Acne Flashcards
Define white head
- closed comodone
- first clinically visible lesion of acne
- completely obstructed
Define black head
- open comodone
- dark colour due to contents being oxidized (lipid and melanin)
What is the difference between papule, pustule, nodule, and cyst?
Papule = solid, elevated lesion
Pustule = vesicle filled with purulent liquid <5mm
Nodule = deep lesion, warm, tender, and firm, >5mm diameter
Cyst = nodule containing liquid
What are the three classifications of acne?
Mild/comedonal = presence of comedones, papules or pustules or a mix
Moderate/papulopustular = primarily several/many papules and pustules
Severe/papulopustular and nodular = several/many papules and pustules plus nodules and cysts
What are the risk factors for exacerbation of acne?
Medications: anabolic steroids, COCs high in progestin, coal tar products, crystal meth, gabapentin, lithium
Cosmetics, hair products, bacteriostatic soaps
Use of occlusive garments: helmets, chin straps and hijabs
What are the red flags associated with the presentation of acne?
- <12 years
- new onset >30 years
- widespread distribution of lesions beyond face
- severe acne (risk of scarring) –> URGENT derm referral
- significant psychosocial impact
- signs of hyperandogenism (infrequent menses, infertility, insulin-resistant diabetes)
- sudden onset associated with fever or arthralgias –> URGENT ER referral
- unresponsive to therapy or unclear diagnosis
What are the goals of therapy for the treatment of acne?
- Clear existing lesions and prevent new ones
- Lessen physical discomfort from inflamed lesions
- Improve dermal appearance
- Prevent or minimize potential adverse psychological effects
- Prevent or minimize scarring or dyspigmentation
Which products should be used for dry/sensitive skin versus oily skin?
Dry/sensitive –> use cream or lotion which are less drying
Oily –> less greasy formulas like gel
To improve adherence to treatment, what should treatment be chosen according to?
- symptoms
- skin type
- skin sensitivity
- risk of adverse effects
- patient preference
When should systemic therapy be considered?
- moderate/severe acne
- lesions affecting a large number of sites (back, chest, face)
- patient presents with scarring
- patients with significant psychosocial impact
- topical therapy fails
What is the first line agent for mild-moderate acne (comedonal)?
Benzoyl peroxide 2.5%
Evidence suggests that it is no better to use >2.5%
What are some important counselling points to communicate to patients when recommending BPO? (onset, peak effectiveness, how to use, AEs)
- effective in prevention of bacterial resistance; always added to oral or topical antibiotics to decrease resistance
- avoid washes and soaps because they don’t have enough contact time with the skin
- starts working within a week but optimal improvement is 8-12 weeks (possibly gets worse before it gets better)
- apply topically to entire effected area and start applying for 15 minutes/night, to eventually overnight
- AE: dryness, peeling, irritation, burning, bleaches clothing, smell lingers, CD possible
- safe in pregnancy and breastfeeding
When is salicylic acid appropriate in the management of acne and what are important counselling points to communicate when recommending it? (MOA, strengths, onset, directions, AEs)
Available as another non-prescription product for comedonal acne; mildly comedolytic, keratolytic, mildly antibacterial and anti-inflammatory
Strength: 0.5-3.5% twice daily strength, anything under 20% is unscheduled
Onset: optimal improvement seen in 8-12 weeks
Directions: TID usually but follow package instructions
AE: drying, burning, stinging, peeling
When should azelic acid be used in the management of acne and what are important counselling points to communicate when recommending it? (MOA, strengths, onset, directions, AEs)
PRESCRIPTION topical product for comedonal acne which helps reduce hyperpigmentation, less irritation than BPO but less efficacy
MOA: camedolytic and antibacterial Strength: 15% gel (good for oily skin) Onset: optimal improvement in 8-12 weeks Directions: TID AE: well tolerated
EFFECTIVE AND SAFE IN PREGNANCY
When should dapsone be recommended in the management of acne and what are important counselling points to communicate when recommending it? (MOA, strengths, onset, directions, AEs)
PRESCRIPTION topical product used for inflammatory acne and has no cross reactivity with sulphonic allergies
MOA: synthetic anti-inflammatory and anti-bacterial sulfone
Strength: 5% gel
Onset: optimal improvement in 8-12 weeks
Directions: TID
AEs: mildly irritating and MAY DISCOLOUR SKIN
Safety in pregnancy NOT ESTABLISHED
