76: Acne Flashcards
acne
-inflammatory diseasse of sebaceaous glands and hair follicles
-comedones, papules, pustules
-inc androgens in adolescents
Aggravating factors acne
-oil cosmetics
-emotional stress
-irritation
-drugs
Drugs that worsen acne
-androgenic steroids
-corticosteroids
-lithium
-anti-epileptics
-tuberculostatic drugs
-oral contraceptives
Acne patho
-keratin obstruction of sebaceous follicle
-traps sebum
-comedone
-bacteria colonize in trapped sebum
comedone
-hair follicle plugged w sebum, keratin, dead skin
propionibacterium ances
-naturally colonize in skin/sebaceous glands
-proliferates in sebum environment
-convert TG to FFA = irritate cell = inflammation
Types of acne
-non-inflammatory (white/black heads)
-inflammatory (papules, pustules, ruptured contents)
Secondary lesions from acne
-excoriations
-erythematous macules
-hyperpigmented macules
-scars
acne tx complications
-dermabrasion
-chemical eels
-laser resurfacing
-$$$
Goals of acne therapy
-long-term control
-relieve discomfort
-improve skin appearance
-minimize stress
-prevent scars
MOA of acne therapy
-antimicrobial
-anti-inflammatory
-dec sebum production
-keratolytic
-comedolytic
keratolytic
-break down outer layers of skin
-dec thickness
-sloughing
-slicylic acid, urea, a-hydroxy acids
comedolytic
-inhibits formation of comedones
-tretinoin, adapalene, azelaic acid
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
tx of mild comedonal, noninflammatory acne
-topical retinoids
-esp adapalene
-alt: benzoyl peroxide or azelaic acid low strength
tx of mild papulopustular inflammatory acne
-adapalene + BP
-or Clindamycin + BP
-alt: other retinoids, adapalene + oral antibiotic for disease
Tx of severe papulopustular and moderate nodular acne
-oral isotrentinoin
-alt: OA + adapalene, azelaic acid, oral antiandrogens, or antiandrogens + topicals
tx of nodular/conglobate acne
-oral isotrentinoin
-alt: OA + azelaic acid or any other topical agents or oral antiandrogens
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
