
  • Peeling
  • Stinging
  • Rare cases can cause contact dermatitis
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36
Q

Can salicylic acid be used for long-term treatment?

A

Yes

37
Q

What is sulfur often combined w/ and why?

A

Salicylic acid or resorcinol to increase its effects

38
Q

What are disadvantages to sulfur?

A
  • Offensive odour
  • Noticeable colour
  • Comedogenic w/ continued use
39
Q

Should resorcinol be used on its own?

A

No, has little effects

40
Q

What is a side effect to resorcinol?

A

Dark brown scales on dark-skinned px

41
Q

Which strength of glycolic acid is used for acne treatment?

A

8%

42
Q

Can glycolic acid be used alone?

A

Yes, or can be used as a base for topical antibiotic preparations

43
Q

Does salicylic acid or glycolic acid produce more skin irritation?

A

Salicylic acid

44
Q

What is the first line OTC treatment for non-inflammatory or mild inflammatory acne?

A

Topical benzoyl peroxide

45
Q

What are the available OTC strengths of benzoyl peroxide?

A

2.5 and 5%

46
Q

What are the available Rx strengths of benzoyl peroxide?

A

Over 5%

47
Q

What is BPO combined w/ for treatment of mild-moderate acne?

A

Topical retinoid and topical antibiotic

48
Q

What is BPO combined w/ for treatment of moderate and moderate-severe acne?

A

Topical retinoid and oral antibiotic

49
Q

Can benzoyl peroxide be used on a long-term basis?

A

Yes

50
Q

What are side effects to benzoyl peroxide?

A
  • Irritant dermatitis
  • Redness
  • Scaling
  • Dryness
  • Itching
  • May cause photosensitization, bleaching, or odour on clothing/bed sheets
  • Rare cases can cause contact dermatitis or a hypersensitivity reaction
51
Q

What is the dosing of benzoyl peroxide?

A

Once or twice daily

52
Q

What is self-care treatment for acne usually started w/?

A

2.5% BPO water-based product

53
Q

What are some counselling points on topical acne products?

A
  • Apply to entire affected area, do not spot treat
  • Must be used regularly
  • Skin may worsen before improves
  • Allow 6-8 weeks before assessing improvement, may take 8-12 weeks to see full benefit
  • Avoid washing area or using other skin products for 1 hour after application
  • If missed dose, continue use as normal
  • Don’t use other acne products that will further irritate skin
54
Q

What strength of azelaic acid is available in Canada?

A

15% gel

55
Q

Which type of acne is azelaic acid used to treat?

A

Mild - moderate acne in patients who don’t tolerate BPO or tretinoin

56
Q

What is the dosing of azelaic acid?

A

BID

57
Q

What are some side effects to azelaic acid?

A
  • Burning
  • Pruritus
  • Stinging and tingling
58
Q

What are monitoring parameters for azelaic acid?

A

Px w/ darker skin should be monitored for hypopigmentation

59
Q

What is the dosing for topical retinoids and retinoid analogues?

A

Apply once daily

60
Q

Which type of acne are topical retinoids and retinoid analogues used to treat?

A
  • Comedonal acne and mild-moderate inflammatory acne

* *Maintenance therapy

61
Q

What are side effects of topical retinoids and retinoid analogues?

A
  • Itching
  • Stinging
  • Redness
  • Peeling
  • Photosensitivity
  • Skin discolouration
62
Q

Can topical retinoids be used w/ isotretinoin?

A

No

63
Q

Which type of acne are topical antibiotics used to treat?

A

Mild to moderate inflammatory acne in combination w/ topical retinoid and/or BPO

64
Q

Should topical antibiotics be used alone?

A

No

65
Q

Can topical antibiotics be used w/ oral antibiotics?

A

No

66
Q

Can topical antibiotics be used for long-term treatment?

A
  • No b/c of possibility of antibiotic resistance

- Should be used for no more than 6 months

67
Q

What are side effects of topical antibiotics?

