Acne Flashcards
Cause of acne
genetics, diet, gender
Acne pathophysiology
-increased androgens: increased sebum, colonization of bacteria, imflammation, follicular blockage
closed comedo
enlarged microcomedo
whitehead
open comedo
cells and sebum push to surface
blackhead
papule
raised, reddened area
pustule
papule with pus
nodule
small hard bump under skin
mild acne
-few papules
-occasional pustules, comedones
moderate acne
-many papules and pustules
-prominent scariing
exacerbating factors
-mechanical
-excoriation(picking)
-chlorine
-hydration
-occupational
-stress
-medications
-hormonal
-cosmetics
Rosacea
-inflammation on central part of face
-sets in in adulthood
-solid red papules/pustules
-no comedones
-need referral for treatment
Treatment for acne
-long term and consistent
-control, not cure
-topical therapy
Exclusions self treatment
moderate to severe
-exacerbating factors
pregnancy/lactation
acne prevention
-water based cosmetics
-no picking
-wash oily hair
-stay hydrated
-consider diet changes
cleanse skin
-2x/day
-warm water with mild soap
-avoid abrasive products
Adapalene gel
-first line topical
-1x daily
Adapalene gel MOA
-retinoid: comedolytic, keratolytic, anti-inflammatory
Adapalene gel onset
1-2 weeks
-8-12 weeks full effect
Adapalene gel side effects
redness, scaling, dryness, itching, burning
-usually diminish after first month
-cost
Benzoyl peroxide
-most widly used topical product
Benzoyl peroxide MOA
-antibacterial
-comedolytic
-keratolytic
Scaly dermatoses
-scaling od kin
inflammation: dandruff->seborrhea->psoriasis
Cyst
large, red, deep, filled with pus, painful
Severe acne
-extensive pustule, papules
-multiple nodules on inflammed background
non pharma treatment acne
-mechanical: brushes, heat, scrubs, cleansing cloths
-comedo extraction: nose trips, professional
-light: visible, pulsed dye laser, photodynamic
Referral for adapalene gel
-lack of improvement in 3 months
-allergic reaction
Benzyl peroxide onset
-5 days to 3 weeks
-max effect 8-12 weeks
benzyl peroxide administration
-avoid cuts, scrapes, mucous membranes
-small amount
-lowest conc.
-gradually increase contact time by 15 min increments
-1x/daily for 1-2 weeks, up to 2-3x/daily
-increase strength weekly
benzyl peroxide adverse effects
-transient stinging or burning
-drying, peeling, erythema, edema: reduce strength and exposure
-may bleach hair, clothes
-photosensitivity
-rare allergic contact dermatitis
Salicylic acid MOA
-comedolytic
-anti-inflammatory
Salicylic acid administration
1-3x/day, gel or cleanser
Salicylic acid adverse effects
-dryness/peeling
-possible drug interactions
-salicylic acid toxicity
0contraindicated in diabetes, poor blood circulation
Benzyl peroxide and salicylic acid
-local hypersensitivity
-active ingredients
Alpha hydroxy acids(AHA) MOA
exfoliate, simulate growth of new, smother skin
AHA administration
-cleansers, creams, lotions, cleansing cloth
-use once acne is controlled
-every 102 weeks, up to daily as tolerated
tea tree oil MOA
-antibacterial and antiinflamatory
mild acne product selection
-cleansing product
-solutions and washes: large areas
gel: most effective, on skin longest, astringent
-gels and solutions: drying effect, irritation, contact dermatitis, oily skin
-lotions and creams: dry, sensitive skin, cold, dry weather
scaly dermatoses symptoms
-epidermis
-scaling of skin
-erythema, inflammation, other changes
-Inflammation: dandruff->seborrhea->psoriasis
-nonprescription therapy: most dandruff and seborrheic, mild psoriasis
Dandruff pathophysiology
-hyperproliferative epidermal condition
-turnover 2x
dandruff treatment
-wash with non-medicated shampoo every 1-2 days
-medicated shampoos: massaged into scalp 3-5 min., daily 1 week, 2-3x/week, then every 1-2 weeks
Seborrheic dermatitis
-chronic inflammation of greatest sebaceous gland activity
Seborrheic dermatitis pathophysiology
-3x proliferation
-increase sebaceous gland activity
Seborrheic dermatitis symptoms
-dull, yellowish, oily, scales on reddened skin, well defined
-pruritis common
-adults: scalp, face, trunk
-infants: scalp, may extend
-darker skinned: hypopigmentation, erythema may be difficult to see
Seborrheic dermatitis adult treatment
-non-medicated shampoo, mineral/olive oi, dishwashing liquid to remove scales
-emollients
-hydrocortisone up to twice daily
Types of medicated shampoos
–1st line: Pyrithione zinc, selenium sulfide, ketoconazole
-2nd line: coal tar, salicylic acid, sulfur
Referal for Seborrheic Dermatitis
- less than 2 yrs
-no response to topical steroid after 7 days
-worsening/no improvement after 2 weeks
Psoriasis etiology
-unknown
-genetics
-triggers
-proliferation 8x higher
-inflammation
Psoriasis symptoms
-symmetrical
-plaques: well defined, light pink/bright red, thick, silvery-white scale
-localized or diffuse lesions
-painful/itchy
-involve nails and synovium
-hypo or hyper pigmented skin
Psoriasis treatment limitations
-only mild cases can be treated
-control not cure
Referal for Psoriasis
-lesions larger than a quarter
-face
-joint pain
- <2 years
-no response within 7 days(emollients and hydrocortisone)
-worsening/o improvement after 2 weeks
Psoriasis non pharma
-avoid triggers
-lose weight
-remove scales
-apply emollients liberally(4x/day)
Psoriasis OTC
-scalp: coal tar or salicylic acid shampoos
-limbs. body: coal tar, hydrocortisone(1%)
-acute localized: hydrocortisone, emollients
-thick, scaled plaques: salicylic acid
Anti-Malassezia Agents
-Pyrithione zinc, selenium sulfide, ketoconazole
Anti-Malassezia Agents MOA
-decrease yeast count
-decrease cell turnover and inflammmation
Ketoconazole
-MOA: antifungal
-2x/week for 4 weeks, then weekly
-12+
-improvement 2-4 weeks
Ketoconazole adverse effects
-hair loss
-skin irritation
-abnormal hair texture
-dry skin
-significant eye irritation
Coal tar
-MOA: cross-link with DNA, decrease cell turnover
rate, cytostatic
-treats seborrheic dermatitis and psoriasis
