Acne & Rosacea Flashcards
Medications that cause Acne
Corticosteroids
Isoniazid
Lithium
Phenytoin
Trimethadione
Topical Acne: Tretinoin Drug Facts
MOA: acts on the epidermis to decrease cohesion between epidermal cells, increase epidermal cell turnover
Apply: once daily in the evening, start with low strength and increase.
SE: Erythema, irritation, photosensitivity
Contraindication: Pregnancy, Exzema, sunburn
Topical Acne: Adapalene (Differin) Drug Facts
MOA: retinoid, derivative of naphtholic acid. Binds to retinoid receptors in the skin to turnover skin cells
Apply: once daily in the evening
SE: Erythema, dryness, photosensitivity
Contraindication: Pregnancy
Topical Acne: Tazarotene Drug Facts
MOA: retinoid prodrug, skin turnover
Apply: once daily
SE: irritation, photosensitivity
Contraindication: Pregnancy Cat X
Topical Acne Bactericidal: Benzyl Peroxide Drug Facts
MOA: comedolytic and bactericidal to C. Acnes. anti-inflammatory
Apply: 2.5%-5% 1-2 times daily
SE: irritation, erythema, dryness
Contraindication: Hypersensitivity reactions
Consideration: may bleach colored items, do not apply with other topicals
Topical Acne Bactericidal: Azelaic Acid Drug Facts
MOA: interfere with DNA synthesis of acne-causing bacteria. Mild to moderate acne
Apply: 20% cream 1-2 times daily
SE: irritation, erythema, dryness
Considerations: May cause hypopigmentation, may exacerbate asthma
Topical Acne Bactericidal: Dapsone Drug Facts
MOA: antiinflammatory and antibacterial
Apply: once daily if combo, BID if monotherapy
Use: females only
SE’s: methemoglobinemia
Considerations: use with benzyl peroxide (BPO) may cause orange-brown discoloration
Topical Acne ABX: Clindamycin Drug Facts
Apply: BID
SE: burning, stinging, pseudomembranous colitis
COnsideration: D/C if diarrhea develops, may potentiate neuromuscular blocking agents
Oral Acne ABX: Tetracycline, Minocycline, Doxycycline Drug Facts
MOA: Inflammatory acne, suppress C. Acnes and inhibit bacterial lipases, neutrophil chemotaxis, follicular plugging
Dose: 500-1,000 mg daily BID/QID, taper, 3-4 weeks until improvement
Duration: 4-6 months
SE’s: photosensitivity, GI upset, pseudotumor cerebri, decreased efficacy of OCP’s
Contraindication: Renal failure, children <12 (tooth staining), Pregnancy Cat D
Oral Acne ABX: TMP/SMX Drug Facts
MOA: Gram Neg bacteria
Oral Acne ABX: Erythromycin Drug Facts
Use: when tetracycline fails, Children <12 yrs
SE: GI upset
Dose: 240, 333, 500, 1,000 mg/d
Oral Acne: Isotretinoin Drug Facts
MOA: Retinoid acid derivative, decreases sebum, follicular obstruction, number of skin bacteria, antiinflammatory
Dose: 0.5-1 mg/kg/d for 20-34 weeks
SE’s: Increased cholesterol and triglyceride levels, dry skin, depression, aggressive / violent behavior, back pain, arthralgia in peds
Contraindications: Cat X
Considerations: Prescriber SMART program, iPledge program (2 types of birth control, monthly negative pregnancy tests), monthly questionnaire, patient registration and contract
2 negative pregnancy tests 1 month apart p/t prescribing
Pregnancy avoidance 1 month after discontinuation
Monitor: Pregnancy test, cholesterol, triglyceride, CBC, LFTs. Beginning, 1 month in, after each dose change
First-Line Acne Treatment
Topical comedolytics (Retinoids, Benzoyl Peroxide)
Bacteriocidal or Topical ABX addition for closed comedones and pustules
Improvement takes 6 weeks
Second Line Acne Treatment
Oral ABX (Doxycycline, Minocycline, Tetracycline) and topical medications
For severe papulocystic acne
OCPs consideration
Aldactone for females
Improvement takes 6 weeks
Third-Line Acne Treatment
Isotretinoin for severe nodulocystic acne
Prescribe with caution in women of childbearing age
Rosacea Cause
Fungal infection
Demodex Folliculorum mite infestation
Menopause
Helicobacter Pylori
Genetic: Vascular dysregulation
Immune: antimicrobial peptides causing inflammation
Vascular: vasodilatory triggers
Rosacea Diagnostic Criteria
Fixed telangiectasia
Erythema –> extravascular fluid accumulates –> blood flow to superficial dermis increases –> persistent telangiectasia –> papules and pustules
Topical Rosacea Treatment: Metronidazole Drug Facts
MOA: Antiinflammatory
Apply: 1-2 times daily
SE’s: burning, irritation, erythema, dryness
Consideration: increased anticoagulant effect
Topical Rosacea Treatment: Sodium Sulfacetamide with Sulfa Drug Facts
Apply: 1-3 times daily
SE’s: irritation, allergic dermatitis
Contraindications: Kidney disease, breastfeeding, sulfa allergy
Consideration: Pregnancy Cat C
Topical Rosacea Treatment: Azelaic Acid
MOA: modulates the immune response, decreases ROS, decreases inflammation
Apply: BID
SE’s: burning, stinging, pruritus
Contraindications: Children
Consideration: hypopigmentation
Topical Rosacea Treatment: Ivermectin
MOA: macrocyclic lactone, targets Demodex mites
Apply: once daily
SE’s: skin irritation
Topical Rosacea Treatment: Alpha Adrenergic Oxyometazoline, Brimonidine Drug Facts
MOA: decongestion and vasoconstriction
Apply: once daily in the morning
Contraindications: topical only, not for those with glaucoma
SE’s: erythema, flushing, burning
Oral Rosacea Treatment: Doxycycline, minocycline, tetracycline Drug Facts
MOA: antiinflammatory reducing cytokines
Dose: subclinical doses. 20 mg BID for 3-5 months
SE: GI upset, photosensitivity
First-Line Rosacea Treatment
Topical therapy
6 weeks for improvement
Second-Line Rosacea Treatment
Oral ABX. After 2 weeks, decrease dose by 50%, after 6 weeks, discontinue
6 weeks for improvement
