Acne (Bellanger)

Question 1

I - mild:

• mainly ____
• generally in one area (face, back..)
• occasional ____
• no ____, no ____
• mostly non-inflammatory

Answer 1

• comedones
• papules
• nodules; scarring

Question 2

II - moderate:

• -comedones, more ____ & ____
• -mainly ____
• -mild scarring
• -____ lesions

Answer 2

• papules; pustules
• facial
• inflammatory

Question 3

III - moderate:

• numerous & extensive comedones, papules, pustules and ____
• facial, back, chest, shoulders
• occasional ____ or nodule
• ____ scarring

Answer 3

• nodules
• cyst
• moderate

Question 4

IV - severe:

• numerous ____ cysts or nodules on face, neck and upper trunk
• ____ scarring
• persistent pustulocystic OR
• recalcitrant cystic

Answer 4

• large
• severe

Question 5

Acne treatment goals:

• SCHOLAR-MAC
• discontinue ____ factors
• alleviate discomfort
• control acne lesions and prevent ____/____
• prevent new lesions (may take up to __ weeks or more for results
• minimize ____ -____ can be used for mild or in combo with ____

Answer 5

• aggravating
• pitting/scarring
• 6
• ADRs
• OTC; Rx

Question 6

Acne treatment options: (8)

Answer 6

• topical agents
• systemic antibiotics
• hormonal agents
• isoretinoin
• intra-lesional steroids*
• chemical peels*
• comedo removal*
• complimentary therapy

(*should be done by a dermatologist)

Question 7

Oily to normal skin types should use what formulations? (3)

Answer 7

gels, solutions and lotions

Question 8

Normal skin types should use what formulations? (4)

Answer 8

gels, solutions, lotions and creams

Question 9

Normal to dry skin types should use what formulations? (2)

Answer 9

lotions and creams

Question 10

____ and ____ (formulations) are not usually recommended.

Answer 10

ointments & bars

Question 11

Acne OTC topicals: (3) Which is first line?

Answer 11

• benzoyl peroxide (first line)
• salicylic acid
• sulfur

Question 12

Describe the following properties of benzoyl peroxide:

• bacericidal?
• keratolytic?
• comedolytic?
• formulations
• pregnancy category
• ADEs

Answer 12

• yes
• slight
• no
• wash, liquid, lotion, cream, gel
• C
• bleached hair & clothing; drying; photosensitivity

Question 13

Describe the following properties of salicylic acid:

• bacericidal?
• keratolytic?
• comedolytic?
• formulations
• pregnancy category
• ADEs

Answer 13

• no
• yes
• yes
• cleansing pads, cream, gel
• C
• potent keratolytic at high concentrations; drying; photosensitivity

Question 14

Describe the following properties of sulfur:

• bacericidal?
• keratolytic?
• comedolytic?
• formulations
• pregnancy category
• ADEs

Answer 14

• yes
• yes
• yes
• cream, lotion
• C
• color; malodorous; drying

Question 15

Acne OTC application is used as a ____ treatment. There will be visible improvement in a few days but will take ___ weeks of continued used to see the effectiveness. ____ are generally not effective because there is not enough contact time with the skin.

Answer 15

long-term; 6; washes

Question 16

Retinoids are ____ __ derivatives. Some examples are: ____, ____ and ____. They are for ____ to ____ acne. Apply to dry, clean skin and avoid skin near ____, mucous membranes and abrasions. They cause photosensitivity, so wear sunscreen but wait __-__ minutes after applying retinoid. It [is/is not] safe to use with benzyl peroxide cleansers.

Answer 16

vitamin A; tretinoin; adapalene; tazarotene; moderate; severe; eyes; 15-20; is

Question 17

Examples of topical antibiotics (macrolides) are ____ and ____. Apply to dry, clean skin. Formulations come in gel, pledget, lotion, solution to be applied ____ and foam (clindamycin) to be applied ____. Wait __ minutes to shave area or apply makeup.

Answer 17

erythromycin; clindamycin; BID; daily; 30

Question 18

____ antibiotics are the standard of care for moderate to severe acne. ____ is the best at reducing P. acnes. There is also ____ and ____. Bacterial ____ is an increasing problem. Adverse effect ____ should be developed.

Answer 18

Systemic; Minocycline; erythromycin; trimethoprim; resistance; profiles

Question 19

Hormonal agents:

• ____ containing oral contraceptives can decrease acne in some women
• oral anti-androgenic agents: ____ and ____ ____ (be careful with males)

Answer 19

• estrogen
• spironolactone; cyproterone acetate

Question 20

Hormonal agents: oral corticosteroids have limited data but have shown temporary benefit for severe ____ acne and low doses may benefit those with ____ hyperandrogenism

Answer 20

inflammatory; adrenal

Question 21

Spironolactone ADEs (2)

Answer 21

• hyperkalemia
• may cause menstrual irregularity

Question 22

Isoretinoin (oral):

• use in severe ____ nodular acne
• useful for ____ resistant acne
• potent ____
• ____ program
• lab monitoring (triglycerides, cholesterol, LFTs and CBC)
• potential ____ adverse effects

Answer 22

• recalcitrant
• treatment
• teratogen
• iPledge
• psychiatric

Question 23

CAM - tea tree oil

• essential oil
• may have ____ properties
• may be irritating if applied ____, so add to a ____ or gel vehicle

Answer 23

• antiseptic
• directly; moisturizing

Question 24

Acne non-pharmacologic therapy:

• do not ____/____/____ acne
• do not ____ the skin
• wash face with ____ water and a ____ cleanser no more than ____ daily
• wait __ minutes after washing face to apply medications
• avoid ____ factors (use only ____ skincare and hair care products, cleanse skin after sweating, keep hair and hands away from affected areas)

Answer 24

• pop/squeeze/pick
• scrub
• lukewarm; mild; twice
• 15
• exacerbating; oil-free

Question 25

Lifestyle modifications:

• increase intake of (3)
• decrease intake of (2)

Answer 25

• fluids, fish oil, probiotics
• glycemic load/sugar, dairy

Question 26

Answer 26

Question 27

Answer 27

Question 28

Answer 28