Acne (self-care) Flashcards
Main pathogenic mechanism of acne
- increased sebum production
- Increased follicular hyperkeratinisation
- P.acnes colonisation
Risk factors for acne
- Hormonal (e.g. puberty)
- Environment: Humidity and sweating
- Hormonal meds (e.g. corticosteroids, contraceptives)
- Genetic factor
- Smoking
- Repetitive skin trauma
Classification of acne
- Mild: Lesion count <30 (<20 comedones, < 15 inflammatory lesions)
- Moderate: lesion count 30-125 (20-100 comedones, 15-50 inflammatory lesions)
- Severe: comedo count > 100, or > 5 pseudocyst
(no universal grading system)
Exclusion criteria for self-treatment
- <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
Consequences of acne
- Scarring
- Psychological effects (e.g. self-esteem, anxiety)
Treatment goals of acne
- Prevent new lesion
- Prevent scarring
- Decrease psychological effects
List of OTC preparations for acne and their direction for usage
- Benzoyl peroxide 2.5-10% cream/scrub/facewash OD-BD
- Salicylic acid 0.5-2% lotion/cream/cleanser/pads etc., OD application
- Sulfur 4.6% gel BD, thinly
Other than OTC preparations, what other preparations should be added in the case of mild-inflammatory acne?
Topical antibiotic or topical tretinoin
Doctor has prescribed topical clindamycin 1% gel to a patient with mild-inflammatory acne. Suggest if an intervention is needed and state the intervention
Yes, topical antibiotics should NOT be used as monotherapy in acne
- Should be used in conjunction with OTC preparations like benzoyl peroxide
List the topical antibiotics that could be used for mild-inflammatory acne. State their forensic classification and maximum supply if applicable
- Clindamycin 1% gel BD
- Azelaic acid 20% BD
- Erythromycin 2% gel/solution BD
Forensic classification: POM with exemption
Maximum supply: 30g or 30mL to >12yo
State the range of adapalene products available. State their forensic classification and maximum supply if applicable
- Adapalene 0.1% cream/gel OD
- Adapalene/benzoyl peroxide 0.1%/2.5% ON
Forensic classification: POM with exemption
Maximum supply: 30g or 30mL to >12yo
Similarities and differences in treatment between mild acne and moderate acne?
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
State the name and the dose of the ORAL medication used to treat severe acne.
Isotretinoin 0.5-1 mg/kg OD for 20 weeks, or cumulative dose of 120 mg/kg
When using moisturisers or face-wash, what is one important property that they should have?
Non-comedogenic
Common side effects in most preparations for acne?
Burning, stinging, skin irritation
Counselling points for topical adapalene/tretinoin?
- 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
What is the plan for contraception in female patients taking isotretinoin?
Two reliable forms of contraception:
- One month before therapy
- During therapy
- One month after therapy
This is due to serious adverse fetal effects
Minimum time to response with acne therapy?
At least 4 weeks (4-8 weeks)
Time to full response with acne therapy?
Months
Non-pharmacological counselling points of acne
- 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
Besides tetracyclines, name another antibiotics that could be used for acne
Macrolides (erythromycin, azithromycin)
Exclusion from self-treatment
- Age <12yo or > 30yo
- Preg
- Widespread lesions
- Moderate-severe acne
- Family history of scarring acne
- Psychological condition suspected
- Possible hormonal problems
