derm Flashcards
first line therapy for acne
benzoyl peroxide 2.5%
antibacterial for P acnes
benzoyl peroxide teaching
start with less potent
may cause bleaching of fabric
topical antibiotics for acne info
clindamycin 1% preferred, dapsone
gels, creams, ointments, foams
photosensitivity
clinical improvement in 4-8 weeks
dapsone
inhibits dihydrofolic acid in bacteria; anti-inflammatory
topical AEs, orange/brown discoloration
12 weeks for effect
retinoids
vitamin A derivatives
bind to retinoid receptors & turn on genes that promote keratinocyte differentiation
topical AEs - photosensitivity
tretinoin - no use w BP
azalaic acid
cream/foam/gel
Qweek, 2x/week
use for post-inflammatory dyspigmentation
local AEs
oral antibiotics for acne
1- TETRACYCLINES
2- macrolides
3 - trimethoprim-sulfamethoxazole
decrease P acnes colonization
used after trial w topical agents
clinical improvement in 6-10 weeks
limit duration 3-4months
not used as monotherapy
doxycycline teaching
take with water on empty stomach
avoid admin with other ions
AE - teeth staining, GI discomfort, photosensitivity
avoid in pregnancy, children <8
isotretinoin
used for severe, recalcitrant acne
prevents scarring & resistant acne
potential toxicity - hypervitaminosis A, IBS, SI/anxiety/depression, HLD, elevated LFTs
iPledge program for providers to be registered; pregnancy tests every 30 days BBW
isotretinoin dosing
0.5mg/kg/day x 1 month
1 mg/kg/day as tolerated
lower dose for AEs
treatment duration 4-5 months, repeated after 2-month washout interval
isotretinoin AEs
CYP2C9, 3A4, 2B6
dry skin, cheilitis (lips), hypertriglycerideia, leukopenia, photosensitivity, depression
monitor lipids/LFTs
avoid in breast feeding/teratogenic!!!
mild acne regimen
benzoyl peroxide or BP with topical abx (clindamycin/erythromycin)
moderate/severe ance regimen
BP w topical retinoid ando/or systemic antibiotic
comedal acne regimen
topical retinoids only
inflammatory/nodular (cystic) acne regimen
topical retinoid w oral abx
combination therap