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
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
3
Q
Black heads
A
- open comedo
- rarely become inflammed
4
Q
White heads
A
- Closed comedo
5
Q
Pimple
A
- small, inflammed white or yellow lesion
6
Q
What are some predisposing factors for acne?
A
- Hormonal changes:
–> Puberty
–> Pre-menstrual flares
7
Q
Polycystic Ovary Syndrome
A
- Need to consider
- Acne a symptom
Headaches, pelvic pain, hair growth, weight gain
8
Q
Skin Hydration Acne
A
- Heat and hydration tends to make acne worse
9
Q
Irritation Acne
A
- Irritation - Chin gaurd acne
Occlusion –> Mechanical irritation
10
Q
Cosmetics
A
- Can make acne worse
- Most anti-comedogenic
11
Q
Dietary aspects and acne
A
- sugary diets –> insulin –> more oils
12
Q
Stress Acne
A
- Body steroid levels –> Stimulates sebum
13
Q
Acne progression (age)
A
- Typically starts at puberty
- Increases in severity until the late teens then slowly abates
14
Q
Adult onset of acne?
A
- Cases that continue from teenage years - 80%
- Adult onset cases - 20% –> not key players
15
Q
Where does acne typically affect?
A
Face, neck, chest, upper back, upper arms
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
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
18
Q
Mild Acne
A
- <20 comedones or < 15 inflammatory lesions or < 30 lesions
19
Q
Moderate/Severe
A
- Refer to MD
20
Q
When should we be nervous about acne onset?
A
Acne onset:
Drug Induced –> Topical steroids and birth control pills
Adults –> Adult onset
21
Q
Millia
A
- appears during the first few days of life
- normal for newborns
- diasppears w/t tx in 2 weeks
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
23
Q
How is roscea treated?
A
- In pharmacy –> Nothing of value
- Medical care with topical agents
24
Q
Perioral Dermatitis
A
- Dermatitis around the mouth
- Can happen in kids
- No blackheads
25
Treatment of perioral derm
- MD Care
- Remove suspected causes
Oral/topical antibiotics --> via anti-inflammatory action
Patients should be ready for frustration re-treatment
26
Basic Skin Care for Acne
- 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
27
Therapy for Acne
- BP and/or retinoid
- 2-4 years of tx
- Starting earlier and being more aggressive
28
Salicylic Acid
- Kertalolytic
- 0.5%/2.0%
- Not much contact time --> Directions for use
- Okay agent; but minor role
- Non-medicated acne pads okay
29
Sulfur
Anti-bacterial
30
Rescorinol
Exfoliant
31
Tea Tree Oil
- May have anti-bacterial but how much, how often, etc.
32
Topical Nicotinamide
- Future of otc
33
Benzyl Peroxide Strength, Use, and MOA
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
S/e of Benzyl Peroxide
Redness, peeling, dryness, burning, bleaches clothes
35
Benzyl Peroxide Vehicle
Soap/Wash --> Not much contact time
Lotion
Gel (Acetone >alcohol>aqeous)
Only one product needed
36
What is a good starting point for benzyl peroxide?
- BP 5% lotion
Can upgrade or downgrade
- Gel stronger than lotions
37
BP and Skin tone
- Sensitive skin --> Lotion more so than gel
38
Bp and Winter/Summer
Winter --> Lotion
Summer --> Oilier skin --> Gel
39
When starting BP should they keep using their other products?
No. Skip all that if can.
40
How much BP should be applied?
- Small amount
- NOT FTU'S
- More is not better
41
Directions for BP Use
- Start slowly
1-2 hrs x few days
3-4 hours x few days
- Eventually be left on overnight
42
Is spot tx valuable?
No. DO not spot tx.
43
How can dry skin in BP tx be handled?
- 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
BP OD vs. BID Dosing
- 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
Topical Retinoids
- 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
Tretinoin Tx
- Start slow, then reasses in 2 months
0.001% cream --> 0.025% cream --> 0.025% gel --> 0.05% gel
- HS --> use at night
47
S/e of tretinoin
Ertheyma, etc
48
Directions for use of tretinoin
- 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
Topical retinoid choices and charcateristics
Adapelene --> least irritating
Tretinoin --> Most photo sensitizing
Tazarotene --> Most potent --> psoriasis
50
Retinoids in Pregnancy
- Likley safe but can be teratogenic
- Always refer
51
Can BP and a retinoid be used together in tx?
Yes
52
Directions for tretinoin and BP tx. Exceptions
- 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
When is BP better for use?
- 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
When is a retinoid better for use?
- Non-inflammatory --> Prevents formation
55
Topical Antibiotics in Acne and Dosing
- Clindamycin
- Erthyromycin
OD or BID
56
Topical ANti-Biotic Consideration
- combination with BP or retinoid needed to decrease bacteria resistance
57
Mild-moderate ACne tx
BP + anti-biotic
Retinod + a-biotic
58
Severe acne tx (antibiotic)
Clind + BP (am)
Tretinoin (HS)
59
Anti-biotic Cream Directions for Use and S/e
- apply a pea-sized amount to each area (forehead, cheeks, chin)
- not adding more s/e
60
How much cream/gel should be applied?
- 4 pea sized amounts --> cheeks, chin, forehead
- 6 pea sized amount --> 2 forehead, cheeks, chin and nose
-GO WITH WHAT MANUFACTURER SAYS
61
Should anti-biotics be used long term?
- topical anti-biotics should be discontinued after resolution of inflammatory lesions
62
Azelaic Acid
- MOA = antibacterial (normalizize keratin stickiness)
- Mild to moderate acne
- BID
63
Can pharmacists prescribe topical anti-biotics?
NO
64
Oral ANtibiotics MOA
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
Oral Anti-biotics Exampes and Interactions
Tetracycline --> avoid food/dairy, avoid antacids --> Photosens
Minocycline --> Less food int, avoid antacids --> less photosens
Doxycycline --> Give with food, avoid antacids --> greater photosens
66
How long should oral anti-biotics be used for? Should a topical also be used?
- 3 months
- No improvement, increasing dose or frequency does not add any benefit
- Oral and topical at same time not beneficial
67
Isotretinoin Use, Dosing, S/e, pregnancy?
- 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
Oral Contraceptives
- 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
Back Acne
- refer to MD
