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PHRM 504 > Lecture 17: Dermatology II > Flashcards

Lecture 17: Dermatology II Flashcards

1
Q

Acne

A 
● Inflammatory skin disease affecting pilosebaceous glands
● Common on the face, back, chest, shoulders/arms, neck
● Most prevalent during adolescence
● Often correlates with onset of puberty
● Affects 85% of 15-24 year-olds
● Impacts quality of life
● Physical scarring
● Emotional impact
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2
Q

Acne – Pathophysiology

A 
1. Hormonal (androgenic)
trigger
▪Associated with puberty;
genetic risk
2. Sebum production
3. Altered keratinization/
Plugged duct 
4. Propionibacterium
acnes (P. acnes)
follicular colonization
▪Break down sebum →
irritating free fatty acids
5. Release of inflammatory
mediators
6. Local tissue injury
7. Comedones →
papules/pustules →
nodules
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3
Q

Acne Pathophysiology

A

● Pilosebaceous unit in the dermis
○ Hair follicle + sebaceous gland
○ Connected to skin surface by duct lined with epithelial cells
■ Hair shaft passes through

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4
Q

Sebaceous gland produces

A

sebum
It:
● Protects skin from light and retain moisture
● Antibacterial properties, pro- and anti-inflammatory
● Involved in wound healing

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5
Q

Acne – Clinical Presentation

A

Open or close comedones
Nodules
Pustules
Papules

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6
Q

Open comedone

A

raised open follicle → black surface pigmentation (“black head”)

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7
Q

Closed comedone

A

raised blocked follicle (“white head”)

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8
Q

Nodule

A

disruption of follicular wall and release of

contents to surrounding dermis

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9
Q

Pustule:

A

papule with noticeable white or yellow centered

center (purulence)

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10
Q

Papule

A

closed, swollen, erythematous

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11
Q

Acne – Risk/Exacerbating Factors

A 
● Chemicals
● Cosmetics
● Diet (breads, starches, sugar)
● Excoriation (picking, squeezing)
● Hormones (pregnancy, puberty)
● Hydration (humidity, sweating)
● Mechanical (hats, headbands, helmets)
● Medications
● Occupational
● Stress
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12
Q

Acne – Grading/Classification

A

Severity defined by the number and type of acne lesions

●Not standardized

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13
Q

Mild acne

A

Few erythematous papules and occasional pustules mixed with comedones

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14
Q

Moderate acne

A

Many erythematous papules and pustules and prominent scarring

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15
Q

Severe acne

A

Extensive pustules, erythematous papules, and multiple nodules in an inflamed background

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16
Q

Acne – Self-Treatment Pearls

A

Self-treatment is appropriate for mild acne only
• Address exacerbating factors – can be done before or in conjunction with treatment
• Treatment needs to be chronic, continuous, consistent -> adherence is important
• Set realistic goals: Symptoms likely to improve, but may not
resolve

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17
Q

Acne – Exclusions to Self-Care

A

Moderate to severe acne
● Pregnancy
● Suspected rosacea

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18
Q

Rosacea

A
  • common skin condition that causes blushing or flushing and visible blood vessels in your face
  • It may also produce small, pus-filled bumps
  • These signs and symptoms may flare up for weeks to months and then go away for a while
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19
Q

Acne – Non-Pharmacologic Therapy

A 
● Avoid abrasive scrubs/brushes
○ May worsen acne
● Cleanse skin twice daily
○ Mild soap or cleanser
● Dietary changes?
● Hydration
● Limit/eliminate exacerbating factors
● Physical therapies – glue-based strips, light therapy
○ Evidence?
○ Considered adjunct to pharmacologic therapy
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20
Q

Acne – Pharmacologic Therapy

A 
Topical therapy is the standard of care
● Several OTC options
• Adapalene
• Benzoyl peroxide
• Hydroxy acids (AHA, BHA)
• Sulfur +/- resorcinol
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21
Q

Adapalene Brand Name

A

Differin

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22
Q

Adapalene MOA

A
  • Anti-inflammatory; comedolytic; keratolytic

- Affects lesions not yet visible on the skin.

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23
Q

Adapalene OTC

A

0.1% gel

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24
Q

Adapalene Dosing

A

Apply daily at bedtime.

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25
Q

Adapalene Adverse Effects

A

allergic dermatitis; dry skin; skin irritation

*Tend to improve after the first month of therapy

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26
Q

Adapalene Patient Education

A

Avoid prolonged sun exposure/use sunscreen.

Full therapeutic effect takes 8-12 weeks.

