Acne

Question 1

risk factors

Answer 1

age - teens 
genetic 
environment 
hormones
stress
diet
medications

Question 2

how is acne formed

Answer 2

increased follicular keratinization forms a keratotic plug at the top of the gland preventing sebum release
increased sebum production causes it to build up
p.acnes feeds of sebum and causes lipolysis of triglycerides into free fatty acids
immune system cause inflammation

Question 3

what are the two types on non-inflammatory lesions

Answer 3

open comedone - black head

closed comedone - white head

Question 4

what are the 4 types of inflammatory lesions

Answer 4

papules
pustules
nodules
cysts

Question 5

what are the 3 types of acne scars

Answer 5

atrophic
hypertrophic
depressed

Question 6

drug induced acne

Answer 6

all at same stage

Question 7

neonatal acne

Answer 7

babies

dont treat

Question 8

acne conglobata

Answer 8

large area

deep nodules and cysts

Question 9

acne flumanins

Answer 9

brown dots

systemic

Question 10

contact acne

Answer 10

cosmetics
hair
oily skin

Question 11

endocrine acne

Answer 11

large area

excessive gluticocorticoids or antigens

Question 12

acne machanica

Answer 12

mechanical pressure such as a helmet

Question 13

what is mild acne

Answer 13

mostly comedones with a few papules and pustules

no more than 50% of the affected area involved

Question 14

what is moderate acne

Answer 14

numerous comedones, papules, and pustules
maybe a nodules or scarring
more than 50% of the affected area

Question 15

what is severe acne

Answer 15

numerous, extensive comedones, papules, pustules
nodules, cysts, and scarring
entire area covered

Question 16

red flags for acne

Answer 16

moderate-severe
drug induced
atypical - later in life 
infection 
scarring

Question 17

what acne is self treatable

Answer 17

mild to moderate acne vulgaris, acne mechanica, contact acne
if typical, onset between 12-25, and no scarring

Question 18

4 goals of therapy

Answer 18

alleviate symptoms by reducing number and severity of lesions
limit duration and recurrance
alleviate psychological distress
prevent scarring and hyperpigmentation

Question 19

4 non pharms

Answer 19

wash with mild soap 1-2 times daily
avoid picking, poppin, or manipulating lesions
avoid aggravating factors
minimize stress

Question 20

gel formulations

Answer 20

most efficient
acetone/alcohol for oily skin
water based for more sensitive oily skin

Question 21

when to use lotions, why are they better

Answer 21

large, hairy areas
good for all types of skin, especially sensitive
second best efficacy
less side effects

Question 22

what is cream good for

Answer 22

dry skin but less effective

Question 23

bar/wash formulations

Answer 23

all skin but least effective

Question 24

why are microsphere formulations good for sensitive skin

Answer 24

they localize at the hair follicle and relase the medication over time, less medication on the skin

Question 25

non prescription acne products

Answer 25

``` benzoyl peroxide salicylic acid sulfur resorcinol glycolic acid ```

Question 26

how does salycilic acid .5-2% work for acne and when should it be used

Answer 26

comedolytic and keratolytic | when BPO not tolerated

Question 27

how does benzoyl peroxide work

Answer 27

an antibiotic wiht no resistance because releases oxygen (p.acnes is anaerobic) antiinflammatory normalizes follicular keratinization

Question 28

what are the strengths of benzoyl peroxide

Answer 28

non prescription 2.5-5% | pr 5%

Question 29

what is first line treatment for mild inflammatory acne or non inflammatory acne

Answer 29

benzoyl peroxide once or twice daily to the entire infected area

Question 30

treatment for mild-moderate acne

Answer 30

topical antibody topical retinoid benzoyl peroxide

Question 31

treatmeent for moderate and severe acne

Answer 31

oral antibody topical retinoid benzoyl peroxide

Question 32

side efects of BPO

Answer 32

itching redness scaling drying

Question 33

what is the treatment approach for acne

Answer 33

6-8 weeks after each product if no improvement then switch, may take 8-12weeks for full effect 1. BPO water based 2.5% 2. water based 5% BPO 3. acetone/alcohol based BPO 4. refer

Question 34

application of topical acne products

Answer 34

``` wash hands before and after wash with mild soap pat dry apply pea sized amount ensure stays on for one hour, and no other products for an hour ```

Question 35

prescription acne products

Answer 35

``` BPO >5% axelaic acid topical retinoids and retinoid analogue topical antibiotics oral antibiotics isotretinoin ```

Question 36

uses of topical retinoids

Answer 36

comedonal only acne in combo maintence therapy - use long term

Question 37

application adn side effects of topical retinoids

Answer 37

once saily | redness, stinging, peeling

Question 38

why do you avoid use of topical antibiotics on their own and for long periods of time

Answer 38

causes resistance

Question 39

what acne products can pharmacists prescrive

Answer 39

clindamycin | BPO

Question 40

duration of use and side effects of oral antibiotics

Answer 40

6 months | GI upset, NV, diarrhea, headahce

Question 41

contraindications for tetracyclines

Answer 41

pregnant under 8 dairy products

Question 42

indications for oral contraceptives

Answer 42

mild-moderate in women who desire contraception adult acne that didnt respond to previous therapies severe acne for females on isotretinoin

Question 43

indication for androgen receptor blockers

Answer 43

females with adult onset that oother treatments didnt works or acne from too many androgen hormones

Question 44

idications for isotretinoin

Answer 44

severe nodulocystic acne relapsing scarring treatment failure

Question 45

treatment duration for iso

Answer 45

12-16 weeks can take 2-3 months will get worse first week

Question 46

why should women be put on oral contraceptives when on iso

Answer 46

causes serious birth defects

Question 47

side effects of isotret

Answer 47

redness dry eyes,nose, mouth depression

Question 48

tests and monitoring for isotret

Answer 48

``` pregnancy lipid and blood glucose levels complete blood count and diferential hepatic function depression ```

Question 49

what should you avoid when using isotret

Answer 49

``` alcohol vit a and beta carotene giving blood transfusions use in under 12 tetracyclines other acne products ```

Question 50

recommendations for maintanence therapy

Answer 50

for mild-moderate: topical retinoid | moderate- severe: topical retinoid and BPO

Question 51

treatment for pregnany patients

Answer 51

non pharms | refer to doctor

Question 52

monitoring

Answer 52

lesions improve in 2-4 wekks comedones resolve in 3-4 months inflammation resolves within a couple weeks anxiety improves in 2-4 months