Acne, Actinic keratosis, Pityriasis rosea, Psoriasis, Rosacea Flashcards
Acne Vulgaris: What is it?
- most common skin condition in the U.S.
- begins during puberty and most common in adolescents
- increased androgen production leads to increases in sebum production which leads to:
* Comedones
* Pustules
* Papules
* Cystic nodules
* Scarring
Acne Vulgaris: Risk Factors
- genetics (50% have family history of acne)
- skin trauma
- milk consumption (skim and low-fat)
- high glycemic load diets
- insulin resistance
- low BMI
- worsens with stress and menses
- skin contact with chin straps, shoulder pads
- adolescents
- PCOS, adrenal hyperplasia, hormonal tumors
- white race
- hot, humid climates
Acne Vulgaris: Diagnostic Studies
- clinical exam
- If PCOS, investigate this further
Acne Vulgaris: Prevention
- avoid occupational irritants
- good hand/face hygiene
- frequent gentle cleansing of the skin
- rapid treatment for inflammatory and cystic acne
- avoid anabolic steroids
Acne Vulgaris: Non-Pharmacological Management
- address psychosocial concerns
- phototherapy
- laser therapy
- address stress
- mechanical extraction of comedones does not affect disease course, but may improve appearance
Describe Mild Acne
- scattered, small (< 5 mm), comedonal or inflamed papules or pustules without associated scarring
- limited skin involvement (involvement of one body area or relatively few lesions in more than one body area)
- absence of nodules
- absence of near confluent skin involvement
Describe Moderate-Severe Acne
- visually prominent acne consisting of many comedonal or inflamed papules or pustules
- presence of nodules
- involvement of multiple body areas with more than a few scattered lesions
- associated scarring
Mild Acne Management: Comedonal Lesions (first treatment)
Topical Retinoid:
1. Adapalene
2. Tazarotene
3. Tretinoin topical
4. Trifarotene
Mild Acne Management: Comedonal Lesions (if first treatment has unsatisfactory response)
- Increase concentration of topical retinoid or change to an alternate topical retinoid.
- If still has an unsatisfactory response, switch to treating as moderate or severe acne
Mild Acne Management: Papulopustular +/- Comedonal Lesions (first treatment)
Topical retinoid and benzoyl peroxide:
- if satisfactory response after 3-6 months, transition to topical retinoid therapy only
Mild Acne Management: Papulopustular +/- Comedonal Lesions (if first treatment has unsatisfactory response)
- add topical clindamycin or topical dapsone (to the existing topical retinoid and benzoyl peroxide treatment already in place)
* if this treatment is satisfactory after 3-6 months, then transition to topical retinoid therapy only - if unsatisfactory response, consider alternative topical therapies (clascoterone or minocyocline) or treat as moderate to severe acne
Moderate to Severe Acne Management: Papulopustular and/or nodular lesions are present
Treatment options include: (pick one)
1. Oral tetracycline
2. Combined estrogen-progestin OCP
3. Oral spironolactone
4. Oral isotretinoin
Moderate to Severe Acne Management: Papulopustular and/or nodular lesions are NOT present, comedones only
Treatment options include: (pick one)
1. Combined estrogen-progestin OCP
2. Oral spironolactone
3. Oral isotretinoin
* No tetracycline
Adapalene
- Topical retinoid
- apply daily at bedtime, after washing
- redness, dryness, scaling of skin common in first 2-4 weeks
- caution with other photosensitizing agents (tetracyclines, thiazides, sulfonamides, fluoroquinolones)
- do NOT use on broken skin
Tazarotene
- Topical retinoid
- apply thin film at bedtime, after cleansing
- caution with other photosensitizing agents (tetracyclines, thiazides, sulfonamides, fluoroquinolones)
- do NOT use on more than 20% of body surface
- women of childbearing potential: begin during normal menses
- do NOT use on broken skin
Tretinoin Topical
- Topical retinoid
- apply sparingly to affected areas at bedtime
- improvement may not occur before week 12
- within 2 weeks: peeling, redness in treated areas
- At 3-6 weeks, there could be new blemishes; continue to use
- caution with other photosensitizing agents (tetracyclines, thiazides, sulfonamides, fluoroquinolones)
- do NOT use on broken skin
Trifarotene
- Topical retinoid
- apply thin layer to affected areas of face and/or trunk once a day, in the evening on clean, dry skin
- most common adverse reactions: skin irritation, pruritus, and sunburn
- specifically indicated to treat acne on face and trunk
Benzoyl Peroxide
- initial daily wash, may increase to BID or TID as tolerated
- may bleach fabric or hair
- avoid unnecessary sun exposure and use sunscreen
Actinic Keratosis
- AKA solar keratosis
- usually presents on sun-exposed areas as scaly, red papules or plaques
- may progress to squamous cell carcinoma
Actinic Keratosis: Risk Factors
- common in middle ages and older adults
- more common in men
- more common in those with fair skin or chronic sun exposure, tanning bed use
Actinic Keratosis: Assessment Findings
- round or oval, raised, scaly papules or plaques
- flesh-colored, red, pink, brown, or black
- 2 mm to 5 mm