Acne Flashcards
risk factors
age - teens genetic environment hormones stress diet medications
how is acne formed
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
what are the two types on non-inflammatory lesions
open comedone - black head
closed comedone - white head
what are the 4 types of inflammatory lesions
papules
pustules
nodules
cysts
what are the 3 types of acne scars
atrophic
hypertrophic
depressed
drug induced acne
all at same stage
neonatal acne
babies
dont treat
acne conglobata
large area
deep nodules and cysts
acne flumanins
brown dots
systemic
contact acne
cosmetics
hair
oily skin
endocrine acne
large area
excessive gluticocorticoids or antigens
acne machanica
mechanical pressure such as a helmet
what is mild acne
mostly comedones with a few papules and pustules
no more than 50% of the affected area involved
what is moderate acne
numerous comedones, papules, and pustules
maybe a nodules or scarring
more than 50% of the affected area
what is severe acne
numerous, extensive comedones, papules, pustules
nodules, cysts, and scarring
entire area covered
red flags for acne
moderate-severe drug induced atypical - later in life infection scarring
what acne is self treatable
mild to moderate acne vulgaris, acne mechanica, contact acne
if typical, onset between 12-25, and no scarring
4 goals of therapy
alleviate symptoms by reducing number and severity of lesions
limit duration and recurrance
alleviate psychological distress
prevent scarring and hyperpigmentation
4 non pharms
wash with mild soap 1-2 times daily
avoid picking, poppin, or manipulating lesions
avoid aggravating factors
minimize stress
gel formulations
most efficient
acetone/alcohol for oily skin
water based for more sensitive oily skin
when to use lotions, why are they better
large, hairy areas
good for all types of skin, especially sensitive
second best efficacy
less side effects
what is cream good for
dry skin but less effective
bar/wash formulations
all skin but least effective
why are microsphere formulations good for sensitive skin
they localize at the hair follicle and relase the medication over time, less medication on the skin
non prescription acne products
benzoyl peroxide salicylic acid sulfur resorcinol glycolic acid
how does salycilic acid .5-2% work for acne and when should it be used
comedolytic and keratolytic
when BPO not tolerated
how does benzoyl peroxide work
an antibiotic wiht no resistance because releases oxygen (p.acnes is anaerobic)
antiinflammatory
normalizes follicular keratinization
what are the strengths of benzoyl peroxide
non prescription 2.5-5%
pr 5%
what is first line treatment for mild inflammatory acne or non inflammatory acne
benzoyl peroxide once or twice daily to the entire infected area
treatment for mild-moderate acne
topical antibody
topical retinoid
benzoyl peroxide
treatmeent for moderate and severe acne
oral antibody
topical retinoid
benzoyl peroxide
side efects of BPO
itching
redness
scaling
drying
what is the treatment approach for acne
6-8 weeks after each product if no improvement then switch, may take 8-12weeks for full effect
- BPO water based 2.5%
- water based 5% BPO
- acetone/alcohol based BPO
- refer
application of topical acne products
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
prescription acne products
BPO >5% axelaic acid topical retinoids and retinoid analogue topical antibiotics oral antibiotics isotretinoin
uses of topical retinoids
comedonal only acne
in combo
maintence therapy - use long term
application adn side effects of topical retinoids
once saily
redness, stinging, peeling
why do you avoid use of topical antibiotics on their own and for long periods of time
causes resistance
what acne products can pharmacists prescrive
clindamycin
BPO
duration of use and side effects of oral antibiotics
6 months
GI upset, NV, diarrhea, headahce
contraindications for tetracyclines
pregnant
under 8
dairy products
indications for oral contraceptives
mild-moderate in women who desire contraception
adult acne that didnt respond to previous therapies
severe acne for females on isotretinoin
indication for androgen receptor blockers
females with adult onset that oother treatments didnt works or acne from too many androgen hormones
idications for isotretinoin
severe nodulocystic acne
relapsing
scarring
treatment failure
treatment duration for iso
12-16 weeks
can take 2-3 months
will get worse first week
why should women be put on oral contraceptives when on iso
causes serious birth defects
side effects of isotret
redness
dry eyes,nose, mouth
depression
tests and monitoring for isotret
pregnancy lipid and blood glucose levels complete blood count and diferential hepatic function depression
what should you avoid when using isotret
alcohol vit a and beta carotene giving blood transfusions use in under 12 tetracyclines other acne products
recommendations for maintanence therapy
for mild-moderate: topical retinoid
moderate- severe: topical retinoid and BPO
treatment for pregnany patients
non pharms
refer to doctor
monitoring
lesions improve in 2-4 wekks
comedones resolve in 3-4 months
inflammation resolves within a couple weeks
anxiety improves in 2-4 months
