Acne (Exam 1) Flashcards
Acne Vulgaris
Abnormality in structure or function of sebaceous follicle
Blackhead (Open comedo)
Sebaceous glands atrophy and sebum mixes with loose cells to form keratinous plug
Whitehead (Closed comedo)
Trauma or inflammatory changes secondary to overgrowth of bacteria
Acne begins in pre-pubertal period due to overproduction of _____.
Androgen
Factors of Acne Vulgaris
Increased sebum production
Abnormal keratinization
Growth of P. acnes
Inflammation
Acne is classified based on ____.
Severity
Goals of Acne Treatment
Heal existing lesions
Prevent/minimize scarring
Prevent formation of new lesions
Nonpharmacological acne therapy
Use gentle, nondrying cleansers
Do not scrub skin/excessive washing
Soap and water has minimal impact on acne
Do not pick/pop pimples
Drugs that target abnormal keratinization
Azelaic Acid
Salicylic Acid
Benzoyl Peroxide
Topical Retinoids
Isotretinoin
Drugs that target P.acnes proliferation
Benzoyl Peroxide
Topical/oral antibiotics
Topical Dapsone
Azelaic Acid
Drugs that target inflammatory response
Azelaic Acid
Corticosteroids
Topical/oral antibiotics
Topical Retinoids
Topical Dapsone
Isotretinoin
Clascoterone
Drugs that target abnormal sebum
Anti-androgens
Isotretinoin
Corticosteroids
Estrogens
Clascoterone
First Line Therapy for Acne Vulgaris Topical
Benzoyl Peroxide
Tretinoin
Adapalene
Tazarotene
Trifarotene
Main side effect of topical retinoids?
Photosensitivity
First Line Therapy for Acne Vulgaris Oral
Erythromycin
Minocycline
Clindamycin
Sodium Sulfacetamide w/ Sulfa
Azelaic Acid
Salicylic Acid
Topical Combinations for Acne Vulgaris
Benzoyl Peroxide + erythromycin or clindamycin
Epiduo (Adapalene + Bnezoyl peroxide gel)
Ziana, Veltin (Tertinoin + Clindamycin)
Cabtreo (Adapalene + Benzoyl peroxide + Clindamycin)
Oral Dapsone Contraindications
Increased risk of hemolytic anemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency
Topical clascoterone (Winlevi)
Blocks effects of testosterone and DHT that bind to androgen receptor
Decreases sebum production and inflammation
Second Line Therapy for Acne Vulgaris
Oral Antibacterial Agents
Oral Contraceptives
Spironolactone
Oral Corticosteroids
Oral Antibacterial Agents
Tetracycline
Minocycline
Doxycyline
Erythromycin
SMX-TMP
How long do oral antibacterial agents take for improvement?
3-4 weeks
Used for 4-6 months
Oral Contraceptives
Tri-Sprintec
YAZ
Estrostep
Oral contraceptives containing ____ and ____ reduce androgen action and suppress sebum production.
estrogen
progestins
Oral contraceptives MOA
5alpha-reductase inhibitors prevent testosterone —> DHT
How long do oral contraceptives take for improvement?
3-6 months
Spironolactone is structurally similar to _____ through ______.
progesterone
5alpha-reductase inhibition
Spironolactone should not be initiated in patients with
Baseline hypotension and hyperkalemia
Monitor gynecomastia in males
How long does spironolactone take for improvement?
3-6 months
Oral corticosteroids used for temporary benefit in patients with _____ acne.
inflammatory
How long should you wait before restarting isotretinoin?
2 months
Parameters needed before initiation of treatment of isotretinoin
CBC
chemistry profile
fasting triglyceride and cholesterol levels
Pregnancy category X medications
Tazarotene
Oral isotretinoin
IPLEDGE Requirements for patients
Females must have two negative pregnancy tests 1 months before starting + one every month on it
Two forms of contraception
Consent form on birth defects
Avoid blood donations
Prescribers, patients, and pharmacies must be registered and activated in IPLEDGE. T/F
TRUE
Wholesalers can send isotretinoin to pharmacies not enrolled in IPLEDGE. T/F
FALSE
How many days and refills can a prescriber write for for isotretinoin?
30 days
No refills
Who must register and activate the pharmacy in IPLEDGE and how often?
Responsible Site Pharmacist (RSP)
Annually
Dispensing pharmacist must receive a _______ before filling/dispensing isotretinoin.
Risk Management Authorization (RMA)
“Do Not Dispense to Patient After” guidelines for isotretinoin
Males: 30 days from office visit
Females: 7 days from pregnancy test
Acne Rosacea
Chronic inflammatory skin disorder that affects blood vessels
Hyperplasia of sebaceous glands
Factors affecting Acne Rosacea
Genetics
Immune dysfunction
Vascular hyperreactivity
Microorganisms (Demodex mites)
Erythematotelangiectatic Rosacea
Persistent centrofacial erythema-Chronic redness of nose and cheeks
Telangiectasias-enlarged blood vessels
Papulopustular Rosacea
Papules and pustules on central face
Comedones do NOT occur
Phymatous Rosacea
Tissue hypertrophy that may occur on chin, forehead, and cheeks
Most severe
Treatment for persistent erythema
Mirvasco - selective a2-agonist
Rhofade-selective a1a-agonist
Treatment for erythematotelangiectatic rosacea and mild/moderate papulopustular disease
Topical metronidazole
Azelaic Acid
Topical ivermectin
Topical minocycline
Treatment for moderate/severe papulopustular disease
Tetracycline
Doxycycline
Minocyline, erythromycin, metroniddazole
Isotretinoin
For mild acne with predominantly noninflammatory lesions, active agents of first choice include
Topical retinoids or benzoyl peroxide
For severe acne with inflammatory lesions, moderate nodules, and cysts, the most appropriate initial drug regimens should include
Fixed-dose combination (adapalene plus benzoyl peroxide) with oral antibiotic
