Dermatology Flashcards
Topical Retinoids Examples
- Tretinoin/Retin-A - 1st gen
2. Adapalene/differin - 3rd gen
Oral Retinoids examples
isotretinoin/accutane - 1st gen
what are Retinoids?
vitamin A derivatives
special considerations with Accutane/Isotretinoin
- extremely teratogenic (category X) - causes craniofacial abnormalities, CNS structural malformations, cardiovascular abnormalities
- need to be part of iPledge program to prescribe and take - can only give 30 days at a time
- should avoid pregnancy for 3 years after acitretin is discontinued
general Retinoids MOA
increase growth factors –> causes epidermal hyperplasia and thickened skin –> subsequent desquamation and peeling of skin
Isotretinoin/Adapalene Indications
- acne
2. photoaged skin
Indications for retinoids in general
- acne
- photoaged skin
- severe psoriasis not responsive to other treatments
- cutaneous T cell lymphoma
Retinoids CI
- pregnancy - must have extensive conversation
2. tetracycline coadministration - risk of increased intracranial HTN
who are you most concerned about pseudotumor cerebri? how does it present?
- females, early adolescents to 20s - taking oral retinoids and tetracycline
- new onset headache and blurred vision
Retinoids MOA in acne
- decreases sebum secretion and sebaceous gland size
- reduces abnormal follicular epithelial differentiation and desquamation
- reduces comedogenesis (comedone is blackhead)
- reduces colonization of proprioibacterium
Retinoids MOA in photoaged skin
partial restoration of markedly reduced levels of collagen
instructions on how to take oral retinoids
- take with meals, fatty foods to increase absorption
2. take will full glass of water
Retinoids metabolism
liver
Retinoids SE
- mucocutaenous side effects
- cheilitis
- xeroderma
- skin peeling
- sicca (dry eyes)
- epistaxis - myalgias
- photosensitivity
- depression / changes in mood
- hyperostosis (excessive bone growth) after 5 years of treatment
Retinoids patient education
- side effect of dryness is common, would expect to see it
- combat w/ lip balm, vasaline, eye drops, sugarless candy, saline nasal spray
- may get worse before you get better
- don’t donate blood if taking oral isotretinoin
- pregnancy
Retinoids less common SE
- reversible increase in liver enzymes
- elevated cholesterol
- transient loss of color or night vision
Retinoids rare SE
- pseudotumor cerebri
- psychosis
- IBD
labs to do with isotretinoin
baseline LFTs and follow every 1-2 months
urine pregnancy test monthly
keratolytic examples
- alpha hydroxyl acids
- salicyclic acid
- benzoyl peroxide (mild) - Benzac
keratolytic MOA
break down keratin in skin