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Phar 153 > Acne > Flashcards

Acne Flashcards

1
Q

What is the patient perspective in regards to acne?

A
  • Tried many various therapies
  • Majority expect to see improvement in a month
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2
Q

Describe the etiology of acne?

A
  • As hit puberty, follicular wall of skin gets thicker (more skin oils) and that means things plug up
  • Increase in sebum
  • P. acnes
    Inflammation
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3
Q

Black heads

A
  • open comedo
  • rarely become inflammed
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4
Q

White heads

A
  • Closed comedo
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5
Q

Pimple

A
  • small, inflammed white or yellow lesion
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6
Q

What are some predisposing factors for acne?

A
  • Hormonal changes:
    –> Puberty
    –> Pre-menstrual flares
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7
Q

Polycystic Ovary Syndrome

A
  • Need to consider
  • Acne a symptom
    Headaches, pelvic pain, hair growth, weight gain
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8
Q

Skin Hydration Acne

A
  • Heat and hydration tends to make acne worse
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9
Q

Irritation Acne

A
  • Irritation - Chin gaurd acne
    Occlusion –> Mechanical irritation
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10
Q

Cosmetics

A
  • Can make acne worse
  • Most anti-comedogenic
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11
Q

Dietary aspects and acne

A
  • sugary diets –> insulin –> more oils
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12
Q

Stress Acne

A
  • Body steroid levels –> Stimulates sebum
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13
Q

Acne progression (age)

A
  • Typically starts at puberty
  • Increases in severity until the late teens then slowly abates
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14
Q

Adult onset of acne?

A
  • Cases that continue from teenage years - 80%
  • Adult onset cases - 20% –> not key players
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15
Q

Where does acne typically affect?

A

Face, neck, chest, upper back, upper arms

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16
Q

Inflammation and Black/White Heads

A

White heads –> Closed comedo –> Will usually become inflammed
Black Heads –> Open comedo –> Usually will not become inflammed

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17
Q

Describe the stages of acne

A

Comedone –> White/Black Head –> Non-inflammatory
Papule
Pustule
Nodule
Cyst

  • Last 4 –> Inflammatory lesions –> P. acnes bacteria
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18
Q

Mild Acne

A
  • <20 comedones or < 15 inflammatory lesions or < 30 lesions
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19
Q

Moderate/Severe

A
  • Refer to MD
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20
Q

When should we be nervous about acne onset?

A

Acne onset:

Drug Induced –> Topical steroids and birth control pills
Adults –> Adult onset

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21
Q

Millia

A
  • appears during the first few days of life
  • normal for newborns
  • diasppears w/t tx in 2 weeks
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22
Q

Roscea

A
  • Differential Diagnosis
  • Affects the face like acne
  • No comedones
    Can have ocular symptoms
    Transient flushing and warmth - 5 mins
    Blood vessels appear on skin
    Comes and goes over time
    Triggers: sun, stress, alcohol
    Pt’s usually older than 30; rarely affects kids
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23
Q

How is roscea treated?

A
  • In pharmacy –> Nothing of value
  • Medical care with topical agents
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24
Q

Perioral Dermatitis

A
  • Dermatitis around the mouth
  • Can happen in kids
  • No blackheads
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25
Q

Treatment of perioral derm

A
  • MD Care
  • Remove suspected causes
    Oral/topical antibiotics –> via anti-inflammatory action
    Patients should be ready for frustration re-treatment
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26
Q

Basic Skin Care for Acne

A
  • face washing BID
  • Do not scrub –> over-cleaning can increase sebum levels on skin
    Minimize picking
  • Ecezma grade soap (unsecented glycerin soap)
  • No need for astringents
    ACne cleansing pads –> Not a problem
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27
Q

Therapy for Acne

A
  • BP and/or retinoid
  • 2-4 years of tx
  • Starting earlier and being more aggressive
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28
Q

Salicylic Acid

A
  • Kertalolytic
  • 0.5%/2.0%
  • Not much contact time –> Directions for use
  • Okay agent; but minor role
  • Non-medicated acne pads okay
29
Q

Sulfur

A

Anti-bacterial

30
Q

Rescorinol

A

Exfoliant

31
Q

Tea Tree Oil

A
  • May have anti-bacterial but how much, how often, etc.
32
Q

Topical Nicotinamide

A
  • Future of otc
33
Q

Benzyl Peroxide Strength, Use, and MOA

A

2.5%, 5% –> OTC
10% –> Rx

  • Solo for mild acne
  • Combo for moderate acne

Anti-bacterial Action (O2) –> Blast of oxygen that decreases P. acnes
Exfoliant Action –> Closed comedos opened up and have less build up –> mild surface peeling

34
Q

S/e of Benzyl Peroxide

A

Redness, peeling, dryness, burning, bleaches clothes

35
Q

Benzyl Peroxide Vehicle

A

Soap/Wash –> Not much contact time
Lotion
Gel (Acetone >alcohol>aqeous)

Only one product needed

36
Q

What is a good starting point for benzyl peroxide?

A
  • BP 5% lotion
    Can upgrade or downgrade
  • Gel stronger than lotions
37
Q

BP and Skin tone

A
  • Sensitive skin –> Lotion more so than gel
38
Q

Bp and Winter/Summer

A

Winter –> Lotion
Summer –> Oilier skin –> Gel

39
Q

When starting BP should they keep using their other products?

