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7006PHM Prof Pharm II > Acne > Flashcards

Acne Flashcards

1
Q

What factors can cause acne?

A

Stress

Diet

Exercise and weight

Medications

Hormones

Sweat

Bacteria

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2
Q

Summarise the four key processes involved in acne?

A

Inc sebum production = controlled by androgens

Follicular hyperkeratinisation = clogs or blocks pore –> microcomedo

Microbial colonisation = skin bact overgrowth Proprionibacteria acnes in pilosebaceous duct

Inflammatory process

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3
Q

How does P. acnes influence inflammation?

A

P acnes hydrolysis sebum into free fatty acids –> release of inflammatory mediators

Seen in papule, pustule, nodule

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4
Q

What are the different types of comedo?

A

Open = blockage close to skin surface –> oxidation –> blackhead

Closed = blockage further from skin surface –> whitehead

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5
Q

What is a papule?

A

small, red, inflamed bump

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6
Q

What is a pustule?

A

small, red, inflamed bump (same as papule)

contains pus (pimple)

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7
Q

What is a nodule or cyst?

A

deep pustular lesions which if become infected will be painful

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8
Q

What is considered mild acne?

A

Comedones (non inflammatory lesions), some papules and pustules (<10)

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9
Q

What is considered moderate acne?

A

Moderate no. papules and pustules (10-40), comedones present are more widespread (10-40)

May effect trunk, mild scarring

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10
Q

What is moderate/severe acne?

A

Numerous papuples and pustules present (40-100), occasional deeper nodular inflamed lesion (up to 5)

Widespread infection - face, chest, back

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11
Q

What is severe acne?

A

nodular abscesses and cysts

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12
Q

What are some differential diagnoses for acne?

A

Rosacea = no comedones, cysts, scars, inflammatory papules, affects face, erythema, usually after 30 yrs/age

seborrheic dermatitis = greasy scales with yellow-red papules

Drug-induced acne = seen with androgens, corticosteroids, oral contraceptives, lithium, phenytoin

Bacterial folliculitis = abrupt eruption, spread with scratching or shaving, distribution variable, onset after puberty

Perioral/periorbital dermatitis = papules/pustules confined to chin, nasolabial/ocular regions, clear around border, females between 20-45

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13
Q

Summarise some topical drugs for acne (S2)?

What type of acne are they used in?

A

Benzoyl peroxide = comedonal & mild acne

Azelaic acid =mild acne

Salicylic acid (beta hydroxy acid( & tea tree oil = mild acne

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14
Q

Discuss the use of benzoyl peroxide in acne treatment?

A

Antibacterial, mildly comedolytic

Can be used with oral agents EXCEPT retinoids

Begin at lower strength, can bleach clothes/towels/etc.

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15
Q

Discuss the use of azeleic acid in acne treatment?

A

less irritating than benzoyl peroxide

May cause hypopigmentation or photosensitisation

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16
Q

Discuss the use of salicylic acid/tea tree oil in acne treatment?

A

Antibacterial

Mildly comedolytic

Anti-inflammatory

17
Q

What are the topical prescription medications for acne?

A

*all for moderate/severe acne

Clindamycin = add to topical retinoid

Erythromycin = add to topical retinoid

Tretinoin = treat for 6 wks, combine w/ other topical/oral treatments –> teratogen

Adapalene = treat for 6 wks, combine w/ other topical/oral treatments –> teratogen

18
Q

List the systemic S4 drugs used in acne treatment

A

doxycycline

minocycline

erythromycin

COC = cyproterone, drospirenone, desogestrel, or gestodene

spironolactone

19
Q

Elaborate on the hormonal drugs used for acne

(what line of treatment? what acne severity?)

A
  • Moderate-severe acne, Improvement is slow = 6 months

COC = alternative to abx

Cyproterone = 1st line –> most likely to improve acne

Drospirenone = if cypro not tolerated

Desogestrel or gestodene = less androgenic, if cypro not tolerated

20
Q

Discuss the use of spironolactone in acne treatment

A

For women, diuretic/anti-androgenic

Used if COC C/I

Taken once daily for 6 months

Can be combined w/ COC = inf efficacy

C/I in preg

21
Q

When should acne treatment with minocycline be changed?

A

if no response after 3 months

Has more ADRs

22
Q

When is erythromycin used to treat acne? How long until response?

A

3-6 months, can be longer until response

Last line when in comes to abx

23
Q

Summarise the use of doxycycline in acne treatment

A

Works via anti-inflammatory action

Once daily for 6 months

24
Q

How long does it take to see improvement with abx when treating acne?

A

4-8 weeks to see improvement

Change treatment if no response after 3 months

Good response = 3-6 months or longer

25
Q

Discuss the use of isotretinoin in acne treatment

A

Course length = 6-9 months, prolonged remission

Potent teratogen = contraception during and 1 month after

MOA = modulates cell proliferation and differentiation, dec inflma

Avoid topical treatments

26
Q

What are some ADRs for isotretinoin?

A

Dry lips, eyes, mucosal lining of nose

Cheilitis, sun sensitivity, myalgia

paronychia, impaired night vision

27
Q

What are some counselling points for isotretinoin?

A

Absorbed best if take with food

Report headache, nausea, vomiting

Dry eyes, lips = parrafin for lips, lubricating eye drops

Avoid vitamin A supplements

Protect skin from sun

Avoid waxing/dermabrasions

28
Q

What are some referral points for acne?

A

Large comedonal component

Severe acne, acne not responding to treatment after 2-3 months

severe-cystic acne

Social/psych problem

Risk of scarring

Clinical features make acne diagnosis uncertain

Med related/underlying causes of acne

29
Q

Summarise some lifestyle changes for acne

A

cleanse gently

avoid vigorous/abrasive scrubbing

avoid toners, oil-based moisturisers

Dont squeeze pimples

30
Q

Why is acne treated?

A

Improve complexion, reduce lesions

prevent scarring

limit disease duration

reduce psychological stress

31
Q

What are some important self-care points for acne?

A

Gently cleanse twice a day and after exercise

Avoid irritating or oily cleansers

Do not pop, squeeze, rub, or pick acne

avoid perfumed products

keep hair clean and away from face/neck

eat regular, healthy meals

exercise on all or most of days of week

drink heaps of water

don’t smoke

7006PHM Prof Pharm II (24 decks)

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