Derm- Acne

Question 1

what is acne?

Answer 1

polymorphic skin disorder characterized by comedones, papules, pustules, and cysts; most common skin disorder in the U.S. (affects 80% at some point in their lives). it is a disorder of the pilosebaceous follicles

Question 2

acne more common in males or females?

Answer 2

males

Question 3

what (meds) can exacerbate acne?

Answer 3

steroids, anticonvulsants (dilantin). also lithium

Question 4

specific cause of acne?

Answer 4

unknown but appears to be activated by androgens in genetically predisposed people

Question 5

acne can contribute to psych disorders such as

Answer 5

anxiety, depression, low self esteem

Question 6

treatment principles of acne target one or more of four key factors that promote the development of acne lesions which are:

Answer 6

follicular hyperproliferation and abnormal desquamation, increased sebum production, Propionibacterium acnes proliferation (P. acnes), and inflammation

Question 7

what are beneficial for both comedonal (noninflammatory) and inflammatory acne and should be included in initial management of most patients

Answer 7

topical retinoid

Question 8

picture of..

Answer 8

comedonal (noninflammatory)- mild acne

Question 9

picture of..

Answer 9

inflammatory acne

Question 10

what can be used as monotherapy in individuals with exclusively comedonal acne?

Answer 10

Topical retinoids

Question 11

Topical retinoids are effective in the treatment of comedonal acne due to ?

Answer 11

their ability to normalize follicular hyperkeratosis and prevent formation of the microcomedo, the primary lesion of acne

Question 12

Patients with an inflammatory component often benefit from ?

Answer 12

antimicrobial therapies (ie. benzoyl peroxide or topical antibiotics)

Question 13

How do antimicrobial angents work?

Answer 13

they reduce the number of proinflammatory P. acnes

colonizing the skin.

Question 14

Patients with moderate to severe inflammatory acne often warrant more aggressive treatment with what? Specifically?

Answer 14

oral antibiotics- tetracylcines used most for both anti- bacterial and anti- inflammatory properties

Question 15

use of benzoyl peroxide is recommended in patients receiving oral abx because?

Answer 15

use of benzoyl peroxide with topical or oral antibiotics decreases the emergence of antibiotic resistant bacteria.

Question 16

what type of therapy may benefit women with moderate to severe acne, even in the absence of a hyperandrogenic state.

Answer 16

hormonal therapy (Androgens stimulate increased sebum production- hormonal therapy regulates androgens)

Question 17

Pts should be given realistic expectations for how long it will take to see improvement in their acne which is?

Answer 17

At least two to three months of consistent adherence to a therapuetic regimen

Question 18

topical retinoids include.. how to take them? possible side effects?

Answer 18

tretinioin, adapalene, tazarotene- all taken once daily at bedtime. S/E: Local skin irritation, dryness, and flaking; sun sensitivity (tazarotene contraindicated in prego pts)

Question 19

topical antimicrobials to tx acne include? how to take? possible side effects?

Answer 19

Benzoyl peroxide (BPO), clindamycin, erythromycin, dapsone. taken twice daily. (Clinda and erththromycin usually prescribed with BPO to decrease resistance)

S/E of BPO- bleaching of hair or clothing, lcal skin irritation

S/E of clinda- RARE risk of pseudomembranous colitis

Question 20

oral abx to treat acne

Answer 20

tetracylcine, doxycycline, minocycline, erythromycin, bactrim, or azithromycin (tetra and doxy may cause photosensativity, GI upset, and are contraindicated in prego and young children)

Question 21

hormonal agents to treat acne for women

Answer 21

combination oral contraceptives, spironolactone

Question 22

oral isotretinoin for what type of acne?

Answer 22

it is a retinoid, is effective for the treatment of severe, recalcitrant nodular acne. also used for milder acne that is resistant to other treatments or associated with significant scarring. used as monotherapy (usually 20 wk course), risk of teratogenicity so not usually routine acne therapy

Question 23

compelling option for maintenance therapy for patients with acne vulgaris?

