Acne & Rosacea

Question 1

Medications that cause Acne

Answer 1

Corticosteroids
Isoniazid
Lithium
Phenytoin
Trimethadione

Question 2

Topical Acne: Tretinoin Drug Facts

Answer 2

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

Question 3

Topical Acne: Adapalene (Differin) Drug Facts

Answer 3

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

Question 4

Topical Acne: Tazarotene Drug Facts

Answer 4

MOA: retinoid prodrug, skin turnover

Apply: once daily

SE: irritation, photosensitivity

Contraindication: Pregnancy Cat X

Question 5

Topical Acne Bactericidal: Benzyl Peroxide Drug Facts

Answer 5

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

Question 6

Topical Acne Bactericidal: Azelaic Acid Drug Facts

Answer 6

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

Question 7

Topical Acne Bactericidal: Dapsone Drug Facts

Answer 7

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

Question 8

Topical Acne ABX: Clindamycin Drug Facts

Answer 8

Apply: BID

SE: burning, stinging, pseudomembranous colitis

COnsideration: D/C if diarrhea develops, may potentiate neuromuscular blocking agents

Question 9

Oral Acne ABX: Tetracycline, Minocycline, Doxycycline Drug Facts

Answer 9

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

Question 10

Oral Acne ABX: TMP/SMX Drug Facts

Answer 10

MOA: Gram Neg bacteria

Question 11

Oral Acne ABX: Erythromycin Drug Facts

Answer 11

Use: when tetracycline fails, Children <12 yrs

SE: GI upset

Dose: 240, 333, 500, 1,000 mg/d

Question 12

Oral Acne: Isotretinoin Drug Facts

Answer 12

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

Question 13

First-Line Acne Treatment

Answer 13

Topical comedolytics (Retinoids, Benzoyl Peroxide)
Bacteriocidal or Topical ABX addition for closed comedones and pustules

Improvement takes 6 weeks

Question 14

Second Line Acne Treatment

Answer 14

Oral ABX (Doxycycline, Minocycline, Tetracycline) and topical medications
For severe papulocystic acne
OCPs consideration
Aldactone for females

Improvement takes 6 weeks

Question 15

Third-Line Acne Treatment

Answer 15

Isotretinoin for severe nodulocystic acne

Prescribe with caution in women of childbearing age

Question 16

Rosacea Cause

Answer 16

Fungal infection
Demodex Folliculorum mite infestation
Menopause
Helicobacter Pylori
Genetic: Vascular dysregulation
Immune: antimicrobial peptides causing inflammation
Vascular: vasodilatory triggers

Question 17

Rosacea Diagnostic Criteria

Answer 17

Fixed telangiectasia

Erythema –> extravascular fluid accumulates –> blood flow to superficial dermis increases –> persistent telangiectasia –> papules and pustules

Question 18

Topical Rosacea Treatment: Metronidazole Drug Facts

Answer 18

MOA: Antiinflammatory

Apply: 1-2 times daily

SE’s: burning, irritation, erythema, dryness

Consideration: increased anticoagulant effect

Question 19

Topical Rosacea Treatment: Sodium Sulfacetamide with Sulfa Drug Facts

Answer 19

Apply: 1-3 times daily

SE’s: irritation, allergic dermatitis

Contraindications: Kidney disease, breastfeeding, sulfa allergy

Consideration: Pregnancy Cat C

Question 20

Topical Rosacea Treatment: Azelaic Acid

Answer 20

MOA: modulates the immune response, decreases ROS, decreases inflammation

Apply: BID

SE’s: burning, stinging, pruritus

Contraindications: Children

Consideration: hypopigmentation

Question 21

Topical Rosacea Treatment: Ivermectin

Answer 21

MOA: macrocyclic lactone, targets Demodex mites

Apply: once daily

SE’s: skin irritation

Question 22

Topical Rosacea Treatment: Alpha Adrenergic Oxyometazoline, Brimonidine Drug Facts

Answer 22

MOA: decongestion and vasoconstriction

Apply: once daily in the morning

Contraindications: topical only, not for those with glaucoma

SE’s: erythema, flushing, burning

Question 23

Oral Rosacea Treatment: Doxycycline, minocycline, tetracycline Drug Facts

Answer 23

MOA: antiinflammatory reducing cytokines

Dose: subclinical doses. 20 mg BID for 3-5 months

SE: GI upset, photosensitivity

Question 24

First-Line Rosacea Treatment

Answer 24

Topical therapy

6 weeks for improvement

Question 25

Second-Line Rosacea Treatment

Answer 25

Oral ABX. After 2 weeks, decrease dose by 50%, after 6 weeks, discontinue

6 weeks for improvement