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Fall Therapeutics > Acne > Flashcards

Acne Flashcards

1
Q

Etiology/Risk Factors

A

Hereditary, Environment, Hormonal

Drug
* Phenytoin
* Isoniazid
* Moisturizers that are occlusive
* Phenobarbital
* Lithium
* Ethionamide
* Steroids

PIMPLES

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2
Q

Mild Acne: Comedones, Few Inf Lesions

A

Initial treatment
-Benzoyl peroxide (BP) OR
-Topical retinoid OR
-Topical combination
(BP + antibiotic or
BP + retinoid or
BP + antibiotic + retinoid)

2nd line: topical dapsone mono- therapy or in place of topical antibiotic

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3
Q

Moderate Acne: Inf Lesions, few comedones

A

Initial treatment
-Topical combination
(BP + topical retinoid or
[BP + topical antibiotic] + topical retinoid or
[Topical retinoid + topical antibiotic] + BP)

2nd line: topical dapsone may be considered instead of topical antibiotic

OR
Oral antibiotic + [BP + topical retinoid]
+ topical antibiotic (Acad Derm)

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4
Q

Severe Acne: Nodules/Cysts/Scars

A

Initial treatment
-Oral antibiotic + topical retinoid + BP
*+/- topical antibiotic
*Dapsone may be used instead of topical antibiotic
-Oral isotretinoin per Acad Derm

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5
Q

Step Ups

A

Mild
-Add BP or retinoid
-Change retinoid conc/type/form
-Change topical combo therapy

Mod
-Change retinoid conc/type/form
-Change top combo therapy
-Add/change oral abx
-Female: hormonal (spironolactone)
-Oral isotretinoin

Severe
-Change oral abx and oral isotretinoin
-Female: hormonal

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6
Q

BP - Drug of Choice!

A

-Most effective, safe, inexpensive
-Keratolytic, comedolytic, antibacterial
-Prevents and eliminates tx resistance by P. acnes
-2.5/5/10, gels/lotions/creams/washes

AE:
-drying, peeling, redness, stinging, burning
-local/sys hypersensitivity and anaphylaxis (fda warning)

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7
Q

BP Application/Counseling

A

-Wait 15-20 min after washing area to apply
-Thin layer over entire affected area (test first)
-Increase/decrease app (BID-TID) every 2-3 days
-Increase to 5 after 1 wk and 10 after 2 wks
-Avoid eyes/lips/nose/cuts/mouth/scrapes
-Avoid excessive sun, wear sunscreen
-Avoid contact with hair/clothes
-Max effect in 4-6 wks

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8
Q

Topical Retinoids

A

-Safety, efficacy well documented
-Normalize skin cell turnover, heal comedones, decrease sebum production

AE:
-burning, stinging, dryness, scaling
-increased photosensitivity (sensitive to cold weather)

-Apply every other night to adjust for drying
-Take 2-3 months
-Use sunblock on face

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9
Q

Tretinoin

A

-0.01% gel for moderate acne with sensitive oily skin
-0.025% gel for moderate acne with non-sensitive oily skin
-0.025%, 0.05%, and 0.1% creams (least irritating) or lotions for mild acne with sensitive non-oily skin

Twyneo® = tretinoin (0.1%) + BP (3%)

Apply thin layer QHS to skin where lesions occur

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10
Q

Adapalene (Differin®, + BP = Epiduo®)

A

-0.1 fet, cream, solution, lotion, 0.3 gel
-Least irritating retinoid
-Sensitive or dark skin (less discoloration)
-Epiduo for >= 9 yr old
-Apply thin layer to entire face

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11
Q

Tazarotene

A

-Most irritating retinoid, pregnancy category X
-Apply thin layer only to affected area in evening

Available as:
-Tazorac® 0.05% and 0.1% creams and gels
-Fabior® 0.1% foam
-Arazlo® 0.045% lotion - best tolerated formulation -Generics available only in 0.1% cream or foam

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12
Q

Trifarotene (Aklief®)

A

0.00% cream once daily for >= 9 yr old

-Tx both facial and truncal acne as early as 2 weeks (face) and 4 weeks (truncal)
-Apply a thin layer to entire face QHS (1 pump for face; 2 pumps for trunk)
-Avoid wax hair removal on treated skin

