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PEBC > Acne > Flashcards

Acne Flashcards

1
Q

Acne is a multi-factorial inflammatory disease with blockage and/or inflammation of pilosebaceous gland of the skin. It smarted with the presence of ______, _______. _______ and/or ______

A

comedones, pustules, papules and/or cysts

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2
Q

Comedones are pilosebaceous glands that have developed a keratin plug.

If the plug is high in the duct, the keratin becomes oxidized resulting in a:

If the plug is deeper (closed comedone) it results in a:

A

Black Head

White head

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3
Q

Mild acne consists of ________, a few ________ and _________

A

comedones papules and pustules

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4
Q

Moderate acne has several ________ and _______ and may contain a few ________

A

papules and pustules

few nodules

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5
Q

Severe acne has numerous _____, ______, multiple ______, ______ and scarring

A

papules, pustules, nodules, cysts and scarring

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6
Q

Culture and sensitivity of pustules in acne are only appropriate to rule out:

A

Gram -ve folliculitis

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7
Q

Hormonal investigations of acne may be warranted if there are other signs of hyperandorgenism such as:
_________, _________, irregular periods, ________ resistance, onset in middle-aged women

A

hirsutism, infertility, insulin resistance

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8
Q

examples of medication induced acne include:
1.
2.

A
  1. Lithium
  2. Anti-epileptics

Antituberculosis drugs, cobalt in B12, corticosteroids

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9
Q

Examples of non drug options to help with acne
1.
2.

A
  1. refrain from picking/squeezing lesions as this delays healing
  2. use gentle skin cleansing techniques (non-comedogenic products)

Avoid excessive skin care, avoid stress, oil-free makeup, shave lightly, avoid sunlight, diet has uncertain evidence (high fat, sugar dairy)

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10
Q

For the treatment of acne, it can take __ to __ months to see significant improvement with the use of topical and/or systemic agents

A

2-3 months

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11
Q

Benzoyl peroxide is __________ and mildly comedolytic

A

antibacterial, with no evidence of bacterial resistance

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12
Q

1st line treatment for comedonal or mild acne ?

A

BPO

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13
Q

BPO at strengths less than ___ % are available OTC

A

5

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14
Q

The most concerning side effect with BPO is ?

A

bleaching (it can bleach clothing and hair)

Other = Skin irritation

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15
Q

True or false: Limited evidence available shows that 2.5% BPO products have efficacy similar to 5% and 10% formulations

A

True

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16
Q

Salicylic acid is ____________. Concentrations of 1–2% are tolerated; higher concentrations are usually too irritating

A

comedolytic

  • not used much
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17
Q

Glycolic acid (an alpha-hydroxy acid) is ________ _________ and can be used when topical retinoids are not tolerated

A

mildly comedolytic

  • not used much
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18
Q

Azelaic acid is ___________ and ____________ but does not promote resistant organisms.

A

comedolytic and antibacterial

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19
Q

Azelaic acid can cause ____ or ________________ (use with caution in patient with certain complexion)

A

Hyper or hypo-pigmentation (use with caution in patients with dark skin complexions)

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20
Q

Of the topical antibiotics, _____________ is the most commonly used.​ When used in combination with benzoyl peroxide, the risk of bacterial resistance is reduced. It is mainly used in papulopustular acne to decrease skin colonization with C. acnes.

A

Clindamycin

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21
Q

_____________, a synthetic sulfone, is an anti-inflammatory agent effective for acne when given orally, but is not commonly used systemically due to the risk of serious side effects

A

Dapsone (agranulocytosis serious side effect)

22
Q

Injection of intralesional __________________ (ex. _______________) is a technique that can be used for treatment of the occasional or stubborn nodule or cyst. It can result in rapid improvement and reduced pain. The most common side effect is localized atrophy. It is not appropriate for use in patients with multiple lesions

A

corticosteroids (triamcinolone)

23
Q

Topical __________ are the most powerful comedolytic agents, yet they still take months to be effective. They are also effective for inflammatory lesions.

A

retinoids

24
Q

When topical retinoids are used with BPO, they are applied in this order:

_____ in the AM and ______ in the PM

A

BPO in the AM and Retinoid in the PM

25
Q

Topical Retinoids:
The most photosensitizing:
The least irritating:
The most potent:

A

Tretinoin
Adapalene
Tazarotene

26
Q

Common side effects of topical retinoids includes:
1.
2.
3.
4.

