Acne therapeutics part 2 Flashcards
true or false
benzoyl peroxide can be used as monotherapy in mild acne
true - but often used in combination
what strengths is benzoyl peroxide available
2.5-10%, but therapeutic efficacy has been shown to max out at 2.5%
what is the only benzoyl peroxide dosage form that is exclusively available as RX
gel
in what patients should benzoyl peroxide be avoided in
sensitive skin
true or false
benzoyl peroxide causes c. acnes resistance
FALSE - DOES NOT
If a patient experiences redness, burning, itching, peeling, or swelling from benzoyl peroxide, what should be done?
if mild, apply less frequently or reduce concentration
if severe, discontinue
how long does it take to observe results after using benzoyl peroxide
as soon as 5 days
concern with benzoyl peroxide
may bleach hair or fabrics
when using benzoyl peroxide, avoid contact with….
eyes, lips, mouth
name a topical hormone used for acne
clascoterone
what kind of acne is clascoterone used for
how does it work
HORMONAL ACNE
inhibits androgen receptors, which helps to reduce oil production and inflammation
true or false
clasterone is only indicated for men
what age?
FALSE
men and women 12 and older
explain how clasterone should NOT be applied
do not apply under occlusive things - risk of being systemically absorbed
so not apply over large surface areas of use for prolonged period of time
common vs more rare adverse events from using clascoterone
common - redness,dry, itchy
more rare – HPA suppression (hypothalmic-pituitary-adrenal)
LONG TERM SAFETY IS LACKING
since clascoterone has the potential to cause HPA suppression, what is an important consideration
have to taper down if stopping
do not stop abruptly (like steroids)
true or false
clascoterone is the only hormonal acne agent used in men (topically)
true
*****very important consideration when using antibiotics for acne - whether topical or systemic
DO NOT USE ALONE
use other agent with it
increased risk of resistance if you dont
which topical antibiotic is a SULFONE and what is the concern
DAPSONE
should not be used in pts with sulfa allergies
what is the newest topical antibiotic
minocycline
how does minocycline come?
what about dapsone?
minocycline - comes as FOAM
dapsone - comes as 5% and 7.5% gel
is minocycline topical foam expensive?
YES
more costly than erythromycin and clindamycin, but no evidence that it works better than clindamycib
dapsone is used in ______ acne….
inflammatory acne
and for comodomal (noninflammatory acne) in combination with a topical retinoid or benzoyl peroxide
name something that can happen when dapsone is applied
if used with benzoyl peroxide, it may be oxidized and turn an orange-brown, but it’s not a big deal because it can be brushed away
true or false
dapsone has been shown to benefit males more than females
FALSE
females more than males
what is a consideration if wanting to start a fixed-dose topical combination
if they’ve never used either before, may want to just start with 1 to see how their skin reacts and how they respond
concomitant BP use us recommended with combined ____ and _____ to prevent the development of antibiotic resistance
topical retinoid and topical antibiotic
place in therapy for oral (systemic) antibiotics
moderate-severe INFLAMMATORY acne
in conjunction with topical benzoyl peroxide and retinoid
how long should someone be on oral antibiotics for acne?
explain
usually stopped in around 12 weeks
within 12 weeks, the appearance of new inflamm. lesions is reduced, and should start tapering down
if a flare up happens while tapering, increase the dose back up.
while all this is happening, TOPICAL THERAPY IS STILL BEING USED
The goal with using oral antibiotics is to….
discontinue the oral antibiotics and be able to maintain control with topicla therapy
true or false
topical antibiotics and oral antibiotics should not be used together
TRUE
BREEDS RESISTANCE
there is no evidence to use oral antibiotics past….