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13
Q

Clascoterone 1% (Winlevi®) Cream

A

-Ages 12 and up
-Apply a thin layer to affected area(s) BID

AE:
-edema, erythema, pruritus, burning, dryness, peeling, PEEP BD
-(d/c or reduce frequency if occurs)
-counsel pts on wishing syndrome like sx

-Caution for hypothalamic-pituitary-adrenal (HPA) axis suppression and hyperkalemia
-No data on pregnant or lactating patients (avoid)

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14
Q

Antibiotics

A

-NO monotherapy
-Add BP to optimize efficacy

-Apply once to twice daily
-Wait 1 hr before applying other topicals
-4 wks but may take 8-12 wks

AE:
-dry/scaly skin, irritation, itch, headache, SHIID

Clindamycin 1%, Erythromycin 2% (≥ 12)

Minocycline (Amzeeq®) 4% foam - age ≥9

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15
Q

Topical dapsone, 5% and 7.5% (Aczone®)

A

Most effective against inflammatory lesions (enhanced w/ BP)

Temporary orange staining of skin can occur when used w/ BP

Combine with retinoid if comedones

AE: erythema, dryness

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16
Q

Oral Tetracyclines: Minocycline ER and Sarecycline

A

1st line abx in combo with retinoid/BP

Not for < 8, pregnant (bone growth inhibition)

Interact with dairy products

DO NOT combine with isotretinoin

Limit to 3-4 mo

AE: GI, esophagitis, photosensitivity

17
Q

Minocycline and Doxycycline AE and Sare

A

Min
-Many ADRs and hypersensitivity syndromes (ER is safest)

Doxy
-Greatest association with GI ADEs

Sarecycline
-33-54 kg: 60 mg daily
-55-84 kg: 100 mg daily
-85-136 kg: 150 mg daily

18
Q

Other ABX, if tetracycline is inappropriate

A

Azithro > Erythro

Azi: 500 mg 3x wk
-high adh, no phototox, no resistance

Ery: 1 g/day with meals
-increased resistance (use with BP)

19
Q

Isotretinoin

A

10, 20, and 40 mg capsules
-Absorica, Accutane, Amnesteem, Claravis, Myorisan, Zenatane

*0.5-1 mg/kg/day in 2 divided doses with food for 15-20 wks
*Longer courses of 6-8 months

AE:
-teratogenic, REMS, pregnancy tests
-dry, chapped skin/lips, dry eyes, myalgias, nose bleeds
-increase in TG, changes in liver enzymes
-bone/IBD/mood

Fatty meal, moisturizer, petrolatum for nostrils

20
Q

Isotretinoin iPledge Program

A

-Mandatory registration
-Must have 2 negative pregnancy tests before starting + monthly pregnancy test to get rx
-Commit to 2 types of contraception 1 mo B/A
-Do not donate blood (1 mo A)
-Rx must be filled/picked up within 7 days of visit

21
Q

Hormonal Therapies - Combination Oral Contraceptives

A

-Mono or combo

No determination on which is most effective
* Norgestimate/ethinylestradiol
* Norethindrone acetate/ethinyl estradiol
* Drospirenone/ethinyl estradiol
* Ethinyl estradiol/drospirenone/levomefolate

-Obtain FH of thrombotic events and current smoking status d/t VTE risk

AE: NV, breast tenderness, HA, WG, bleeding

22
Q

Spironolactone

A

Not approved for acne but guideline-endorsed in select patients

50-200 mg PO BID

Well tolerated

AE:
-Hyperkalemia, gynecomastia, diuresis
-Irregular menses, breast tenderness
-Fatigue, HA, dizziness

Usually use with contraceptive (pregnancy category C)

23
Q

Pt Ed

A

-Do not pick or attempt to squeeze pimples
-May look worse before looks better
-Avoid ointments and oil-based cosmetics
-Abrasive scrubs or excessive face washing doesn’t open or cleanse pores
-Use gentle, nondrying cleansers to avoid irritation and dryness
-Hydration
-Avoid or reduce exposure to environmental factors
-Avoid touching face
-Cut back on high glycemic load foods

Fall Therapeutics (34 decks)

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