A
  1. skin dryness
  2. redness
  3. peeling
  4. photosensitivity
27
Q

True or Fales:

With acne products, clinical worsening may occur in the first 2-4 weeks

A

True

28
Q

Consider __________ therapy when topical therapy has not been effective after 2–3 months, or has only a small chance of success (such as with moderate-severe acne)

A

systemic

29
Q

This antibiotic class is considered 1st line for the treatment of severe acne

A

Tetracyclines

30
Q

Which of the following tetracyclines are not recommended in acne treatment:
1. Doxycyline
2. Tetracycline
3. Minocycline

A
  1. Minocycline, it is associated with more side effects = drug induced lupus, hepatitis, pigmentation, dizziness, vertigo
31
Q

You should allow for at least ___ weeks to see if a systemic antibiotic is effective. Limit duration of oral antibiotic therapy to ___ months while maintaining topical therapy

A

6 weeks

3 months

32
Q

Oral tetracyclines should NOT be used as mono therapy due to risk of: _______ __________ and should be combined with BPO to reduce that risk

A

bacterial resistance

33
Q

Tetracyclines are contraindicated in ______ and in children ___ years of age

A

pregnancy and children <8 yo

34
Q

Tetracycline adverse effects include:
1.
2.
3.

A
  1. GI upset
  2. Yeast overgrowth
  3. photosensitivity
35
Q

Rare side effect of tetracyclines?

A

Pseudomotor cerebri

36
Q

Hormonal therapy for acne is a useful option for females, particularly those who notice a flare of their acne associated with their menstrual cycle. Those containing the antiandrogens ___________ acetate or ____________ are especially useful in women with other signs of androgen excess.

A

Cyproterone

Drospirenone

37
Q

Although there is a lack of good-quality evidence, some sources recommend the use of _______________ as a form of antiandrogenic hormonal therapy in select women based on the evidence that is available combined with experience and expert opinion

A

spironolactone

38
Q

Hormonal therapy for acne should be discontinued __ to ___ cycles after acne has resolved

A

3-4

39
Q

_____________ is a systemic retinoid. It remains the most powerful anti-acne agent, with the majority of patients achieving clearing and sustained remission, even in the most severe cases. It is a well-documented and potent teratogen.

A

Isotretinoin

40
Q

In women oc childbearing age considering oral retinoids: complete baseline and monthly _______ tests & __ reliable methods of contraception until ___ month after last dose

A

Pregnancy tests and 2 reliable
until 1 month

41
Q

This much time should elapse before pursuing additional courses of oral retinoids

A

8 weeks

42
Q

Oral retinoids are contraindicated with ______ due to risk of pseudotumor cerebri

A

tetracyclines

43
Q

If a patient is switching from a tetracycline antibiotic and wants to start on isotretinoin a ___ day washout should be done

A

7 day

44
Q

Common side effects of oral retinoids:
1.
2.
3.
4. myalgias
5. arthalgias
6. mild nosebleed

A
  1. dry/chapping skin
  2. headache
  3. photosensitivity
45
Q

Rare side effects of oral retinoids:
1.
2.
3.
4. Erythema multiforme
5. SJS

A
  1. Lipid abnormalities
  2. pseudotumor cerbri
  3. mood disorders
46
Q

With isotretinoin therapy, you should monitor:
1.
2.
3.

A
  1. CBC
  2. LFT
  3. Lipids
47
Q

Acne therapy contraindicated in pregnancy:
T
I
R
E

S
O
S

A

T - Tetracycline
I - Isotretinoin (systemic)
R - Retinoids (systemic and topical)
E - Erythromycin

S - Sulfatrim
O - Oral contraceptives
S - Spironolactone

BPO ok
Topical Clinda ok

48
Q

Acne therapy contraindicated in breastfeeding:
R
S
I
T

A

R - retinoids (systemic)

S - Sulfatrim
I - Isotretinoin (systemic)
T - tetracyclines

Topical Abx ok
BPO ok
Topical retinoids ok

49
Q

True or False:
Female partners of male patients taking oral isotretinoin must use a barrier method of birth control

A

False: the amount of drug exposure from semen of patients receiving isotretinoin is not sufficient to cause teratogenicity

50
Q

Oral antibiotics are effective for acne, however, they should never be used alone due to concerns surrounding:

A

antibiotic resistance

51
Q

Red flags for referral in acne:
1.
2.
3.

A

Moderate to severe
Drug induced
Very young age <12

Onset >30
Failed trial of non rx 8 weeks
Scarring
Systemic symptoms
possible hyper-aldosteronism or endocrine abnormality (ex. PCOS)

PEBC (35 decks)

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