Acne Flashcards
Acne Vulgaris
Chronic, inflammatory with open/closed comedones
Adolescents and teens
Multifactorial pathogenic process
Mild: Benzoyl Peroxide (BP) or topical retinoid or a combo of topical BP + everything else
Mod: BP + everything else or Oral abx + topical agents
Severe: Oral Abx + topical treatment or last line: Oral Isotretinoin
Salicylic Acid
Cleanser for sensitive skin and mild acne
Gentle cleansing
NOT as effective as BP or tretinoin but BETTER tolerated
Sulfacetamide
IND: Acne vulgaris, bacterial inf., seborrheic dermatitis
MOA: Interferes with bacterial folic acid synthesis
BOX: n/a
CON: Allergies to sulfa drugs
ADR: Topical use only
Sulfur and Sulfacetamide
IND: Acne, rosacea, seborrheic dermatitis
MOA: Keratolytic
BOX: n/a
CON: Allergy to sulfa drugs. Renal impairment
ADR: Topical reactions. Hemolysis, agranulocytosis
Benzoyl Peroxide
IND: Mild to moderate acne vulgaris and rosacea
MOA: Comedolytic ABX. Oxidizes bacterial proteins = decreases number of bacteria
BOX: n/a
CON: n/a
ADR: Can bleach hair/fabrics. Skin irritation; decrease frequency if it occurs
Adapalene
IND: Acne Vulgaris, off label rosacea MOA: Retinoid-like compound OTC BOX: n/a CON: n/a ADR: Photosensitivity and topical reactions
Tretinoin
IND: Acne Vulgaris, palliation of fine wrinkles, mottled hyperpigmentation, facial skin roughness
MOA: Retinoic acid derivative; decreases cohesiveness of epithelial cells and increases turnover
BOX: n/a
CON: n/a
ADR: Local reactions, hypopigmentation, skin exfoliation, photo/cold/wind sensitivities
Tazarotene
IND: Acne vulgaris, psoriasis, wrinkles, face mottling
MOA: Synthetic retinoid (Vit A derivative)
BOX: n/a
CON: Pregnant or PLAN TO BECOME pregnant
ADR: Local irritation, photosensitivity. Xerodema, erythema, desquamation
Clindamycin
IND: Acne vulgaris. Off label rosacea. Not used alone in acne d/t risk of bacterial resistance development. ALWAYS combine with BP
MOA: Lincosamide ABX; inhibits bacterial protein synthesis
BOX: n/a
CON: n/a
ADR: Xerodema, oily skin, topical reactions
Erythromycin Topical
IND: Acne Vulgaris. Not used alone in acne d/t risk of bacterial resistance development. ALWAYS combine with BP
MOA: Macrolide ABX; inhibits bacterial protein synthesis
BOX: n/a
CON: n/a
ADR: Xerodema, oily skin, topical reactions
Azelic Acid
IND: Mild to moderate Acne Vulgaris, inflammatory papules, pustules of mild to moderate rosacea. Tend to see improvement in 4 weeks. D/c if it isn’t working.
MOA: Dietary constituent in whole grain cereals; unknown mechanism
BOX: n/a
CON: n/a
ADR: Hypopigmentation, local reactions
Dapsone
IND: Acne Vulgaris, evaluate at 12 weeks
MOA: Anti-bacterial and anti-inflammatory; unknown mechanism
BOX: n/a
CON: n/a
ADR: Hemolytic anemia in pts with G6PD deficiency (more in oral form).
When used with BP; can discolor the skin to orange/brown
Systemic (Oral) ABX
Tetracyclines: Doxycycline and Minocycline (and tetracycline but this is resisted). 1st line Abx for moderate to severe acne. Doxy; more photosensitivity. Mino; risk of hepatitis and drug induced lupus
Macrolides: Erythromycin (and azithromycin). E; more GI. Az; QT prolongation
Trimethoprim/Sulfamethoxazole (Bactrim); last line for those who can’t tolerate macrolides or Tetracycline
Doxycycline
IND: Moderate to severe acne vulgaris, rosacea, many others
MOA: Inhibits bacterial protein synthesis
BOX: n/a
CON: n/a
ADR: Photosensitivity; D/C at first sign of erythema. AAD
Chelating. Separate from cations by at least 2 hours
Erythromycin
IND: Moderate to severe acne
MOA: Inhibits bacterial protein synthesis
BOX: n/a
CON: Use with CYP 3A4 substrates
ADR: DIARRHEA from increased GI motility. QTc prolongation
