Exam 1 Flashcards
Patho of acne formation (5)
- There is a blockage in a hair follicle shaft
- Dead cells from inside the follicle shaft that normally go out gets stuck in the follicle shaft
- Sebum produced from sebaceous glands in the shaft build up behind this blockage
- Bacteria grows in this blockage
- This blockage grows and eventually breaks the wall of the shaft which allows WBCs to flow in and cause inflammation
What is the pH of healthy skin?
4.7 - 5.7
Stages of acne (6)
- Whitehead (due to oil or dirt trapped inside pores)
- Blackhead (when hair follicles are clogged due to dirt and dead skin and is exposed to air which causes it to oxidize leading to the black color)
- Papules (small red dots that could cause the skin to be inflamed)
- Cysts (big acne that is painful to touch, swelling, and full of pus –> acne is infected)
- Nodules (crows from inside your skin, mostly painful, and full of pus)
- Pustules (red bump acne that looks white or yellow on top)
Mild acne classification
Few to several papules/pustules (generally < 10) and no nodules
Moderate acne classification
Several to many papules/pustules (10 - 40) along with comedomes (10 - 40) and a few to several nodules
Severe acne classification
Numerous or extensive papules/pustules and many nodules
1st line treatment of mild acne (3 main, 3 sub)
- BP
- Topical retinoid
- Topical combination therapy
a. BP + antibiotic
b. Retinoid + BP
c. Retinoid + BP + antibiotic
1st line treatment of moderate acne (5)
- Topical Combination Therapy
a. BP + Antibiotic
b. Retinoid + BP
c. Retinoid + BP + Antibiotic
d. Oral antibiotic + topical retinoid + BP
e. oral antibiotic + topical retinoid + BP + topical antibiotic
1st line treatment of severe acne (2 main, 3 sub)
- Oral antibiotic + topical combination therapy
a. BP + antibiotic
b. Retinoid + BP
c. Retinoid + BP + antibiotic
- Oral isotretinoin
Exclusions to self-treatment of acne (4)
- Comedogenic drugs (drugs that cause acne)
- Moderate to severe acne (refer to provider)
- Pregnancy (CI to isotretinoin)
- When self-treatment doesn’t work (refer to provider)
Goals of acne therapy (4)
- Remove keratin plug
- Reduce bacterial inflammation
- Reduce sebum production
- Reduce/eliminate scarring
Home care for management of acne
- Gentle synthetic cleansers twice a day (wash using hands not cloths and choose a cleanser that is at healthy skin pH)
- Avoid scrubs
- Use water-based lotions, cosmetics, and hair products
- Don’t pick at lesions (exacerbates scarring and spreads inflammation)
Topical Retinoid Drugs (7)
- Tretinoin
- Adapalene
- Tazarotene
- TWYNEO (combination of retinoid and BP)
- Trifarotene (Aklief)
- Epiduo Forte (adapalene and BP)
- VELTIN (clindamycin phosphate and tretinoin)
Topical Retinoid MOA
- Normalizes follicular hyperkeratosis and decreases cohesiveness of keratinocytes which allows the dead cells to flow out and not be blocked
- Prevents formation of microcomedo (minor clogging of follicular shafts)
- May improve inflammatory acne
- May take 8 - 12 weeks to see improvement
How to apply topical retinoids
- Gently clean area, pat dry, apply thin layer of retinoid, apply moisturizer
- Apply to the entire affected area (don’t spot treat because the acne could migrate)
- Apply at night because of the photolability of tretinoin (you want to avoid the sun when you apply this)
- Don’t apply at the same time as BP because BP causes oxidation which decreases the stability of tretinoin (especially during light exposure)
