Acne Flashcards
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 ______
comedones, pustules, papules and/or cysts
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:
Black Head
White head
Mild acne consists of ________, a few ________ and _________
comedones papules and pustules
Moderate acne has several ________ and _______ and may contain a few ________
papules and pustules
few nodules
Severe acne has numerous _____, ______, multiple ______, ______ and scarring
papules, pustules, nodules, cysts and scarring
Culture and sensitivity of pustules in acne are only appropriate to rule out:
Gram -ve folliculitis
Hormonal investigations of acne may be warranted if there are other signs of hyperandorgenism such as:
_________, _________, irregular periods, ________ resistance, onset in middle-aged women
hirsutism, infertility, insulin resistance
examples of medication induced acne include:
1.
2.
- Lithium
- Anti-epileptics
Antituberculosis drugs, cobalt in B12, corticosteroids
Examples of non drug options to help with acne
1.
2.
- refrain from picking/squeezing lesions as this delays healing
- 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)
For the treatment of acne, it can take __ to __ months to see significant improvement with the use of topical and/or systemic agents
2-3 months
Benzoyl peroxide is __________ and mildly comedolytic
antibacterial, with no evidence of bacterial resistance
1st line treatment for comedonal or mild acne ?
BPO
BPO at strengths less than ___ % are available OTC
5
The most concerning side effect with BPO is ?
bleaching (it can bleach clothing and hair)
Other = Skin irritation
True or false: Limited evidence available shows that 2.5% BPO products have efficacy similar to 5% and 10% formulations
True
Salicylic acid is ____________. Concentrations of 1–2% are tolerated; higher concentrations are usually too irritating
comedolytic
- not used much
Glycolic acid (an alpha-hydroxy acid) is ________ _________ and can be used when topical retinoids are not tolerated
mildly comedolytic
- not used much
Azelaic acid is ___________ and ____________ but does not promote resistant organisms.
comedolytic and antibacterial
Azelaic acid can cause ____ or ________________ (use with caution in patient with certain complexion)
Hyper or hypo-pigmentation (use with caution in patients with dark skin complexions)
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.
Clindamycin
_____________, 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
Dapsone (agranulocytosis serious side effect)
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
corticosteroids (triamcinolone)
Topical __________ are the most powerful comedolytic agents, yet they still take months to be effective. They are also effective for inflammatory lesions.
retinoids
When topical retinoids are used with BPO, they are applied in this order:
_____ in the AM and ______ in the PM
BPO in the AM and Retinoid in the PM
Topical Retinoids:
The most photosensitizing:
The least irritating:
The most potent:
Tretinoin
Adapalene
Tazarotene
Common side effects of topical retinoids includes:
1.
2.
3.
4.
- skin dryness
- redness
- peeling
- photosensitivity
True or Fales:
With acne products, clinical worsening may occur in the first 2-4 weeks
True
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)
systemic
This antibiotic class is considered 1st line for the treatment of severe acne
Tetracyclines
Which of the following tetracyclines are not recommended in acne treatment:
1. Doxycyline
2. Tetracycline
3. Minocycline
- Minocycline, it is associated with more side effects = drug induced lupus, hepatitis, pigmentation, dizziness, vertigo
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
6 weeks
3 months
Oral tetracyclines should NOT be used as mono therapy due to risk of: _______ __________ and should be combined with BPO to reduce that risk
bacterial resistance
Tetracyclines are contraindicated in ______ and in children ___ years of age
pregnancy and children <8 yo
Tetracycline adverse effects include:
1.
2.
3.
- GI upset
- Yeast overgrowth
- photosensitivity
Rare side effect of tetracyclines?
Pseudomotor cerebri
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.
Cyproterone
Drospirenone
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
spironolactone
Hormonal therapy for acne should be discontinued __ to ___ cycles after acne has resolved
3-4
_____________ 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.
Isotretinoin
In women oc childbearing age considering oral retinoids: complete baseline and monthly _______ tests & __ reliable methods of contraception until ___ month after last dose
Pregnancy tests and 2 reliable
until 1 month
This much time should elapse before pursuing additional courses of oral retinoids
8 weeks
Oral retinoids are contraindicated with ______ due to risk of pseudotumor cerebri
tetracyclines
If a patient is switching from a tetracycline antibiotic and wants to start on isotretinoin a ___ day washout should be done
7 day
Common side effects of oral retinoids:
1.
2.
3.
4. myalgias
5. arthalgias
6. mild nosebleed
- dry/chapping skin
- headache
- photosensitivity
Rare side effects of oral retinoids:
1.
2.
3.
4. Erythema multiforme
5. SJS
- Lipid abnormalities
- pseudotumor cerbri
- mood disorders
With isotretinoin therapy, you should monitor:
1.
2.
3.
- CBC
- LFT
- Lipids
Acne therapy contraindicated in pregnancy:
T
I
R
E
S
O
S
T - Tetracycline
I - Isotretinoin (systemic)
R - Retinoids (systemic and topical)
E - Erythromycin
S - Sulfatrim
O - Oral contraceptives
S - Spironolactone
BPO ok
Topical Clinda ok
Acne therapy contraindicated in breastfeeding:
R
S
I
T
R - retinoids (systemic)
S - Sulfatrim
I - Isotretinoin (systemic)
T - tetracyclines
Topical Abx ok
BPO ok
Topical retinoids ok
True or False:
Female partners of male patients taking oral isotretinoin must use a barrier method of birth control
False: the amount of drug exposure from semen of patients receiving isotretinoin is not sufficient to cause teratogenicity
Oral antibiotics are effective for acne, however, they should never be used alone due to concerns surrounding:
antibiotic resistance
Red flags for referral in acne:
1.
2.
3.
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)
