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PHM 604- Dermatology and Glaucoma > Acne > Flashcards

Acne Flashcards

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Dermatology Board Prep flashcards
1
Q

Patho of acne

A

Blockage in hair follicle of dead skin –> excess keratin in the hair shaft mixes with excess sebum and creates a plug of cells and oil –> bacteria rush to the site –> WBCs rush in to respond and inflammation occurs –> pocket of pus forms

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2
Q

Other factors that can cause acne

A

Makeup, sweat, other external factors

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3
Q

Factors in acne pathogenesis

A

Follicular keratinization, androgens, sebum formation, C. acnes, inflammation

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4
Q

Signs/symptoms of mild acne

A

Few to several papules/pustules (<10), no nodules

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5
Q

Signs/symptoms of moderate acne

A

Several to many papules/pustules (10-40) along with comedones (10-40) and few to several nodules

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6
Q

Sign/symptoms of severe acne

A

Numerous or extensive papules/pustules and many nodules

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7
Q

pH of healthy skin

A

4.7-5.7

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8
Q

Medications to treat acne

A 
Topical retinoids
Azelaic acid
Topical antimicrobials
PO ABX
Salicylic acid
Sulfur
AHAs
Tea tree oil
PO isotretinoin
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9
Q

Types of topical retinoids

A

Tretinoin (Atralin)
Adapalene (Differin)
Tazarotene (Tazorac)

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10
Q

When are topical retinoids used?

A

Used as initial management

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11
Q

What do topical retinoids do?

A

Normalize follicular hyperkeratosis and improves inflammatory acne

Also enhances penetration of other topical acne medications and decreases hyperpigmentation of acne scars

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12
Q

How long does it take for topical retinoids to work?

A

8-12 weeks

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13
Q

Counseling on topical retinoids

A

At night: clean skin, pat dry, apply the retinoid, apply moisturizer

Acne may get worse before it gets better

Avoid OTC irritating products

START LOW AND GO SLOW

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14
Q

ADEs of topical retinoids

A

Skin irritation, skin flaking, dryness, “photosensitivity”

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15
Q

When should topical retinoids be avoided?

A

Pregnancy and in patients with fish allergies (Atralin/Tretinoin)

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16
Q

Topical antimicrobial products

A

Benzoyl peroxide, clindamycin, erythromycin, dapsone, minocycline

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17
Q

What do topical antimicrobials do?

A

Decrease C. acnes colonizing skin and decreases inflammatory response

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18
Q

What should topical antimicrobials be combined with to make them more effective?

A

Topical retinoid

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19
Q

Benefits of benzoyl peroxide

A

Comedolytic and antibacterial

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20
Q

How long does it take for benzoyl peroxide to be effective?

A

Benefits within 3 weeks, but max effects in 12 weeks

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21
Q

Dosing for benzoyl peroxide

A

Apply daily, then increase to twice or three times daily after 2 weeks

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22
Q

Strength titration for benzoyl peroxide

A

Start at 2.5%, increase weekly as needed to 5%, then 10%

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23
Q

ADEs of benzoyl peroxide

A

Erythema, scaling, xerosis, stinging/burning, bleaching of hair and clothing, rare hypersensitivity

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24
Q

Least irritating topical retinoid

A

Adapalene

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25
Q

Properties of azelaic acid

A

Antimicrobial, comedolytic, mild anti-inflammatory properties

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26
Q

Benefits of azelaic acid

A

Can improve acne-induced post-inflammatory hyperpigmentation

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27
Q

Dosing frequency of azelaic acid

A

QD

28
Q

ADEs of azelaic acid

A

Burning, itching, redness, hives and anaphylaxis rare

29
Q

How to reduce resistance to PO ABX

A

Limit duration, avoid changing too soon, restart same ABX if still effective and it was stopped, don’t combine MoAs, use with benzoyl peroxide or topical retinoids

30
Q

PO ABX products

A

TTC, doxycycline, minocycline, sarecycline, erythromycin, Bactrim, azithromycin

31
Q

Salicyclic acid properties

A

Comedolytic effects, mild anti-inflammatory properties

32
Q

Salicyclic acid has a synergistic effect with what other acne medication?

A

Benzoyl peroxide

33
Q

What class does salicylic acid belong to according to the makeup industry?