A

No. Skip all that if can.

40
Q

How much BP should be applied?

A
  • Small amount
  • NOT FTU’S
  • More is not better
41
Q

Directions for BP Use

A
  • Start slowly
    1-2 hrs x few days
    3-4 hours x few days
  • Eventually be left on overnight
42
Q

Is spot tx valuable?

A

No. DO not spot tx.

43
Q

How can dry skin in BP tx be handled?

A
  • Add a dry skin lotion –> Ecezma grade
  • Go slower
  • Change BP strength or formulation base (lotion vs gel)
  • Avoid contact around eyes/mouth/nose
44
Q

BP OD vs. BID Dosing

A
  • Start with OD Dosing
  • Wash face in evening, let skin dry, apply BP, do nothing until morning
  • After a month, move to BID dosing
  • Was face in morning, let skin dry, apply
  • Evening –> wash face, let skin dry, apply BP
45
Q

Topical Retinoids

A
  • Vitamin A derivatives
  • Decrease cohesiveness of follicular wall –> Less stickiness, less leisons forming
  • Increase penetration of other agents

First line agents or added to others

46
Q

Tretinoin Tx

A
  • Start slow, then reasses in 2 months

0.001% cream –> 0.025% cream –> 0.025% gel –> 0.05% gel
- HS –> use at night

47
Q

S/e of tretinoin

A

Ertheyma, etc

48
Q

Directions for use of tretinoin

A
  • Start slow
  • Skin needs to be dry before application
  • Pea-sized amount (should disappear in one min)
  • HS –> apply at night –> Phostosensitive
  • Initial worsening of condition
49
Q

Topical retinoid choices and charcateristics

A

Adapelene –> least irritating
Tretinoin –> Most photo sensitizing
Tazarotene –> Most potent –> psoriasis

50
Q

Retinoids in Pregnancy

A
  • Likley safe but can be teratogenic
  • Always refer
51
Q

Can BP and a retinoid be used together in tx?

A

Yes

52
Q

Directions for tretinoin and BP tx. Exceptions

A
  • Tretinoin and BP applied at same time = drug interaction –> Sun sensitivity issue
  • BP oxidizes retinoid
  • Daily ritual two agents –> retinoid HS and BP AM

Exceptions –> retin-A-Micro, tactupump, epiduo –> Combo products that avoid intercation

53
Q

When is BP better for use?

A
  • ANti-bacterial
  • need to see pimples for it to be effective
  • Not the best choice for non-inflammatory acne (blackheads and white heads) because no inflammation occuring
54
Q

When is a retinoid better for use?

A
  • Non-inflammatory –> Prevents formation
55
Q

Topical Antibiotics in Acne and Dosing

A
  • Clindamycin
  • Erthyromycin

OD or BID

56
Q

Topical ANti-Biotic Consideration

A
  • combination with BP or retinoid needed to decrease bacteria resistance
57
Q

Mild-moderate ACne tx

A

BP + anti-biotic
Retinod + a-biotic

58
Q

Severe acne tx (antibiotic)

A

Clind + BP (am)
Tretinoin (HS)

59
Q

Anti-biotic Cream Directions for Use and S/e

A
  • apply a pea-sized amount to each area (forehead, cheeks, chin)
  • not adding more s/e
60
Q

How much cream/gel should be applied?

A
  • 4 pea sized amounts –> cheeks, chin, forehead
  • 6 pea sized amount –> 2 forehead, cheeks, chin and nose

-GO WITH WHAT MANUFACTURER SAYS

61
Q

Should anti-biotics be used long term?

A
  • topical anti-biotics should be discontinued after resolution of inflammatory lesions
62
Q

Azelaic Acid

A
  • MOA = antibacterial (normalizize keratin stickiness)
  • Mild to moderate acne
  • BID
63
Q

Can pharmacists prescribe topical anti-biotics?

A

NO

64
Q

Oral ANtibiotics MOA

A

Antibacterial
- Anti-inflammatory
- Moderate to severe acne (alone or in combo)
- Oral agents must be used with retinoid or BP –> Increase efficacy, decrease resistance

65
Q

Oral Anti-biotics Exampes and Interactions

A

Tetracycline –> avoid food/dairy, avoid antacids –> Photosens
Minocycline –> Less food int, avoid antacids –> less photosens
Doxycycline –> Give with food, avoid antacids –> greater photosens

66
Q

How long should oral anti-biotics be used for? Should a topical also be used?

A
  • 3 months
  • No improvement, increasing dose or frequency does not add any benefit
  • Oral and topical at same time not beneficial
67
Q

Isotretinoin Use, Dosing, S/e, pregnancy?

A
  • Severe acne
  • Very effective
  • Nodular/Cystic Acne

0.5-1 mg/Kg x 12-16 weeks

S/e –> Significant –> Depression, drying on mucous membranes (lips, eyes)
Pregnancy Concerns –> Two reliable forms of Contraception and 2 negative preganncy tests

68
Q

Oral Contraceptives

A
  • Estrogen has beneficial effect on acne
  • Alesse, tricylen, yasmin, etc.
  • Not first line uses

Ethinyl + norgestimate/levonorgestrel

  • Progesterone may make acne worse –> different androgenic properties
69
Q

Back Acne

A
  • refer to MD

Phar 153 (7 decks)

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