Acne in Adolescents-Managing

Question 1

What % of adolescents are affected by acne, and how long can it persist?

Answer 1

85% and can persist into the 30s

Question 2

What skin structure is affected by acne

Answer 2

Pilosebaceous unit

Question 3

What is the disease tetrad of the pilosebaceous unit

Answer 3

1 inflammation
2 shedding of keratinocytes
3 increased sebum and
4 cutibacterium (aka P acnes)

Question 4

What are the 3 classifications of acne?

Answer 4

1. Comedonal
2. inflammatory
3. mixed comedonal/inflammatory

Question 5

what type of acne is described as “ skin colored papule often located on the forehead and chin”?

Answer 5

Comedonal

Question 6

what type of acne is described as “red-colored papules, pustules, nodules, or pseudocysts, are painful and often found on the face and back and chest?

Answer 6

Inflammatory

Question 7

What are the 5 general management steps for acne?

Answer 7

1. mild OTC oil free facial wash nightly
2. apply OTC benzoyl peroxide +/- OTC topical retinoid
3. sun protection
   4: avoid comedogenic cosmetics and moisturizers
4. avoid picking at lesions (increases scarring)

Question 8

What severity of acne is defined as limited disease with noninflammatory comedones plus or minus minimal inflammatory lesions

Answer 8

Mild acne

Question 9

What severity of acne is defined as increased bread including chest and/or back with more inflammatory lesions

Answer 9

Moderate acne

Question 10

What severity of acne is defined as mostly inflammatory lesions with high risk of scarring and nodulocystic disease

Answer 10

Severe acne

Question 11

What is recommended for treating mild acne

Answer 11

Topical benzoyl peroxide, topical antibiotics, plus or minus topical retinoids

Question 12

What is recommended for treating moderate acne

Answer 12

Topical plus or minus systemic treatment of oral antibiotics or oral contraceptive pill

Question 13

What is recommended for treating severe acne

Answer 13

Oral isotretinoin

Question 14

What is recommend treatment for comedonal acne

Answer 14

Topical retinoid plus or minus benzoyl peroxide

Question 15

What is recommended for treating mostly inflammatory acne

Answer 15

Topical antibiotics plus or minus benzoyl peroxide

Question 16

What is recommended for treating mixed comedonal/inflammatory acne

Answer 16

Oral medication including oral antibiotic plus or minus oral contraceptive or topical retinoid plus topical benzyl peroxide plus or minus topical or oral antibiotic plus or minus oral contraceptives

Question 17

What are the 6 classes of medication used for treating acne

Answer 17

1 anti-inflammatory medication
2 topical antibiotics
3 topical retinoids
For systemic antibiotics
5 hormone medications
6 other medication for isotretinoin

Question 18

What is the main anti-inflammatory medicine for acne and what percent is used typically.

Answer 18

Benzoyl peroxide 2.5 to 10%, gels work best and 5% is generally sufficient.

Question 19

Name the topical antibiotics use for acne

Answer 19

Clindamycin or erythromycin and usually combined with benzyl peroxide or retinoid product
Dapsone 5% to 7 and half percent gel (it inhibits bacterial synthesis of folic acid and is also anti-inflammatory)

Question 20

Name the topical retinoids

Answer 20

Tretinoin first generation usually applied at night due to side effect of photosensitivity
Tazarotene and adapalene (third-generation) less skin sensitivity to light and are often combined with benzoyl peroxide

Question 21

What are the systemic antibiotics and how are they used.

Answer 21

Doxycycline daily to twice daily
Minocycline daily for 12 weeks
They should never be used as monotherapy and limit their duration of use
Adverse effects of minocycline include induced lupus-like reaction, pseudotumor cerebri especially in combination with isotretinoin, drug reaction with eosinophilia and systemic symptoms, DR ESS.

Question 22

Describe isotretinoin and its effects on the pathophysiology of acne as well as its use.

Answer 22

Oral retinoid affects all components of the acne tetrad
Give over 20 weeks;
Monitor labs monthly for 3 months, then every 3 months until completed, may increase triglycerides, cholesterol and cause hepatotoxicity;
Screen all females for pregnancy monthly due to teratogenic effects.

Question 23

When treating acne in preadolescent children less than 12 years of age what are the 2 important considerations?

Answer 23

1. avoid oral tetracyclines in children up to age 8 years of age
2. avoid oral contraceptive pills until 1 year after onset of menstrual cycle (this may possibly cause diminished growth and bone density).

Question 24

What are the special considerations when treating acne in pregnant individuals, at least 3 to consider?

Answer 24

1. Contraindications include isotretinoin and topical tazarotene retinoid due to teratogenic effects on the fetus
2. Avoid oral tetracyclines and topical minocycline due to the potential for tooth discoloration in the fetus
3. Insufficient evidence to support the safety of topical clascoterone and topical dapsone

Question 25

What are the considerations for treating acne in highly pigmented skin colored individuals?

Answer 25

They are more likely to develop treatment induced postinflammatory hyperpigmentation

Question 26

When starting medication in hyperpigmented skinned individuals what 2 methods should be considered with treatment initiation?

Answer 26

1. Start with low concentrations of retinoid and slowly titrate up to the frequency of use
   2 consider use of benzyl peroxide wash rather than gel to minimize the amount of time the medication is in contact with the skin

Question 27

What are the hyperandrogenism associated diseases?

Answer 27

1. Polycystic ovarian
2. Late onset adrenal hyperplasia
3. Adrenal tumors
4. Ovarian tumors can contribute to acne

Question 28

What is the term used for “pickers acne”

Answer 28

Acne excoriee