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Competency > Acne (self-care) > Flashcards

Acne (self-care) Flashcards

1
Q

Main pathogenic mechanism of acne

A
  • increased sebum production
  • Increased follicular hyperkeratinisation
  • P.acnes colonisation
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2
Q

Risk factors for acne

A
  1. Hormonal (e.g. puberty)
  2. Environment: Humidity and sweating
  3. Hormonal meds (e.g. corticosteroids, contraceptives)
  4. Genetic factor
  5. Smoking
  6. Repetitive skin trauma
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3
Q

Classification of acne

A
  1. Mild: Lesion count <30 (<20 comedones, < 15 inflammatory lesions)
  2. Moderate: lesion count 30-125 (20-100 comedones, 15-50 inflammatory lesions)
  3. Severe: comedo count > 100, or > 5 pseudocyst

(no universal grading system)

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4
Q

Exclusion criteria for self-treatment

A
  • <12y or >30y
  • Preg
  • Suspected drug-induced
  • Acne did not improve after 6w of self-treatment
  • > 30 lesion
  • Widespread distribution
  • Signs of hyperandrogenism
  • Cannot confirm diagnosis
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5
Q

Consequences of acne

A
  • Scarring
  • Psychological effects (e.g. self-esteem, anxiety)
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6
Q

Treatment goals of acne

A
  • Prevent new lesion
  • Prevent scarring
  • Decrease psychological effects
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7
Q

List of OTC preparations for acne and their direction for usage

A
  1. Benzoyl peroxide 2.5-10% cream/scrub/facewash OD-BD
  2. Salicylic acid 0.5-2% lotion/cream/cleanser/pads etc., OD application
  3. Sulfur 4.6% gel BD, thinly
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8
Q

Other than OTC preparations, what other preparations should be added in the case of mild-inflammatory acne?

A

Topical antibiotic or topical tretinoin

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9
Q

Doctor has prescribed topical clindamycin 1% gel to a patient with mild-inflammatory acne. Suggest if an intervention is needed and state the intervention

A

Yes, topical antibiotics should NOT be used as monotherapy in acne

  • Should be used in conjunction with OTC preparations like benzoyl peroxide
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10
Q

List the topical antibiotics that could be used for mild-inflammatory acne. State their forensic classification and maximum supply if applicable

A
  1. Clindamycin 1% gel BD
  2. Azelaic acid 20% BD
  3. Erythromycin 2% gel/solution BD

Forensic classification: POM with exemption
Maximum supply: 30g or 30mL to >12yo

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11
Q

State the range of adapalene products available. State their forensic classification and maximum supply if applicable

A
  1. Adapalene 0.1% cream/gel OD
  2. Adapalene/benzoyl peroxide 0.1%/2.5% ON

Forensic classification: POM with exemption
Maximum supply: 30g or 30mL to >12yo

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12
Q

Similarities and differences in treatment between mild acne and moderate acne?

A

Similarity: Both include topical agents

Difference:
- Full benefits observed in 12w for moderate acne
- Oral abx may be added in moderate acne in combination with topical benzoyl peroxide to minimise potential for abx resistance

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13
Q

State the name and the dose of the ORAL medication used to treat severe acne.

A

Isotretinoin 0.5-1 mg/kg OD for 20 weeks, or cumulative dose of 120 mg/kg

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14
Q

When using moisturisers or face-wash, what is one important property that they should have?

A

Non-comedogenic

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15
Q

Common side effects in most preparations for acne?

A

Burning, stinging, skin irritation

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16
Q

Counselling points for topical adapalene/tretinoin?

A
  • Takes months to work, may worsen for first 2 weeks (as comedones are extruded)
  • Apply to whole face as it minimises formation of new comedones
  • Causes sun-sensitivity: avoid sun exposure and use sunscreen
  • Cold temperature or wind may increase skin irritation
17
Q

What is the plan for contraception in female patients taking isotretinoin?

A

Two reliable forms of contraception:
- One month before therapy
- During therapy
- One month after therapy

This is due to serious adverse fetal effects

18
Q

Minimum time to response with acne therapy?

A

At least 4 weeks (4-8 weeks)

19
Q

Time to full response with acne therapy?

A

Months

20
Q

Non-pharmacological counselling points of acne

A
  • Hair: keep it off face, and shampoo daily
  • Sunscreen when going outdoors
  • Don’t squeeze/pick acne to prevent scarring
  • Avoid scrubbing when cleaning Acne to prevent irritation
  • Wash face at least BD with a soft washcloth,
    warm water, and mild facial cleanser
  • Use noncomedogenic facial cleanser
21
Q

Besides tetracyclines, name another antibiotics that could be used for acne

A

Macrolides (erythromycin, azithromycin)

22
Q

Exclusion from self-treatment

A
  • Age <12yo or > 30yo
  • Preg
  • Widespread lesions
  • Moderate-severe acne
  • Family history of scarring acne
  • Psychological condition suspected
  • Possible hormonal problems

Competency (28 decks)

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