Acne Flashcards
What are 3-4 Acne red flags?
<12
* Mod-severe signs and sx
* Widespread distribution (areas other than face i.e. bachne)
*Signs hyperandrogenism
*Systemic sx
Famhx of scarring acne
Suspected drug-induced acne
New onset age >30 yrs
High level anxiety, low self esteem or shame
Suspect roasecia, perioral dermatitis, or folliculitis
What are 3-4 non pharm trxs?
1) Cleanse face BID (more than this, no added benefit)
2) Avoid picking and squeezing
3) Choose cosmetic products that are oil free or water-based.
4) Minimize mechanical occlusion from turtlenecks, bra straps, sports helmets etc.
5) Reduce stress.
What are the main 3 categories of Pharm trx YOU WOULD PRESCRIBE?
Benzoyl peroxide or
Retinoid (topical) or
Combo therapy
What is the max # of agents you could prescribe before you must refer?
2
What is the best OTC option for mild-moderate acne?
Benzoyl peroxide 2.5-5 % (Rx required for >5%, and not more effective)
What is the first line Rx Trx for mild-moderate NON INFLAMMATORY comedonal acne?
TOPICAL RETINOIDS
What are the 4 choices of topical retinoids?
adapalene (Differin), tazarotene (Arazlo, Tazorac) , Tretinoin (Retin-A 0.05% cream, Retin A Micro, Stieva-A 0.025% cream) and trifarotene.
What is active ingredient in Retin-A and Stieva-A?
Tretinoin
what is the one oral retinoid indicated for acne?
Isotretinoin (Accutane, Clarus, Epuris)
When choosing a dose for a topical retinoid, what is the strategy?
Start with the lowest concentration available of the chosen product, and increase as needed.
Topical abx are reserved for what types of acne?
for inflammatory acne (e.g. papules, pustules, nodules, and cysts).
- Not recommended for monotherapy; use in combination with benzoyl peroxide reduces the chance of bacterial resistance developing.
What are the most useful abx for topical inflam. acne trx?
Clindamycin and erythromycin
What are the directions for use for Benzoyl peroxide topical?
- apply how?
- How should they start?
- dosage can be incr to what?
- Should you administer BP and topical retinoids at the same time? explain.
- What problematic thing associated with benzoyl peroxide do you have to warn pts about?
- it may take up to how many weeks to see benefits?
1) Apply to entire affected area once daily at bedtime
2) Start with lower strength (2.5%-5%) or less frequent nighttime application (e.g. every other night)
3) Dosage may be increased to twice daily
4) Increase strength or frequency as tolerated
5) NO! Benzoyl peroxide degrades retinoids - administration times must be separated (e.g. benzoyl peroxide in the morning, retinoid at night) or a combination product used
6) May cause bleaching of hair, clothing, towels, and bedding
- 4-6 wks.
What are 3-4 a/es from benzoyl peroxide topical?
dryness or peeling of skin
feeling of warmth
tingling
slight stinging
What are the directions for use for topical retinoids?
Directions:
1) Apply to entire affected area, at bedtime waiting 30 minutes after washing to ensure that skin is dry. (Moist skin is more absorbent. This increases the risk of skin irritation.)
2) Product should disappear almost immediately; if some product remains unabsorbed, decrease the amount applied.
3) Skin redness and irritation are the most common side effects. Slowly titrating up application time can reduce this.
4) Start with a low concentration product and apply only once every 2 to 3 nights.
5) Use short contact times -start with 2 hours and add 30 minutes per dose.
6) Apply separately from benzoyl peroxide products (e.g. benzoyl peroxide in the morning, retinoid at night), unless using a combination product.
7) Initial worsening may occur in the first 2 to 4 weeks of treatment; allow up to 12 weeks to see maximum improvement.
8) After successful course, may consider step-down to less frequent (once every 2 to 3 nights) maintenance treatment.
9) Recommend that the patient also use sunscreen SPF 15-30 due to risk of photosensitization (lower risk with adapalene).
