Mehlman/Uw acne treatment 04-08 (3)

Question 1

M. 5 Tx steps

Answer 1

.

Question 2

M. 1st step Tx? what adverse?

Answer 2

Topical retinoids (ie topical tertinoin, NOT oral isotretinoin)
adverse: cause photosensitivity (RASH) + desquamation

Question 3

M. 1st. step. Topical retinoids also used for …

Answer 3

for photoaging

Question 4

M. 1st. step. Topical retinoids mechanism?

Answer 4

decreasing sebum production

Question 5

M. 1st. step. Topical retinoids (NOT oral isotretinoin) is teratogen?

Answer 5

NO!!!
It is not a teratogen and does NOT have any effect on pregnancy or male sperm

Question 6

M. 2nd step Tx?

Answer 6

Benzoyl peroxide

Question 7

M. 2nd step. Benzoyl peroxide used with?

Answer 7

often coadministered with TOPICAL RETINOIDS

Question 8

M. 2nd step. Benzoyl peroxide mechanism?

Answer 8

killing of bacteria + clear pores

Question 9

M. Topical retinoids (ie topical tertinoin, NOT oral isotretinoin) what step?

Answer 9

1st step

Question 10

M. Benzoyl peroxide, what step?

Answer 10

2nd step

Question 11

M. step 3 Tx?

Answer 11

Topical clindamycin

Question 12

M. Topical clindamycin what step?

Answer 12

step 3

Question 13

M. step 4 Tx?

Answer 13

Oral tetracycline

Question 14

M. step 4. Oral tetracycline. what adverse?

Answer 14

photosensitivity (BLISTERING)

Question 15

M. Oral tetracycline what step?

Answer 15

4 step

Question 16

M. Step 5 Tx?

Answer 16

Oral isotretinoin

Question 17

M. Oral isotretinoin what step?

Answer 17

5 step

Question 18

M. step 5, oral isotretinoin. what must to do?
what ,,prevention”?

Answer 18

do beta-hCG in women
recommend barrier contraception even if on OCP.

Question 19

M. step 5, oral isotretinoin. adverse?

Answer 19

can cause elevations in LFTs, dyslipidemia
Main complaint is dry skin+peeling

Question 20

M. step 5, oral isotretinoin. onset?

Answer 20

takes several week to really start working but ultra-effective according to most patients

can be commenced earlier in patients with severe nodulocystic acne

Question 21

M. step 5, oral isotretinoin. mechanism?

Answer 21

works by diffusely shutting of sebum production

Question 22

M. NBME case.
Girl + starting OCP + same time takes oral isotretinoin. Q - what else should do?

Answer 22

recommend barrier contraception

Question 23

M. USMLE what to know mechanism that were mentioned there.

Answer 23

.

Question 24

M. USMLE want to know that:
1 and 2nd are initial steps.
5th is the last resort
1st and 4th cause photosensitivity

also mechanism

Answer 24

.

Question 25

UW. Drug induced acne. It is also called steroid-induced folliculitis or steroid acne.

Answer 25

.

Question 26

UW. Drug induced acne. Common triggers?

Answer 26

*GLUCOCORTICOIDS, androgens *Immunomodulators (eg azathioprine, EGFR inhibitors) *Anticonvulsants (eg phenytoin), antipsychotics *Antituberculous drugs (isoniazid)

Question 27

UW. Drug induced acne. CP?

Answer 27

MONOMORPHIC PAPULES or pustules Lack of comedones, cysts and nodules Location and age of onset may be atypical for acne

Question 28

UW. Drug induced acne. management?

Answer 28

discontinue offending medication Standard acne therapy unlikely to be effective

Question 29

UW. Drug induced acne. Case (buvo pamineta ,,you got this wrong"). Girl + use GK + got acne on back, arms, many places + all they were same size (monomorphic)

Answer 29

.

Question 30

UW table. Comedonal acne. CP?

Answer 30

closed or open comedones on forehead, nose and chin; may progress to inflammatory pustules or nodules

Question 31

UW table. Comedonal acne. Tx?

Answer 31

Topical retinoids also: salicylic, azetaic or glycolic acid

Question 32

UW table. Inflammatory acne. CP?

Answer 32

Inflamed papules (<5mm) and pustules, erythema

Question 33

UW table. Inflammatory acne. Tx? mild

Answer 33

topical retinoinds + benzoyl peroxide

Question 34

UW table. Inflammatory acne. Tx? moderate

Answer 34

add topical abs (clindamycin, erythromycin)

Question 35

UW table. Inflammatory acne. Tx? severe

Answer 35

add oral antibiotics

Question 36

UW table. Nodular (cystic) acne. CP?

Answer 36

Large (>5 mm) nodules that can appear cystic nodules may merge to form sinus tracts with possible scarring

Question 37

UW table. Nodular (cystic) acne. Tx? moderate

Answer 37

topical retinoid + benzoyl peroxide + topical antibiotics

Question 38

UW table. Nodular (cystic) acne. Tx? severe

Answer 38

add oral antibiotics

Question 39

UW table. Nodular (cystic) acne. Tx? unresponsive severe

Answer 39

ORAL ISOTRETIOIN *check for pregnancy

Question 40

M. topical retinoids photosensitivity. how looks, how prevent?

Answer 40

HY foto: mazyciai balti taskuciai ant veido, rausvu demeliu fone. atrodo kaip mazi spuogiukai. Prevent: “avoidance of sun exposure”; tetracycline photosensitivity, in contrast, tends to be blistering

Question 41

M. do not choose answers such as “avoidance of spicy/sweet foods” for acne questions.

Answer 41

.