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PHAR153 > Acne > Flashcards

Acne Flashcards

1
Q

What is critical in each case of acne?

A

simple skin care
handling patient expectations

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2
Q

Amongst those who seek advice for acne, what is the % for pharmacists compared to MDs?

A

10% seek a pharmacist
90% seek an MD

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3
Q

What is the etiology for acne?

A

follicular changes (follicular wall becomes sticky, stuff plugs up)
increased sebum (due to puberty)
P. acnes (bacteria)
inflammation (redness and zits are inflammatory processes)

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4
Q

What is the difference between a blackhead and a whitehead?

A

blackhead:
-open comedo
-does not lead to more acne/inflammation
-mainly a cosmetic issue
whitehead:
-closed comedo
-due to sticky follicular wall
-can become worse

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5
Q

What are predisposing factors for acne?

A

puberty for boys and girls
pre-menstrual flares (acne especially on the jawline)
skin hydration (sweat clogs pores)
cosmetics
irritation and occlusion
dietary aspects
stress
occupation
hereditary

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6
Q

What are some of the symptoms of polycystic ovary syndrome (PCOS)? What should you do?

A

acne, hair loss, male pattern baldness
refer

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7
Q

What is PCOS?

A

hormonal disorder that causes enlarged ovaries, small cysts may form on the outer edges, can affect fertility

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8
Q

True or false: acne is common during pregnancy

A

true
more than one out of every two pregnant women can develop acne

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9
Q

How does diet contribute to acne?

A

diet high in sugar–>more insulin–>more oils

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10
Q

How does stress contribute to acne?

A

stress induces body steroid levels to rise–>stimulates more sebum production

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11
Q

What kind of jobs are more prone to acne?

A

fast-food workers (“McDonalds acne”)

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12
Q

Which type of adult acne are we not involved in?

A

adult-onset cases should be immediate referral

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13
Q

Where are some typical locations for acne to appear?

A

face
neck
chest
upper back
upper arms

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14
Q

Which acne lesions tend to be inflammatory?

A

papules
pustules
nodules
cysts

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15
Q

What is the definition of mild acne?

A

<20 comedones or <15 inflammatory lesions or <30 total lesions

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16
Q

True or false: pharmacists only deal with moderate acne

A

false
pharmacists only deal with mild acne

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17
Q

Which drugs can cause drug-induced acne?

A

topical steroids (improper use)
some birth control pills (most are helpful)

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18
Q

What % of adult acne cases are continuing from teenage years? What about adult onset cases?

A

80% are cases that continue from teenage years
20% are adult-onset cases

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19
Q

What is milia?

A

“baby acne”
not true acne
appears in the first few days of life and disappears in a few weeks without any treatment

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20
Q

What is rosacea?

A

a skin condition that affects the central face
no comedones
there can be ocular symptoms
transient flushing and warmth
blood vessels appear on skin
comes and goes

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21
Q

What triggers rosacea?

A

nobody really knows the exact cause

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22
Q

Which group of people are typically affected by rosacea?

A

usually people older than 30
rarely in kids

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23
Q

What is the treatment for rosacea?

A

topical agents

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24
Q

Are there any products in the OTC aisle to help with rosacea?

A

no
refer if you think the patient has rosacea

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25
Q

What is perioral dermatitis? What does it look like?

A

it is a facial rash that tends to occur around the mouth
appears red and slightly scaly or bumping, burning or itching is mild
NO BLACKHEADS

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26
Q

What is the treatment for perioral dermatitis?

A

oral/topical antibiotics
MD care

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27
Q

What are the non-medical measures for acne treatment?

A

basic skin care:
-washing face BID
-do not scrub
-minimize picking
eczema grade soaps
no need for astringents
acne cleansing pads are fine

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28
Q

True or false: over cleaning can increase sebum levels on the skin

A

true
BID washing is fine

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29
Q

What are the cornerstones of acne therapy?

A

BP and/or retinoids

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30
Q

How long should an acne patient expect to undergo therapy?

A

2-4 years

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31
Q

If parents had acne, then what could be a good move for their kid?

A

start treatment early to prevent mild acne from getting moderate or severe

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32
Q

How does salicylic acid work?

A

keratolytic
-dries out oils on the face
-reduces plugging on the surface

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33
Q

What strengths does salicylic acid typically come in?