A
  • Erythema
  • Dryness
  • Peeling of skin
  • Stinging
68
Q

If a px is allergic to an oral antibiotic, can a topical antibiotic of the same class be used?

A

No

69
Q

What is clindamycin?

A

Lincosamide antibiotic

70
Q

What are contraindications for use of topical clindamycin?

A
  • Allergy to clindamycin or lincomycin
  • Previous C. difficile-associated diarrhea
  • Inflammatory bowel disease
  • *Caution w/ atopic individuals
71
Q

Which type of acne are oral antibiotics used to treat?

A

Treatment-resistant forms of mild to moderate inflammatory acne

72
Q

Oral antibiotics are the first line treatment for ____

A

Moderate or moderate-severe acne in combination w/ topical retinoid and/or BPO

73
Q

Can oral antibiotics be used for scarring?

A

Yes, if patient won’t take isotretinoin

74
Q

Should oral antibiotics be used alone?

A

No, combine w/ topical retinoid and add BPO to reduce resistance

75
Q

What are side effects to oral antibiotics?

A
  • GI upset
  • Nausea, vomiting
  • Diarrhea
  • Headache
  • Tetracyclines - photosensitivity and esophagitis (rare)
  • Monocycline - dizziness, drowsiness, ataxia
76
Q

Which type of acne are oral contraceptives used to treat?

A
  • Mild or moderate acne in combination w/ topical therapies
  • Adult onset acne in females that have been treated unsuccessfully w/ other agents
  • Severe acne for females on isotretinoin
77
Q

What are side effects to oral contraceptives?

A
  • Nausea, vomiting
  • Weight gain (maybe)
  • Breakthrough bleeding
  • Breast tenderness
  • Headache
78
Q

Which type of acne are androgen-receptor blockers used to treat?

A
  • Females who have adult onset acne that have been treated unsuccessfully w/ other agents
  • Women who suffer from acne due to excess of androgen hormones
79
Q

What are side effects of androgen-receptor blockers?

A
  • Dizziness, drowsiness
  • Nausea, vomiting, diarrhea
  • Headache
  • Mensstrul irregularities
  • Spironolactone - hyperkalemia
80
Q

What are the indications of isotretinoin?

A
  • Severe nodulocystic acne
  • Treatment failures
  • Scarring
  • Frequently relapsing acne
  • Cases where psychological distress is severe
81
Q

What is the duration of treatment for isotretinoin?

A

12-16 weeks

82
Q

What are side effects of isotretinoin?

A
  • Cheilitis (cracking of skin around lips)
  • Facial redness
  • Dry skin/itching
  • Photosensitivity
  • Depression
  • Joint/muscle pain
83
Q

What are some non-pharm recommendations for a px on isotretinoin?

A
  • Non-comedogenic moisturizer
  • Apply lip moisturizers
  • Use humidifier
  • Drink lots of water
84
Q

What are contraindications of isotretinoin?

A
  • Hyperlipidemia
  • Diabetes
  • Severe osteoporosis
  • Breastfeeding or pregnancy
  • Previous allergic reaction
  • Hepatic or renal insufficiency
85
Q

What are the monitoring parameters for isotretinoin?

A
  • Lipid and blood glucose levels
  • Liver function test
  • Pregnancy test!!
  • Signs of depression
86
Q

What age should take isotretinoin?

A

About 12 years old

87
Q

What should be the treatment approach for pregnant px w/ acne?

A
  • Non-pharms are first line

- If deemed appropriate by physician – topical BPO, erythromycin, or clindamycin considered safe

88
Q

What are short-term monitoring parameters for acne?

A
  • Lesions decrease by 10-25% in 4-8 weeks of >50% in 2-4 months
  • Comedones resolve by 3-4 months
  • Inflammatory lesions resolve w/in few weeks

Clinical Pharmacy 1 - Term 1 (18 decks)

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