A

BHAs (0.5%-2% available commercially)

34
Q

Properties of sulfur

A

Keratolytic effect, inhibits proliferation of C. acne

Not used as often anymore due to the odor

35
Q

Properties of AHAs

A

Improve post-inflammatory hyperpigmentation and diminishes signs of aging skin

36
Q

AHAs may work synergistically with what acne medication?

A

Retinoids

37
Q

Properties of tea tree oil

A

Antimicrobial and anti-inflammatory properties

38
Q

When should a patient seek a provider for acne?

A

Comedogenic drugs
Moderate-severe acne
Pregnancy
Treatment doesn’t work

39
Q

When can you use hormonal agents for acne?

A

Moderate-severe acne in women who aren’t trying to get pregnant

Benefits adult women who present with inflammatory acne following lower face/neck with premenopausal flares

40
Q

Hormonal acne agents

A

Ethinyl estradiol/progestin

Spironolactone and drospirenone

41
Q

What can happen to a male fetus if spironolactone is taking during pregnancy?

A

Feminization of the fetus

42
Q

Minimum amount of therapy required for evaluation of hormonal acne therapy efficacy

A

3-6 months

43
Q

COC ADE

A

thromboembolism (especially in smokers)

44
Q

Spironolactone ADEs

A

Breast tenderness, menstrual irregularities, GI upset, orthostatic hypotension, HA, dizziness, fatigue

45
Q

Spironolactone dosing for acne

A

50-100mg PO BID

46
Q

Spironolactone CIs

A

renal failure, liver dysfunction

47
Q

Spironolactone monitoring

A

Serum K+, make sure patient is on concomitant BC

48
Q

Brand names for PO isotretinoin

A

Zenatane, Amnesteem, Claravis, Sotret, Absorica, Absorica LD is micronized form

49
Q

Indications for PO isotretinoin

A

Moderate-severe, recalcitrant, nodular acne

50
Q

MoA of PO isotretinoin

A

Shrinks sebaceous glands

51
Q

Dosing for standardized PO isotretinoin

A

0.5-1 mg/kg/day in divided doses with food

52
Q

Alternate dosing for standardized PO isotretinoin

A

0.5mg/kg/day x1 month, then 1 mg/kg/day

53
Q

Micronized PO isotretinoin dosing

A

0.4-0.8 mg/kg/day in divided doses for 15-20 weeks MAX

54
Q

PO isotretinoin CIs

A

PREGNANCY, psychiatric conditions (taking it is associated with depression and suicide), use with tetracyclines

55
Q

What should you avoid taking while on isotretinoin?

A

Vitamin A supplements

56
Q

Lab monitoring for PO isotretinoin

A

LFT and FLP

57
Q

If LFTs and FLPs are normal, what happens next?

A

Take again in 2 months; if it’s still normal after that, no monitoring needed unless there’s a dose increase

58
Q

If LFTs and FLPs are elevated, what happens?

A

If it’s x3 ULN, D/C

59
Q

What should you avoid for ≥6 months after stopping isotretinoin?

A

Dermabrasion, laser epilation

60
Q

ADEs of PO isotretinoin

A

Night blindness, skin photosensitivity, eczema-like rash, dry lips, eyes, nasal passages; muscle pain, calcification of ligaments and tendons, hair thinning, headache, stunted growth, bone marrow suppression

61
Q

iPLEDGE program

A

Program that prevents patients from getting pregnant while taking isotretinoin and prevents pregnant patients from taking it

62
Q

Who must be enrolled in iPLEDGE?

A

Patient, provider, and pharmacy

63
Q

How should a doctor write a script for isotretinoin?

A

No more than a 30 days supply with no refills

64
Q

What happens if a patient needs a refill on isotretinoin?

A

Get a new script, but have to verify that they’re not pregnant

65
Q

When do you put the isotretinoin back in inventory when the patient hasn’t picked it up?

A

Patients who can’t get pregnant: >30 days

Patients who CAN get pregnant: >7 days

66
Q

Number of pregnancy tests to take over the course of isotretinoin treatment

A

N+4, with N being the number of months the patient is on treatment

67
Q

How many forms of BC should a patient be on while taking isotretinoin?

A

At least 2

PHM 604- Dermatology and Glaucoma (9 decks)

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