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PHAR 153 > Acne > Flashcards

Acne Flashcards

1
Q

Are patient’s expectations of acne medications overstated?

A

Yes, patients expect acne drugs to work fast (within 1 month), but it could take months or years

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2
Q

Do dermatologists recconmend doctors to go light on acne treatment?

A

No, dermatologists want doctors to prescribe agents that can mount an agressive response at the early stages

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3
Q

What is the etiology of acne?

A

Follicular changes (become stickier), increased sebum due to puberty

P. acnes is the bacteria

Inflammation

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4
Q

What are some predisposing factors for acne?

A

Hormonal changes (boys/girls)

pre-menstrual flares

skin hydration

irritation

occlusion (really bad acne-like bumps)

poor quality cosmetics

dietarty aspects

stress

occupational

heredity

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5
Q

How is acne associated to polycystic ovary syndrome?

A

Most young women with acne do not have polycystic ovary syndrome, but if acne is accompanied by symptoms like irregular menstruation, pelvic pain, weight gain, hirsutism, it could be polycystic ovary syndrome

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6
Q

When does acne have its onset?

A

Typically starts at puberty (increases in severity until the late teens, then slowly abates)

Acne in adults:

cases that continue from teenage years (80%)

actual adult-onset cases (20% and it is more serious)

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7
Q

What is the difference between whiteheads and blackheads?

A

Whiteheads (closed comedo)

Blackheads (open comedo)

They are both non-inflammatory

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8
Q

What type of acne lesions are inflammatory?

A

The following lesions are infected with P. acnes bacteria. They are listed from least to most severe

Papule

Pustule

Nodule

Cyst

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9
Q

When are cases of acne too severe to be managed by a pharmacist?

A

If there are more than 20 comedones OR 15 inflammatory lesions OR 30 total lesions.

All severe cases need to be referred to a physician

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10
Q

What drugs can induce acne?

A

Topical steroids

Some birth control pills

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11
Q

How is Milia different from Acne?

A

“Baby acne”

Appears during the first few days of life

Normal for newborns (1/2 have it)

Disappears without treatment

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12
Q

How is Rosacea different from Acne?

A

Like acne it affects the central face, but it does not have comodones

It can also have ocular symptoms

Transient flushing + warmth

Blood vessels appear on skin

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13
Q

What is perioral dermatitis?

A

Dermatitis around the mouth

Keep this in the back of your head, affects older people more, but kids can have it too

Patients should be ready for frustration (retreatment)

MDs can prescribe oral/topical antibiotics

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14
Q

What are some non-medical measures for the treatment of acne?

A

Do not go overkill with the following measures, condition could worsen otherwise

Face washing BID

do not scrub

use an eczema grade soap

no need for astringent

minimize picking

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15
Q

Which formulation is better for acne products:

lotions or cleansers?

A

Cleansers are designed remove oil and lipids from the skin

lotions on the other hand add more lipids to the skin

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16
Q

What is the most common therapy option for acne

A

Benzoyl Peroxide (BP) and retinoid are cornerstones of therapy

Expect 2-4 years of treatment

Dermatologists tell doctors to hit acne hard

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17
Q

How is salicylic acid useful in acne treatment?

A

It is keratolytic

Usually found as 0.5-2.0%

It isn’t the best agent for acne, go with BP or retinoid instead

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18
Q

What are some non-conventional acne therapies?

A

Sulfur (anti-bacterial)

Resorcinol (exfoliant)

Tea Tree Oil (some antibacterial properties)

Topical nicotinamide

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19
Q

What doses for Benzoyl Peroxide are available in Canada?

A

Between 2.5% and 5% are OTC

Between 5%-10% are all prescribed

Solo use is fine for mild acne, but can be used in combo with another agent in more severe cases

20
Q

What is the mechanism of action for Benzoyl Peroxide?

A

BP exposes P. acnes to a blast of oxygen, which effectively destroys the bacteria

BP also has an exfoliant effect

21
Q

What are some side effects for Benzoyl Peroxide

A

If BP is used to agressively without gradual increase in application duration, the following side effects can manifest:

Redness, peeling, dryness, burning

22
Q

Are Benzoyl Peroxide washes effective in acne patients?

A

The duration of contact in washes is so low that no appreciable effects can be measured, hust get a lotion or cream

Do not use more than one product if you have mild acne

23
Q

What is the difference between BP gel and lotion?

A

BP gel is slightly stronger and can be useful in oilier skin

BP lotion is milder and can be used if skin is more sensitive to BP

24
Q

By applying more product, do we get a more intense response?