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27
Q

Benzoyl Peroxide Brand Name

A

Acne Medication®; AcneFree®; BPO®; PanOxyl®; etc

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28
Q

Benzoyl Peroxide MOA

A

Antibacterial; comedolytic; keratolytic

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29
Q

Benzoyl Peroxide OTC Products

A

2.5-10% (higher strengths available as Rx)

Creams, gels, washes

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30
Q

Benzoyl Peroxide Dosing

A

Initiate 2.5% with 1-2 applications daily.
Increase frequency/strength every 1-2 weeks.
May increase until a mild peeling occurs.

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31
Q

Benzoyl Peroxide Adverse effects

A

Allergic contact dermatitis/anaphylaxis; bleaching; photosensitivity;
skin irritation*
*Tend to improve after the first month of therapy

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32
Q

Benzoyl Peroxide Patient Education

A

Avoid contact with clothes or hair – product has bleaching effects.
Avoid prolonged sun exposure/use sunscreen.
Full therapeutic effect takes 4-6 weeks.

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33
Q

Hydroxy Acids - AHAs Types

A

Alpha hydroxy acids (AHAs): citric, glycolic, and lactic acids

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34
Q

Hydroxy Acids - AHAs MOA

A

Keratolytic (assist in skin turnover/exfoliation)

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35
Q

Hydroxy Acids - AHAs OTC Products

A

4-10% (higher strengths available through dermatologists)

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36
Q

Hydroxy Acids - AHAs Adverse Effects

A

irritation; stinging

37
Q

Hydroxy Acids - BHAs Types

A

Beta hydroxy acids (BHAs): salicylic acid

38
Q

Hydroxy Acids - BHAs MOA

A

Comedolytic; keratolytic

39
Q

Hydroxy Acids - BHAs OTC Products

A

0.5-2% (higher strengths available as Rx)

Gels, washes

40
Q

Hydroxy Acids - BHAs Dosing

A

Gel: 1-2 times per day to affected area
Wash: 1-3 times per day
May increase until a mild peeling occurs

41
Q

Hydroxy Acids - BHAs Adverse effects

A

Dryness; peeling
Toxicity: dizziness; hyperpnea; loss of hearing; nausea; tinnitus;
vomiting

42
Q

Hydroxy Acids - BHAs Patient Education

A

Avoid excessive use.
Drug interactions – anticoagulants, NSAIDs, etc.
Full therapeutic effect takes 4-6 weeks.
Limit use to affected area.

43
Q

Sulfur ± Resorcinol

A

Sulfur: precipitated or colloidal
Resorcinol: enhances effect of sulfur; not effective as monotherapy

44
Q

Sulfur ± Resorcinol MOA

A

Antibacterial; keratolytic

45
Q

Sulfur ± Resorcinol OTC Products

A

3-8% ± 2-3%

Creams, gels, lotions

46
Q

Sulfur ± Resorcinol Dosing

A

1-3 times per day

47
Q

Sulfur ± Resorcinol Adverse effects

A

Chalky yellow color; unpleasant odor

Avoid with allergy to sulfa drugs

48
Q

Sulfur ± Resorcinol Patient Education

A

Not generally recommended for long-term use.

49
Q

Creams/lotions as acne formulations

A

Less irritating/less effective – sensitive skin

50
Q

Gels as acne formulations

A

Longest contact time – generally most effective

• Drying effects

51
Q

Ointments as acne formulations

A

Occlusive – not used, worsen acne

52
Q

Soaps/cleansers as acne formulations

A

Short contact time – little value

53
Q

Acne – Product Selection

A

Product selection is based on individual patient needs,
skin type and acne severity
● “start low go slow”

54
Q

Acne Product efficacy

A

Adapalene and benzoyl peroxide have similar efficacy
• Benzoyl peroxide: efficacy low concentration = efficacy high concentration
• Salicylic acid: less effective than benzoyl peroxide or adapalene
• Sulfur: adjunct therapy

55
Q

Acne Patient education

A

Avoid eyes, mouth, open skin (cuts/scrapes).

• Do not combine with other products (unless instructed)

56
Q

Improvement of acne

A

Complete resolution is unlikely
○ Decrease in number and severity of lesions is realistic
○ No improvement in 6 weeks → REFER

57
Q

Continuation

A

Once symptoms have improved, continue treatment for
prevention
○ May decrease dose/frequency as tolerated

58
Q

UVC Rays

A
  • are short and don’t penetrate the ozone layer
59
Q

UVB rays

A
  • are longer and reach the skin, causing burning, tanning and signs of aging
60
Q

UVA rays

A
  • are the longest, they penetrate deep into the skin and cause the release of free radicals, as well as DNA changes that can result in skin cancer
61
Q

Ultraviolet Radiation

A

Includes UVA and UVB rays
• Clouds only filter out 10-30%
• White or light colored surfaces reflect UVR
• Water reflects no more than 5% UVR (so you can burn
while under water…)
• Is cumulative

