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Derm/Ophth > Acne > Flashcards

Acne Flashcards

1
Q

key factors in acne pathogenesis

A

follicular keratization
androgens/sebum formation
cutibacterium acnes
inflammation

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2
Q

acne vulgaris

causes

A 
emotional stress
rpetitive stress
occlusoin and pressure
heat and humidity
occupational acne
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3
Q

drugs that casue acne-like acneiform lesions

A 
Lithium
valproic acid
isoniazid GCs
po contracept. 
cyclosporine
azathioprine
disulfuram
phentermine
iodides, bromides
danazol
high dose vitamin B and D
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4
Q

mild acne definitition

A

few to several papules/pustules (<10) and no nodules

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5
Q

moderate acne definition

A

10-40 papules/pustules along with 10-40 comedomes and few to several nodules

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6
Q

severe acne definition

A

numerous or exensive papules/pustules and many nodules

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7
Q

exclusions to self tx

A

comedogenic drugs
mod-severe acne
pregnancy
when tx does not work

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8
Q

mild acne 1st line tx options

alternative?

A

BP or TR

OR

TCT (BP + ABX), (BP + R), (BP + ABX + R)

Alt? add topical R or BP or consider diff retinoid or consider topical dapsone

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9
Q

goals of acne tx

A

remove keratin plug
reduce bacterial inflammation
reduce sebum production
reduce/eliminate scarring

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10
Q

acne home care

A 
gentle synthetic cleansers BID
wash with fingers
avoid scrubs
water-based lotions
dont pick at lesions
skin should be dry before applying topicals
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11
Q 
dry skin =
oily skin = 
hairy areas = 
solutions =
pledgets
A 
dry skin use lotions or creams
oily skin use gels or foams
hairy area use foams
solns are drying but cover large areas
pledgets cover large areas
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12
Q

tx that target follicular hyperproliferation

A

oral/topical retinoids
azelaic acid
salicylic acid
hormonal therapies

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13
Q

tx that target inc sebum production

A

po retinoids
hormonal tx
clascoterone cream

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14
Q

tx targeting c. acnes prolif

A

benzoyl peroxide (BP)
ABX
Azelaic acid
dapsone topical

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15
Q

tx for inflammation

A 
po/topicla retinoids
po TTCs
azelaic acid
clascoterone cream
dapsone topical
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16
Q

topical retinoids
use
onset

A 
initial management in most patients
monotherapy w comedonal acne
normalize follicular hyperkeratosis
prevent formation of microcomedo
may improve inflammatory acne
maytake 8-12 weeks to work
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17
Q

clascoterone cream
moa
storeage

A

androgen receptor inhibitor
HPA suppression has been reported
store at 2-8C before dispensing, patient cans tore at room temp, discard 180 days after dispensing, 30d once opened

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18
Q

topical retinoids for acne treatment

A 
tretinoin (Atralin, Renova)
Adapaline (Differin)
Tazarotene (Tazorac, Fabior foam, Avage)
TWYNEO (tretinoin/BP)
Trifarotene (Aklief)
Epiduo Forte (Adapalene and BP)
VELTIN
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19
Q

topical retinoids
admin
with BP?

A

gently clean area, pat dry, apply retinoid and then moisturizer

thin layer, qd hs, no not apply tretinoin the same time as BP, applied to entire effected area

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20
Q

topical retinoids AE

A

irritation, dryness, flaking of skin, transient worsening of acne, photosensitivity, titrate up frequency
avoid use in preggo

21
Q

Moderate acne 1st line tx

Alternative?

A

TCT (BP + ABX), (BP + R), (BP + ABX + R)

OR
(BP + po ABX + R)

OR
(BP + po ABX + topical ABX + R)

Alternative:
consider alt combo tx or consider diff po ABX or add COC or po Spironolactone (female) or consider po isotretinoin

22
Q

Severe acne 1st line

Alternative?

A

po ABX + TCT (BP + ABX), (BP + R), (BP + ABX + R)

OR
po isotretinoin

Alternative: consider diff po ABX or add COC or po Spironolactone (female) or consider po isotretinoin

23
Q

Topical ABX options

A 
BP
Clinda
Erythro
Dapsone
Minocycline
24
Q

topical BP freq and AE

A

twice daily

local skin irritation, may bleach hair or clothing

25
Q

topical clinda freq and AE

A 
twice daily (qd if foam)
rare risk of pseudomonas colitis
usually prescribed w BP to decrease resistance
26
Q

topical erythromycin freq and AE

A

twice daily

usually prescribed w BP to decrease resistance

27
Q

topical dapsone freq and AE

A

5% - BID
7.5% - QD
yellow-orange skin discoloration when applied at the same time as BP

28
Q

Minocycline freq and AE

A

QD!
4% foam
Headache

29
Q

Azelaic acid
MOA
use
AE

A

20% cream, 15% gel
antimicrobial - limits melanin prod via inhibiting tyrosinase
QD
burning, itching, redness, hives, anaphylaxis v rare