A

No, only side effects get worse. The clinical effect does not change my increasing amount applied

25
Q

How to ramp up BP to final dose?

A

Apply for 1-2 hours for a few days

Apply for 3-4 hours for a few days

Start leaving overnight once the skin has adjusted for BP

You can slow down ramp up of BP or eczema grade dry skin lotion to help manage side effects

26
Q

Are topical retinoids an effective treatment for acne?

A

Very effective topical agents

MOA:
Reduce cohesive (stickiness) of follicular wall

Increased penetration of other agents (increased efficacy of secondary agent)

First line agent or is added to others (GPs encouraged to be more aggressive)

27
Q

What are some good starting retinoid doses?

A

0.01% cream
0.025% cream

28
Q

What are some side effects for retinoids?

A

Erythema

to minimize these effects apply on dry skin and stay out of the sun (use at bedtime)

29
Q

Is a ramp up needed for retinoids?

A

Yes, like BP we don’t start with full regimen. We need to ramp up the dose to minimize irritation

The condition could get worse, before it gets better. This can be bad for patient expectations

30
Q

What are some examples of retinoids?

A

Most commonly used for acne
Adapalene (least irritating)
Tretinoin (most photosensitizing)
Trifarotene (marketed for back acne)

Not used for acne, mostly for psoriasis
Tazarotene (most potent)

31
Q

Are retinoids available over the counter in Canada?

A

No, they require prescriptions from doctors

32
Q

Should pregnant mothers be worried about retinoids?

A

Tazarotene(a retinoid) is a teratogenic and should not be used by pregnant mothers

Pregnant mothers should use BP instead

33
Q

Is giving BP and retinoid to a patient from a pharmacist’s assessment alone with in their scope of practice?

A

No, forward this patient to a doctor. If a situation needs combo therapy, it is too severe to be seen by a pharmacist alone

34
Q

If patient is using BP and retinoid from separate products, when should they take the two agents?

A

Take BP in the morning

Take retinoid at night

35
Q

Do physicans reccommend combo products over separate agents for acne?

A

Doctors prefer BP-retinoid combo agents due to their convienence and single dosing at night.

36
Q

What is the best agent for inflammatory acne?

A

BP is better

retinoids don’t help with inflammation but reduce formation of new lesions. retinoids still have some value

37
Q

What is the best agent for non-inflammatory acne?

A

Retinoids are better

BP has anti-inflammatory activity, not needed fot non-inflammatory acne. BP still has some value

38
Q

Are topical antibiotics effective in treating acne?

A

This is used in more severe cases

clindamycin
erythromycin

These antibiotics are found in combo products (BP or retinoids). This helps with reducing concerns about antibiotic resistance

Additional antibiotics do not increase side effects

But pharmacists can only prescribe if case is mild

39
Q

Should combiniatiopn products for acne with antibiotics be used until the skin is clear?

A

Technically speaking, antibiotics should be discontinued once the inflammatroy symptoms are resolved.

40
Q

Can pharmacists prescribe antibiotic and benzoyl peroxide combination products?

A

No, as they are not indicated for mild acne

41
Q

Are oral antibiotics useful in acne treatment?

A

This is indicated for moderate to severe acne (alone or in combination with other agents)

Oral antibiotics are used if topical antibiotics don’t work or aren’t practical

42
Q

What to look out for when patients are prescribed oral antibiotics?

A

Tetracycline (avoid food/dairy avoid antacids/photosensitivity)

Minocycline (lessproblems with food avoid antacids/less photosensitivity)

Doxycycline (give with food avoid antacids/ greater photosensitivity)

43
Q

What is the role in therapy for isotretinoin in acne?

A

Indicated for very severe acne and it is a very effective agent

0.5-1 mg/kg for 12-16 weeks

We have to watch out for side effects as they are quite significant. Be proactive and circle dry eyes and lips on the info sheets. reccommend artifical tears and lipbalm

Take isotretionin with a high fat meal for better absorption

CANNOT GIVE IF PATIENT IS PREGNANT

44
Q

What is the role in therapy for oral contraceptives in acne?

A

Not first line, unless woman needs birth control and has acne.

Alesse, Tricyclen, Yasmin

Some birth control pills might make acne worse due to progestin effects

45
Q

What is Diane-35R

A

This is a potent agent against androgenic acne in women. It is a birth control pill, but it should be discontinued once acne is gone. If taken long-term, it can cause cardiovascular issues

46
Q

Is salicylic acid an effective treatment option for acne?

A

No, they aren’t the best. Use BP/retinoids and simple wash BID

PHAR 153 (20 decks)

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