A

0.5% or 2%

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34
Q

What is the active ingredient in oxy wipes?

A

salicylic acid

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35
Q

What is the main reason that salicylic acid is added to products?

A

allows the manufacturer to advertise their product as medicated

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36
Q

Other than our cornerstone acne treatments, what are some other therapies?

A

sulfur (antibacterial)
resorcinol (exfoliant, antibacterial)
tea tree oil (antibacterial)
topical nicotinamide (might be doing something)

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37
Q

Which strengths of BP are OTC? Which strength is Rx?

A

OTC: 2.5% (uncommon) and 5% (good starting point)
Rx: 10%

38
Q

When should BP be used as a solo product? When should it be used as a combo product?

A

solo: mild acne
combo: moderate acne

39
Q

What are the side effects of BP?

A

redness, peeling, dryness, burning, bleaches clothes

40
Q

What is the mechanism of action of BP?

A

antibacterial (not an antibiotic)
-hits P acnes with a blast of O2
exfoliant action

41
Q

True or false: it is necessary to use sunscreen while on BP

A

false
not as sun-sensitive as retinoids

42
Q

Which vehicles are more valuable for BP? Which vehicles are less valuable for BP?

A

lotions and gel (acetone>alcohol>aqueous) are better
soaps/washes are less valuable due to concerns of contact time

43
Q

True or false: gels are stronger than lotions but it is not a massive jump in therapy

A

true

44
Q

If a patient has oily skin which vehicle should you go for? What about if the patient has sensitive skin?

A

oily skin go for a gel because it can dry it out
sensitive skin go for a lotion

45
Q

How much BP should be applied to an affected area?

A

smaller than an FTU (pea-sized)
more is not better

46
Q

What are the directions for use of BP?

A

start slowly
-ex: apply for 1-2hrs then wipe off for a few days and then apply
for 3-4hrs for a few days before moving to a full night of
contact

47
Q

What is a good way to verbalize the “start slowly” directions?

A

“This will eventually be left on overnight. Now, how you get there is this way…”

48
Q

True or false: we should resist the temptation to spot treat with BP

A

true

49
Q

What can be done for overly dry skin that is the result of BP?

A

add dry skin lotion (non-cometogenic)
go slower
change % or formulation base

50
Q

As a pharmacist, what is critical during an OTC consult with regards to acne?

A

expectations in regards to improvement

51
Q

Explain the once-a-day regimen for BP.

A

wash face in the morning

wash face in the evening
let skin dry
apply BP (thus contact time is 8-10hrs)

52
Q

Explain the BID regimen for BP.

A

wash face in the morning
let skin dry
apply BP

around 8pm, wash face
let skin dry
apply BP (thus contact time is ~24hrs)

53
Q

What is the mechanism of action of topical retinoids?

A

they decrease the cohesiveness of the follicular wall
they increase the penetration of other agents like BP

54
Q

Which vitamin are topical retinoids a derivative of?

A

vit A

55
Q

What are the dosing and formulations for tretinoin?

A

0.01% cream and 0.025% cream
0.025% gel and 0.05% gel

56
Q

What are the side effects of tretinoin?

A

erythema or irritation

57
Q

What are the directions for use of tretinoin?

A

skin needs to be dry before application
pea-sized amount
start slowly (start with low strength aka cream and then re-asses)
apply at night

58
Q

Why should topical retinoids be applied at night?

A

tretinoin is a sun sensitive agent
if applied at night, it should all be gone by the morning

59
Q

Why might your acne worsen upon initial usage of topical retinoids?

A

retinoids bring “soon to be” acne up to the surface

60
Q

What are the choices of topical retinoids?

A

adapalene (least irritating)
tretinoin (most photosensitizing)
tazarotene (most potent)

61
Q

Which product is advertised as being for truncal acne? Would agents like retinoids be fine for truncal acne?

A

Aklief, it just a marketing move
yes they would

62
Q

What do we do in regards to topical retinoids and pregancy?

A

referral
vit A in as retinoids can be teratogenic for unborn kids
adapalene: Category C (caution)
tazarotene: Category X (contraindication)

63
Q

When are the BP and retinoid combos used?

A

moderate acne

64
Q

What is starting to become the recommended first line approach in most acne cases?

