Acne Vulgaris

Question 1

Benzoyl Peroxide

Answer 1

Alternative 1st line for mild to moderate
Main effectiveness is antibacterial activity against P. Acnes

Can be used in combo with topical retinoids or topical antibacterial or oral antibacterial for acne of all severities

Question 2

Azelaic Acid

Answer 2

Alternative for mild to moderate
Used for pts who can’t tolerate benzoyl peroxide or topical retinoids

Antibacterial and anti inflammatory properties
May even out skin tones
Pregnancy category C

Question 3

Clindamycin

Answer 3

Topical antibacterial
1% is Preferred agent
2% can be used
Should not be used as mono therapy or long term
Used in combo with benzoyl peroxide, topical retinoids, or azelaic acid
Can come in combo with benzoyl peroxide

Question 4

Erythromycin

Answer 4

Topical antibacterial
Used in combo with benzoyl peroxide, topical retinoids, or azelaic acid for mild to moderate acne

Can come in combo with benzoyl peroxide

Question 5

Sulfur, resorcinol, and salicylic acid

Answer 5

Keratolytics
2nd line for mild to moderate
Cause less skin irritation than benzoyl peroxide or topical retinoids

Disadvantages: foul smell, resorcinol can cause brown scaling of the skin, salicylism with continual salicylic acid use (rare)

Question 6

Tetracycline, doxycycline, and minocycline

Answer 6

Oral antibiotics
Moderate to severe acne with topical therapy
Avoid topical and oral antibiotics together
Limit use to 3-4 months
Doxycycline and minocycline are more effective
Avoid in children less than 8 yo (discolors developing teeth)
Avoid in pregnancy (category D)
Take 1 hr before or 2 hrs after dairy products, antacids, vitamins, or iron supplements

Question 7

Erythromycin

Answer 7

2nd line when other treatment fails
Drug of choice in pregnancy and children under 8yo
Adverse effects: GI upset, rash, hearing loss, hypersensitivity, vaginal candidiasis
Drug drug interactions

Question 8

Azithromycin

Answer 8

Oral antibiotic
Alternative if unable to use other antibiotics
Adverse effects: GI upset, rash, HA, drowsiness

Question 9

Trimethoprim+Sulfamethoxazole

Answer 9

Oral antibiotic
2nd line
Advair effects: GI upset, allergic rash, Stevens-Johnson Syndrome, photosensitivity

Sulfamethoxazole avoid in pregnancy (category D)

Question 10

Isotretinoin

Answer 10

Oral Etinoid
Moderate to severe acne
1st line with pts with severe modular acne
Adverse effects: cheilitis, dryness of nose, eyes, and mouth, peeling, pruritus, drying of the face and skin, alopecia, depression/suicidality, muscle and joint pain, lab abnormalities, teratogenic

Pregnancy category X 
iPledge REMS program
2 negative pregnancy test prior to start
1 negative test each month while using 
Commitment to use 2 forms of effective BC 1 month prior, during, and at least 1 month after discontinuation therapy

Question 11

Ethinyl estradiol/norgestimate, ethinyl estradiol/norethindrone acetate/ferrous fumerate, and ethinyl estradiol/drospirenone

Answer 11

Hormonal agents
Oral contraceptives and anti androgens
2nd line for moderate to severe in female pts
Adverse effects: nausea, HA, weight gain, breast tenderness, thrombosis