Answer 23

Topical retinoids;

they are able to combat active acne through comedolytic and anti-inflammatory properties, and also play a critical preventive role through the inhibition of the formation of the microcomedone, the precursor lesion in acne vulgaris

Question 24

treatment for postinflammatory hyperpigmentation

Answer 24

“dark spots”, usually a problem for darker skin colors. Both topical retinoids and azelaic acid accelerate the resolution of postinflammatory hyperpigmentation. Topical hydroquinone is gold standard

Question 26

For patients with comedonal acne who desire treatment, what is recommended as first line therapy?

Answer 26

topical retinoids

Question 27

For patients with mild to moderate inflammatory acne with or without prominent comedonal lesions, suggested therapy?

Answer 27

use of a topical retinoid, topical antibiotic, and benzoyl peroxide

Question 28

When benzoyl peroxide is used with a topical antibiotic..

Answer 28

treatment is more effective than either agent alone

Question 29

To reduce the development of antibiotic resistance, we prescribe topical antibiotics with?

Answer 29

benzoyl peroxide.

Question 30

For patients with moderate to severe inflammatory acne with or without prominent comedonal lesions, what therapies are suggested?

Answer 30

the use of a topical retinoid, topical benzoyl peroxide, and an oral antibiotic (rather than topical agents alone). Oral antibiotics should be used for a limited course, ideally up to 12 to 18 weeks. Concomitant topical benzoyl peroxide should be prescribed to decrease the risk of antibiotic resistance.

Question 31

Patients with severe, recalcitrant, nodular acne, treatment is usually what?

Answer 31

oral isotretinoin. (associated with multiple adverse effects and is teratogenic- use with caution)

Question 32

Women with signs of hyperandrogenism should be evaluated for ? (such as virilization, menstrual irregularity, or hirsutism)

Answer 32

underlying endocrine disorders

Question 33

non- pharm interventions for pts with acne include

Answer 33

use of gentle cleansers and avoiding irritating skin care products, patients should select "noncomedogenic" skin care products and cosmetics. also avoid topical oil- based products

Question 34

Pregnant women should not be treated with

Answer 34

topical retinoids. If treatment during pregnancy is necessary, erythromycin, clindamycin, or azelaic acid may be considered after a review of the risks and benefits of therapy.

Question 35

tazarotene, oral isotretinoin are both

Answer 35

pregnancy category X

Question 36

possible S/E of isotretinoin

Answer 36

Dryness or peeling of skin, soreness and cracking of the lips, itching, muscle pain, nosebleeds, difficulty wearing contact lenses, and sensitivity to the sun may occur during treatment. Also may increase depression or suicidal behavior. ANd can cause increase in triglycerides

Question 37

open comendones

Answer 37

aka blackheads; openings in the skin that are capped with blackened skin debris. Densely packed keratinocytes, oxidized lipids, and melanin all contribute to the dark color of the open comedo.

Question 38

clsoed comedones

Answer 38

aka whiteheads; present as obstructed openings topped with white skin debris; Accumulation of sebum and keratinous material converts a microcomedo into a closed comedo

Question 39

how do androgens contribute to acne?

Answer 39

Androgens contribute to the development of acne through stimulating the growth and secretory function of sebaceous glands.

Question 40

other drugs than can induce acne include

Answer 40

glucocorticoids, phenytoin, lithium, isoniazid, epidermal growth factor inhibitors, iodides, bromides, androgens, vitamins B2, B6 & B12

Question 42

where does acne typically occur?

Answer 42

on areas of the body with hormonally-sensitive sebaceous glands, including the face, neck, chest, upper back, and upper arms

Question 43

possible differential diagnosis of acne vulgaris

Answer 43

acneiform eruptions such as drug- induced acne, acne cosmetica, EGFR inhibitor (ca treatment) acneiform eruptions