A

combination therapy

65
Q

Should BP and a retinoid be applied at the same time?

A

no there is a drug interaction
BP oxidizes the retinoid making it almost not useful

66
Q

If a patient is using BP and a retinoid, when should each agent be applied?

A

BP in the morning
retinoid at night

67
Q

Which formulations bypass the BP-retinoid drug interaction, allowing for BP and the retinoid to both be used at night?

A

micronized tretinoin gel
adapalene+BP

68
Q

If we are really trying to get to the nuances, which situations are BP and retinoids better for as lone agents?

A

BP: actual pimple formation, inflammation
retinoids: prevent white head formation, non-inflammatory

69
Q

Which topical antibiotics are used for acne?

A

clindamycin (more common)
erythromycin

70
Q

Why are topical antibiotics for acne always a combination product?

A

to prevent resistance

71
Q

In terms of topical antibiotics for acne, what is used for mild-moderate cases? What about severe cases?

A

mild-moderate: BP+antibiotic or retinoid+antibiotic
severe: clindamycin+BP (am) and tretinoin (hs)

72
Q

How do you explain “apply a pea-sized amount”?

A

apply 1 pea-sized amount of product onto your fingertip and then dot the 1 pea-sized amount onto 6 areas of your face
this should be enough to cover your entire face

73
Q

When should topical antibiotics be discontinued?

A

after resolution of inflammatory symptoms

74
Q

True or false: pharmacists can prescribe for antibiotic and BP combination products as they are indicated for mild acne cases

A

false
antibiotic+BP is for moderate acne
we can prescribe clindamycin+tretinoin (indicated for mild acne)

75
Q

What is the mechanism of action of oral antibiotics for inflammation?

A

antibacterial and anti-inflammatory
-killing P.acnes, thus reducing inflammation

76
Q

Which acne cases need oral antibiotics?

A

moderate to severe cases (alone or in combo)
-oral agents must be used with a topical retinoid or BP to
increase efficacy and decrease resistance

77
Q

Which oral antibiotics are typically used for acne? List a few things about each of these antibiotics.

A

tetracycline:
-avoid food/dairy
-avoid antacids
-photosensitive
minocycline:
-less problems with food
-avoid antacids
-less photosensitive
doxycycline:
-give with food
-avoid antacids
-greater photosensitivity

78
Q

True or false: if oral antibiotics have been used for 3 months and there is no improvement, then we should increase the dose or frequency

A

false
if no improvement, there is no benefit to increase dose and frequency

79
Q

True or false: there is no benefit to using topical and oral antibiotics at the same time

A

true

80
Q

What is the role in therapy for isotretinoin?

A

severe acne (very effective agent)
-nodular cystic acne

81
Q

What is the action of isotretinoin?

A

hits all 4 actions

82
Q

What is the dosing for isotretinoin?

A

0.5-1mg/kg for 12-16 weeks

83
Q

What are the side effects for isotretinoin?

A

red eyes and dry lips (dries mucous membranes)
maybe depression but this might be due to the acne

84
Q

True or false: isotretinoin is not used in pregnancy

A

true
if used, the woman has to sign off a waiver

85
Q

In terms of diet, what might a patient be asked to do in order to help with absorption of isotretinoin?

A

consume high fat meals
-Epuris does not need fat to be absorbed

86
Q

How do oral contraceptives work for acne?

A

estrogen can have a beneficial effect on acne, progestin is thrown in to help the formulation

87
Q

How can progestins worsen acne? Name some progestins.

A

due to the androgenic properties
norgestimate and levonorgestrel

88
Q

When would an oral contraceptive be a first line acne therapy?

A

if the girl has acne and wants birth control

89
Q

Differentiate between mild, moderate, and severe acne.

A

mild: <20 comedones, <15 inflammatory, <30 total
moderate: 20-100 comedones, 15-50 inflammatory, 30-125
total
severe: >5 pseudocysts, >100 comedones, >50 inflammatory,
>125 total

90
Q

What is the role of Diane-35 in acne?

A

Diane-35 contains a very potent agent against androgenic acne
-hormonal based acne or PCOS (severe acne)
must be stopped after acne clearing
-rarely seen for this reason
-can cause cardiovascular damage if used long term
-not indicated for contraception

PHAR153 (20 decks)

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