Acne Flashcards
Patho of acne
Skin cells tick together due to excess keratin + excess oil from sebaceous glands = blockage of hair follicle
Bacteria grows = WBC, inflammation,
Signs and symptoms of acne
white head-black head- papule- cyst- module- pustule
Onset of acne
at puberty
M>F
Lower incidence in AA and asians
genetic predispositions
Drug induced “acneiform” lesions
LVP (lithium, valproic, phenytoin)
OC, androgens, GC
Cyclosporine, AZA
Disulfiram
Phentermine
Iodides, bromides
Danazol
High dose B or D vitamins
Environmental factors for acne
CRH - emotional stress
pH = repetitive stress
occlusion, pressure
heat, humidity
occupational “chloracne”
Food
pH of healthy skin
4.7-5.7
Staging acne
Mild: <10 papules, no nodules
Mod: many papules, nodules+comedomes
Severe: extensive pustules/modules
Mild acne tx
Topical
BP or retinoid
Topical combo:
BP + abx and or retinoid
Moderate acne tx
Oral abx + topical therapy
Oral abx + topical combo therapy
Severe acne tx
Oral abx + topical combo therapy
Oral ISOTRETINOIN ONLY
Goals of acne treatment
decrease inflammation, sebum, scarring
remove keratin plug
Exclusions to acne self care
comedogenic drug use
mod-severe acne
pregnancy
treatment failure
Targeted treatment factors
- follicular hyperproliferation
- increased sebum production
- C.acnes proliferation
- inflammation
Follicular hyper proliferation
“RASH”
Retinoids (PO/topical)
Azelaic acid
Salicylic acid
Hormonal therapies
Increased sebum production
“CHI”
Clasoterone cream
Hormonal therapies
Isotretinoin
C.acnes proliferation
“BAAD”
Benzyol peroxide
Abx
Azelaic acid
Dapsone
Inflammation
“TRACD”
Tetracycline
Retinol (PO/Topical)
Azelaic acid
Clasterone cream
Dapsone
Topical retinoids
decrease cohesiveness of follicular epithelial cells (increase turnover)
Start low go slow
8-12 weeks for improvement
Most irritating retinoid
Tazarotene
Least irritating retinoid
adapalene
Tazarotene precaution
avoid in pregnancy
Microtretinoin allergy precaution
fish protein
Tretinoin DDI
Benzyoyl peroxide will decrease stability
Clindamycin will enhance
Adapalene DDI
Benzyoyl peroxide will enhance activity
Azaleic acid
limits melanin
inhibits tyrosinase
Drugs for treating hyperpigmentation
Azaleic acid, topical retinoids, alpha hydroxy acids (glycolic, lactic), hydroquinone
Drug-induced hyperpigmentation
Sulfonamides
tetracycline
silver
mercury
antimalarials (hydroquinone)
Amiodarone
Clascoterone cream
decreases sebum and inflammation
REFRIGERATE
STORE AT RT ONCE DISPENSED
CLASCOTERONE CREAM ADR
IF OCCLUSIVE DRESSING = MAY CAUSE HPA SUPRESSION
Hormonal agents
use with topical retinoids for mod-severe acne
K sparing and EE COCs
K sparing monitoring
Serum potassium at first cycle, baseline, 4-6 weeks
Oral isotretinoin
shrinks sevaceous glands
decreases sebum
INDIRECT action on c.acnes
normalize desquamation (prevent keratin)
mod-severe recalcitrant nodular acne
reduces inflammation
isotretinoin use ADR
C/I pregnancy
Underlying psych conditions
Tetracyclines = pseudotumor cerebri (BP)
Avoid vitamin A supplement
Avoid skin procedures (don’t wax ur brows)
Isotretinoin monitoring
Baseline LFT/FLP
- if normal, get again in 2 months
- if abnormal, periodically monitor
- if ALT/ST x3 uln = d/c drug
CK: if joint pain or muscle pain (15-50% elevation)
Isotretinoin ADR
Liver damage (high TG, thin hair)
IBS (want to decrease PM dose)
Night blindness
Dry eye
Growth stunt
muscle pain (CK)
Bone marrow impression
Calcification of ligament/tendons
Skin photosensitivity
eczema-like rash
dry lips, cheilitis
Acne conglobate
Isotretinoin
systemic abx
or intralesional steroids
Acne fulminans
May occur due to isotretinoin (d/c if so)
Systemic = PO GC x 4 weeks then iso
not sys = PO GC x 2 weeks then Iso
Ipledge pregnacy test #
N+4
Calculating the duration of Isotretinoin therapy
Cumulative dose
120-150 mg/kg
Daily dose isotretinoin
0.5-1mg/kg/day
micronized dosing
multiply by 0.8
Isotretinoin counseling
take with food
avoid the sun
dont get pregnant