3-4 months
how long to notice clinical improvement after starting oral antibiotics
6-8 weeks
very long time
if nothing happens at this point, consider stopping (TAPER)
true or false
oral antibiotics should not be used long term for acne
true
if they do well on them but flare up after taking off and keep needing to be put back on — consider alternate therapy
initial dose minocycline for acne
50mg BID
TRUE OR FALSE
minocycline is clinically less efficacious than the other oral ABX for acne
FALSE - actually more effective
this is because it’s more lipophilic than tetracycline and doxycycline — more can accumulate in the hair follicles to produce effefcts
dose of doxy for acne
50-200mg in divided doses
pt education for minocycline
take with food for better absorption (it’s lipophilic!)
sit upright after taking for less side effects like vertigo
which is more likely to cause nausea and photosensitivity - tetracycline or minocycline?
tetracycline more likely
2 main side effects doxycycline
GI side effects (take w food and sit upright)
photosensitivity
what is sarecyckine
an oral antibiotic that can be used for acne. extremely expensive and not 1st or 2nd line
advantages and disadvantages of sarecyckine
has lower GI ADRs because it has less activity against normal GI flora (NARROWER SPECTRUM)
very expensive and no improved efficacy or decreased chance of resistance
name 2 systemic hormone therapies for acne
estrogen
anti-androgens (androgen receptor blocker)
place in therapy for estrogen therapy
teens and women with mild, moderate, or severe acne IF TOPICALS FAIL!!!!!
used as an adjunct with other therapy
treatment for women who also want to use as birth control
place in therapy for anti androgens
women with hyperandrogenism bc of PCOS and adrenal hyperactivity (hirsutism and acne)
ideal birth control product (estrogen therapy) for acne control
LOW ANDROGEN activity and LOW DOSE OF ESTROGENS
what particular patients on oral contraceptives are at high risk of a clot
if they smoke/have family history
common side effects of estrogen therapy
nausea, weight gain, spotting, amenorrhea, breast tenderness
is spironolactone used for acne treatment in men
not really, due to undesirable effects of gynecomastia (inc breast tissue) and decreased libido (sex drive)
true or false
spironolactone is fairly well tolerated in females
true
most side effects occur in men
monitoring in spironolactone
monitor potassium and BP
also check androgen levels at baseline and then every 3 months to make sure androgens are being suppressed
with what drugs should spironolactone be avoided
bactrim
ARBS
ace inhibitors
potassium substutues
place in therapy isotretinoin
SEVERE INFLAMMATORY ACNE
last line
briefly explain dosing isotretinoin
how long is therapy?
WEIGHT BASED
start at low dose and gradually increase as tolerated
16-20 weeks, and in rare cases 24-32 weeks
side effects isotretinoin
hair loss (resolves)
depression, psychosis
suicidal thoughts
benign intracranial HTN
abnormal labs
mucocutaneous side effects (drying)
hyperlipidemia
is isotretinoin taken with or without food
empty stomach for isotretinoin with lidose
with food for norm
explain in further detail how isotretinoin dries you out
dry skin, eyes, nose, and mouth
resolution for dry skin and eyes caused by isotretinoin
skin - moisturize
eyes - artificial tears (may not be able to tolerate contacts)
resolution for dry nose and mouth caused by isotretinoin
nose - petrolatum (vaseline) possibly an antibiotic ointment like bacitractin for colonization of staph aureus
mouth - hard candies
MAIN lab values that isotretinoin effects
hyperlipidemia and increased hepatic enzymes (ALT, AST)
normal triglyceride value
less than 150
as mentioned, isotretinoin causes hyperlipidemia - increased triglycerides
what is the biggest concern with this
can cause pancreatitis
therefore, dont give to someone who is already very high at baseline
normal hepatic enzyme value
5-20
if they were at 5 and went all the way to 20, it’s still in range but it’s a concern bc they quadrupled the value
if was at 19 and now 26, not as big a concern
RARE isotret side effects
decreased WBC
osteoporosis
skeletal abnormalities
hypercalicemia
pts on isotretinoin should eat what kind of diet
LOW IN FAT
it’s gonna cause hyperlipidemia
2 methods of contraception are necessary if on isotretinoin
how long
start at 1 month prior to therapy and continue until 1 month after