62
Q

UVA

A

Majority of UVR
• Penetrates more deeply than UVB (dermis vs. epidermis)
• Less potent than UVB
• Immune system suppression and DNA damage
• Contributes to photoaging and skin cancer
• Primarily responsible for drug-induced photosensitivity
reactions
• Can penetrate window glass

63
Q

UVB

A 
1000x more potent than UVA
• Highest intensity from 10am to 4pm
• Primary cause of skin cancer
• Needed for vitamin D production
• Increases with increasing altitude
• Does not penetrate window glass
64
Q

Suntan/Sunburn

A 
Degree depends on
• Type and amount of radiation
• Thickness of skin layers
• Skin pigmentation
• Skin hydration
• Distribution and concentration of peripheral blood vessels
65
Q

Suntan MOA

A

UVR → stimulates melanocytes → melanin generation and

oxidation

66
Q

Suntan Clinical presentation

A

Immediate/prolonged darkening of the skin

-Does not offer “protection

67
Q

Sunburn MOA

A

UVR → DNA damage → injury → inflammation + RBC leak

68
Q

Sunburn Clinical Presentation

A 
Superficial (partial-thickness) burn
• Mild erythema, tenderness, pain, edema
• Severe (full-thickness) burn
• Development of vesicles
• Fever, chills, shock
69
Q

Sunburn Management

A

Symptomatic/supportive care
• Skin protectants – cocoa butter, petrolatum, aloe
• Systemic analgesics
• Topical anesthetics – benzocaine, dibucaine, lidocaine, tetracaine

70
Q

Photoaging

A

Characterized by a breakdown of

elastin

71
Q

Photoaging Risk Factors

A 
Chemical exposure
• Clinical and histologic changes
• Smoking
• UVR exposure
• Wind exposure
72
Q

Photoaging Clincal Presentation

A 
May present as changes in skin color,
surface texture, and functional
capacity
• May include development of pre and
cancerous lesions
73
Q

Skin Cancer

A
  • Non-melanoma skin cancers (NMSCs)

- Melanoma

74
Q

Non-melanoma skin cancers (NMSCs)

A

Basal cell carcinoma

• Squamous cell carcinoma

75
Q

Melanoma

A

Arises from normal skin or mole

76
Q

Skin Cancer – Melanoma Assessment

A

ABCDE rule for the ealry detection of melanoma
A- asymmetry
B- Borders ( the outer edges)
C- Color ( dark black or have multiple colors)
D- greater than 6 mm)
E- Evolving ( change in size, shape and color)

77
Q

Sunburn & Photoaging Risk Factors

A 
Fair skin
• Blonde or red hair
• Blue, green, or gray eyes
• History of freckling
• History of ≥1 serious/blistering sunburn(s)
• Family history of melanoma
• Immunosuppressant use
• History of autoimmune disease
• Excessive lifetime UVR exposure
78
Q

Exclusions to Self-Care

A

● Allergy to all sun protectant ingredients

● <6 month of age

79
Q

Non-Pharmacologic Treatments

A 
Avoidance
■ Avoid tanning equipment
■ Minimize exposure during peak hours
■ Seek shade
○ Protective clothing
■ Hat
■ Long sleeves
■ SPF clothing
80
Q

Pharmacologic Treatments

A

Sunscreen

81
Q

Prevention – Sunscreen Properties

A

“Broad spectrum”

82
Q

Sun protection factor (SPF)

A

■ Increased SPF = increased protection
● SPF 15 blocks 93% UVB filtered
● SPF 30 blocks 96.7% UVB filtered
● MAX = SPF 50+

83
Q

Water-resistant

A

■ Cream-based > alcohol-based

■ Duration listed on label

84
Q

Prevention – Sunscreen Types Chemical

A

Absorb UVR
● Products combined to maximize
UVA/UVB absorption

85
Q

Prevention: Sunscreen Types Chemical Examples

A 
● Aminobenzoic acid and derivatives
● Anthranilates
● Benzophenones
● Cinnamates
● Dibenzoylmethane derivatives
● Salicylates
86
Q

Prevention: Sunscreen Types Physical

A

Reflect/scatter UVR

87
Q

Prevention: Sunscreen Types Physical Examples

A

Titanium dioxide

● Zinc oxide

88
Q

Prevention – Sunscreen Application

A

Apply 15-30 minutes before exposure
• Reapply every 2 hours, or after 40-60 minutes of swimming or
sweating or after toweling off
• For sufficient protection, the average adult in a bathing suit should
apply 9 portions of sunscreen (approximately ½ teaspoon each)
• Face/neck = ½ teaspoon
• Arms/shoulder = ½ teaspoon per side
• Torso = ½ teaspoon front/back
• Legs/feet = 1 teaspoon per side

PHRM 504 (22 decks)

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