30
Q

po ABX

A 
TTC
Doxy
Minocycline
Sarecycline
Erythromycin
TMP/SMX
Azithro
31
Q

TTC po dose and AE

A

500mg po bid

photosens, GI distress, CI preggo and yoing children

32
Q

Doxy po dose and AE

A

50-100mg bid

photosens, GI distress, CI preggo and yoing children

33
Q

Minocycline po dose and AE`

A

50-100mg bid

dizziness, drug-ind skin discoloration, CI preggo and yoing children

34
Q

Sarecycline po dose and AE

A 
weight based dosing
33-54 kg = 60mg qd
55-84kg = 100mg qd
85-136kg = 150mg qd
photosens, GI distress, CI preggo and yoing children
35
Q

Erythro po dosing and AE

A

500mg bid, GI distress

36
Q

TMP/SMX po dosing and AE

A

160/800mg po qd-bid, SJS/TEN

37
Q

benzoyl peroxide
onset?
AE

A

onset within 3 weeks, max is 12 weeks

erythema, acaling, xerosis, stinging/burning, bleaching of hair and clothing, hypersens is rare

38
Q

differen cleanser vs gel

A

cleanser is BP, gel is adapalene 0.1%

39
Q

salicylic acid
MOA
with BP?

A

desquamating agent, lipophilic properties penetrate pilosebaceous follicle to provide comedolytic effects
synergistic effects with BP!

40
Q

hormonal agents

for who?

A

for women with oderate to severe acne who are not trying to become pregnant
good in adult women who present w inflammatory acne of lower face/neck with premenopausal flares

41
Q

Hormonal agents?
moa
products

A

inhibit androgen actoin in pilosebaceous unit
estrogen suppresses ovarian androgen production

spironolactone and drosperinone competitively inhibit binding of adnrogens to receptors in pilosebaceous unit
Ethinyl Estradiol used to inhibit sebum production
**a progestin only contraceptive ineffective for acne

42
Q 
spironolactone for acne
dose
pearl
onset
AE
CI
A

50-100mg BID
concominant use of birth control is recommended d/t femininization of male fetus
AE: menstrual irregularities, breast tenderness, GI upset, orthostatic hypotension, HA, dizziness, fatigue
CI: renal or hepatic dysfunction, monitor serum K in first cycle!

43
Q 
po isotretinoin
products
MOA
use
CI
dosing
A

Zenatane, Amnesteem, Claravis, Sotret, Absorbica, Absorbica LD is micronized
use: mod-severe acne, recalcitrant nidular acne
CI: pregnancy, underlying psychiatric conditions, concominant use of TTC ABX
MOA: shrinks sebacous glands, normalizes desquamation
dose: 0.5-1 mg/kg/day in divided doses WITH FOOD x20 weeks, micronized Absorbica LD is 0.4-0.8mg/kg/day in divided doses 15-20 weeks max; swallow capsule whole with a full glass of water

44
Q

isotretinoin monitoring

A

take baseline LFT and FLP, if normal take again in 2 months and if normal again no more monitoring

CK elevation (joint/muscle pain)

Hepatotoxicity : if 3xULN–> D/C recommended

45
Q

po isotretinoin warnings

A 
night blindness
skin photosensitivity
aczema-like rash
dry lips and cheilitis
dry eyes
muscle pain
calcification of ligaments and tendons
thinning of hair
dry nasal passages
HA
stunted growth
bone marrow suppression
IBS?
46
Q

contraception and isotretinoin
pregnancy tests (n)
script limitations

A

at least one primary and one secondary (condom, cervical cap diaphragm or sponge) method of birth control

cannot dispense isotret more than 30d after for patients who cannot become preggo, 7d from test
for patients who took a pregnancy test
no automatic refills
no more than 30d supply

47
Q

acne conglobata
s/sx
tx

A

inflammatory, acne nodules and cysts that grow together deep below skin, severe scarring

tx:
isotretinoin
systemic ABX
Intralesional steroids

48
Q

Acne Fulminans
s/sx
tx and duration

A

rare, severe, painful, ulcerating, hemorrhagic +/- fever +/- bone lesions

if d/t isotretinoin –> D/C

if systemic sx–> po glucocorticoids x4wks then isotretinoin for at least 4wks

w/out systemic sx –> po glucocorticoids x2wks then isotretinoin for at least 4wks

49
Q

PIH

tx

A

post inflammatory inflammation, presence of excess melanin, improves slowly with time
tx
1st line = Hydroquinone 2% (avoid spot tx), BID
2nd line = topical retinoids (tretinoin, tazarotene or adapalene), azelaic acid 20%, chemical peels or laser resurfacing (glycolic, salicylic acids)

Derm/Ophth (5 decks)

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