Acne Flashcards
The pathogenesis of acne vulgaris is
multifactorial
Key factor in acne is
Genetics
Acne develops as a reult of
interplay of the following four factors
–Release of inflammatory mediators into the ski
–Follicular hyperkeratinization with subsequent plugging of the follicle
–Cutibacterium acnes (c. acne) (formerly Propionibacterium acnes) follicular colonization (anaerobic organism present in acne lesions)
–Excess sebum production – regulated by a # of different hormones and mediators
Treatment is directted
Directed towards known pathogeneic factors
Follicular hyperproliferation
–Excess sebum
–Cutibacterium acnes (formerly Propionibacterium acnes) infection
–Inflammation.
the grad and severity of
The grade and severity of the acne help in determining which of the following treatments, alone or in combination, is most appropriate.
Give realistic
Give realistic expectations regarding timelines for improvement
two to three
Two to three months of consistent adherence to a regimen
acney typically
Acne typically reoccurs over years; maintenance therapy is important
treatment regimen should be
Treatment regimen realistic for patient
delivery system depnds on
Delivery system; depends on patient’s skin type
some gels have
Some gels – drying effect
creams and lotions are
Creams and lotions – moisturizing
solution sare
Solutions are drying, but cover large areas easier than other preparations
foams are
easy application to hair-bearing areas
pledgets are
single-use absorbents pads impregnated with medication
Treatment for Acne - Nondrug
–Cleansing
Treatment for Acne - Drug therapy
–Benzoyl peroxide–Antibiotics•Topical: Clindamycin•Oral: Tetracycline antibiotics, isotretinoin, hormonal agents–Retinoids•Tretinoin •Adapalene
Benzoyl peroxide - Decreases
Decrease # of C. acnes colonizing the skin
Benzoyl peroxide has what component
inflammatory component
Benzoyl peroxide used with
Used with a topical or oral anti-biotic decreases emergence of antibiotic resistant bacteria
Benzoyl peroxide is
Comedolytic
Benzoyl peroxide limit
Limit application of these products to one or two small affected areas during the initial three days of use to test for hypersensitivity
Topical Antibiotics - example
Clindamycin and erythromycin (most common*)
Topical Antibiotics - reduces
Reduce # of proinflammatory C. acnes colonizing the skin
Topical Antibiotics do not use as
Do no use as monotherapy – combine with retinoids or benzoyl peroxide (better efficacy); decrease occurrence of bacterial resistance
Combination Therapy - examples
Clindamycin 1.2% and tretinoin 0.025% gel•Benzoylperoxide 2.5% and adapalene 0.1% gel•Benzoyl peroxide 2.5% and adapalene 0.3% gel•Antibiotics and benzoyl peroxide
Topical Retinoids - Treatment
Treatment: non-inflammatory and inflammatory acne
Topical Retinoids - derivaties
Vitamin A derivatives
Topical Retinoids apply
Apply once a daily, usually at night
Topical Retinoids do not apply
Do not apply with benzoyl peroxide
Topical Retinoids apply thin
Apply think layer to affected area (pea-size)
Topical Retinoids skin irritation
Skin irritation is common; start with lowest concentration, increase potency as tolerated
Topical Retinoids irritation
Irritation, dryness, flaking of the skin (1st month); can decrease frequency
Topical Retinoids micronized
retinoin 0.05% gel contains soluble fish proteins.
Azelaic Acid - naturally
Naturally occurring dicarboxylic acid with antimicrobial, comedolytic, and mild anti-inflammatory properties.
Azelaic Acid inhibits
Inhibits effect on tyrosinase and can improve acne-induced post-inflammatory hyperpigmentation.
Azelaic Acid inflamm
Inflammatory and no-inflammatory acne
Azelaic Acid 15%
approved - rosacea
Salicylic Acid
Alternative comedolytic agent that is useful for patients who cannot tolerate or cannot obtain a topical retinoid.
Oral Drugs for Acne
Antibiotics
Antibiotics - moderate
Moderate to severe inflammatory acne
Antibiotics - Inhibit
Inhibit growth of C. acnes within the pilosebaceous unit
Antibiotics agents of choice
Agents of choice (tetracycline class – anti-bacterial and anti-inflammatory properties)•Doxycycline [Vibramycin], minocycline [Minocin]
Antibiotics alterantives
Alternatives (resistance is common)•Tetracycline [Sumycin], erythromycin [Ery-Tab]•Use shortest time possible – 3 to 4 months
Oral Isotretinoin - used to
Used to treat severe nodulocystic acne vulgaris
Oral Isotretinoin - is
Teratogenic
Oral Isotretinoin levels must be monitored
Triglyceride levels must be monitored
Oral Drugs for Acne - hormonal
agents moderate to severe acney
Oral Drugs for Acne - hormonal example
Spironolactone [Aldactone]
Skin Care Recommendations
Apply gentle synthetic detergent cleanser with fingers, rinse with warm water twice daily
Do not aggressively scrub skin
Water-based lotions, cosmetics, and hair products are less comedogenic than oil-based products.
Do not pick acne lesions; may exacerbate scarring
