76: Acne Flashcards by Brooke Thornburg

acne

-inflammatory diseasse of sebaceaous glands and hair follicles
-comedones, papules, pustules
-inc androgens in adolescents

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Aggravating factors acne

-oil cosmetics
-emotional stress
-irritation
-drugs

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Drugs that worsen acne

-androgenic steroids
-corticosteroids
-lithium
-anti-epileptics
-tuberculostatic drugs
-oral contraceptives

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Acne patho

-keratin obstruction of sebaceous follicle
-traps sebum
-comedone
-bacteria colonize in trapped sebum

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comedone

-hair follicle plugged w sebum, keratin, dead skin

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propionibacterium ances

-naturally colonize in skin/sebaceous glands
-proliferates in sebum environment
-convert TG to FFA = irritate cell = inflammation

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Types of acne

-non-inflammatory (white/black heads)
-inflammatory (papules, pustules, ruptured contents)

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Secondary lesions from acne

-excoriations
-erythematous macules
-hyperpigmented macules
-scars

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acne tx complications

-dermabrasion
-chemical eels
-laser resurfacing
-$$$

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Goals of acne therapy

-long-term control
-relieve discomfort
-improve skin appearance
-minimize stress
-prevent scars

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MOA of acne therapy

-antimicrobial
-anti-inflammatory
-dec sebum production
-keratolytic
-comedolytic

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keratolytic

-break down outer layers of skin
-dec thickness
-sloughing
-slicylic acid, urea, a-hydroxy acids

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comedolytic

-inhibits formation of comedones
-tretinoin, adapalene, azelaic acid

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non pharma tx of acne

-mild face soap BID
-minimize use of irritating products (aftershave, alcohol bases)
-use TEPID water
-weeks to months to see improvement

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tx of mild comedonal, noninflammatory acne

-topical retinoids
-esp adapalene
-alt: benzoyl peroxide or azelaic acid low strength

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tx of mild papulopustular inflammatory acne

-adapalene + BP
-or Clindamycin + BP
-alt: other retinoids, adapalene + oral antibiotic for disease

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Tx of severe papulopustular and moderate nodular acne

-oral isotrentinoin
-alt: OA + adapalene, azelaic acid, oral antiandrogens, or antiandrogens + topicals

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tx of nodular/conglobate acne

-oral isotrentinoin
-alt: OA + azelaic acid or any other topical agents or oral antiandrogens

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Maintenance tx of acne

-adapalene
-alt: tazarotene, trentinoin, azelaic acid, BP

Retinoids

-Adapalene
-Tazorotene
-Tretinoin

-regulate epithelial growth

Adapalene

-1st line for mild acne both types and maintenance therapy
-gel, cream, solution
-daily at hs

Tazorotene (tazorac)

-retinoid
-maintenance and comedonal tx
-cream, gel
-qd
-start low
-very drying
-category X

Tretinoin

-retinoid
-cream, gel, solution
-qd hs
-sting, burn
-dryness
-photosensitivity
-4-6 weeks for improvement

Azelaic acid (azelex)

-cream
-antibacterial
-keratolytic
-adjunct
-well tolerated

Benzoyl peroxide (Oxy-10)

-cream, gel, lotion -antibacterial -comedolytic/keratolytic -anti-inflammatory -BID -dry skin/irritation -can bleach -start lower strength

topical antibiotics

-clindamycin +/- BP -erythromycin

Clindamycin (Cleocin-T)

-gel, solution, lotion -topical antibiotic -daily or BID -also can come with BP in cream form to limit resistance

Erythromycin

-gel, solution -BID -expires 30 days

Low cost acne tx

-topical retinoid (lots are in OTC stuff)

Medium cost acne tx

-oral abx -anti-androgens -oral corticosteroids

high cost acne tx

-isotrentinoin -anti-androgens -tazarotene

Adverse effects of topical products

-erythema -scaling -burning -flare -resistance (abx) -tretinoin kinda the worst of em

Combo products for acne tx

-Clindamycin + BP -Adapalene + BP -most insurance wont cover combo but will cover individual ingredients

Oral abx

-minocycline -doxycycline -erythromycin -azithromycin -TMP/SMX

Oral abx tx for acne

-dec bacteria and inflammation -give it a few weeks -most effect for inflammation -switch to maintenance after inflammtion under control

Oral abx risks

-allergy -photosensitivity -GI upset -thrush -resistance (limit to 6-8 weeks)

Oral anti-androgen tx for acne

-low dose contraceptives -spironolactone

Topical anti-androgen therapy

-hormone tx -clascoterone 1% cream -androgen receptor inhibitor -applied BID -local erythema most common side effect

Clascoterone 1% cream

-androgen inhibitor -M or F -BID -erythema most common SE

tx of severe ance

-isotretinoin

Isotretinoin

-severe acne tx or pt fail everything else -vit A derivative -v effective -reduces sebum and shrinks sebaceous glands

Isotretinoin dosing

-0.5-2 mg/kg/day in 2 doses wf -15-20 weeks -acne will worsen then get better -if acne flares after 2 months off tx, do 2nd course -effectiveness inc w dose

Isotretinoin side effects

-dry skin, eyes, nose, lips -hair shedding -peeling of palms and soles -photosensitivity -back pain -arthralgias/myalgia -fatigue -risk of osteoporosis/delayed bone healing -high AST/ALT -high cholesterol and triglycerides -category X -HA -mood changes -night blindness -depression/suicide

Isotretinoin counseling tips

-avoid preg -use contraception -side effects -do NOT take vit A -use moisturizer and sunscreen -take w food

iPledge program

-dispensing only occurs after pharmacist receives authorization code -30 day no refills -do not dispense 7 days after office visit -negative preg test every month

Acne tx follow up

-2-6 months to see success -lengthening acne free periods is key