Mehlman/Uw acne treatment 04-08 (3) Flashcards
M. 5 Tx steps
.
M. 1st step Tx? what adverse?
Topical retinoids (ie topical tertinoin, NOT oral isotretinoin)
adverse: cause photosensitivity (RASH) + desquamation
M. 1st. step. Topical retinoids also used for …
for photoaging
M. 1st. step. Topical retinoids mechanism?
decreasing sebum production
M. 1st. step. Topical retinoids (NOT oral isotretinoin) is teratogen?
NO!!!
It is not a teratogen and does NOT have any effect on pregnancy or male sperm
M. 2nd step Tx?
Benzoyl peroxide
M. 2nd step. Benzoyl peroxide used with?
often coadministered with TOPICAL RETINOIDS
M. 2nd step. Benzoyl peroxide mechanism?
killing of bacteria + clear pores
M. Topical retinoids (ie topical tertinoin, NOT oral isotretinoin) what step?
1st step
M. Benzoyl peroxide, what step?
2nd step
M. step 3 Tx?
Topical clindamycin
M. Topical clindamycin what step?
step 3
M. step 4 Tx?
Oral tetracycline
M. step 4. Oral tetracycline. what adverse?
photosensitivity (BLISTERING)
M. Oral tetracycline what step?
4 step
M. Step 5 Tx?
Oral isotretinoin
M. Oral isotretinoin what step?
5 step
M. step 5, oral isotretinoin. what must to do?
what ,,prevention”?
do beta-hCG in women
recommend barrier contraception even if on OCP.
M. step 5, oral isotretinoin. adverse?
can cause elevations in LFTs, dyslipidemia
Main complaint is dry skin+peeling
M. step 5, oral isotretinoin. onset?
takes several week to really start working but ultra-effective according to most patients
can be commenced earlier in patients with severe nodulocystic acne
M. step 5, oral isotretinoin. mechanism?
works by diffusely shutting of sebum production
M. NBME case.
Girl + starting OCP + same time takes oral isotretinoin. Q - what else should do?
recommend barrier contraception
M. USMLE what to know mechanism that were mentioned there.
.
M. USMLE want to know that:
1 and 2nd are initial steps.
5th is the last resort
1st and 4th cause photosensitivity
also mechanism
.
UW. Drug induced acne.
It is also called steroid-induced folliculitis or steroid acne.
.
UW. Drug induced acne. Common triggers?
*GLUCOCORTICOIDS, androgens
*Immunomodulators (eg azathioprine, EGFR inhibitors)
*Anticonvulsants (eg phenytoin), antipsychotics
*Antituberculous drugs (isoniazid)
UW. Drug induced acne. CP?
MONOMORPHIC PAPULES or pustules
Lack of comedones, cysts and nodules
Location and age of onset may be atypical for acne
UW. Drug induced acne. management?
discontinue offending medication
Standard acne therapy unlikely to be effective
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)
.
UW table. Comedonal acne. CP?
closed or open comedones on forehead, nose and chin; may progress to inflammatory pustules or nodules
UW table. Comedonal acne. Tx?
Topical retinoids
also: salicylic, azetaic or glycolic acid
UW table. Inflammatory acne. CP?
Inflamed papules (<5mm) and pustules, erythema
UW table. Inflammatory acne. Tx? mild
topical retinoinds + benzoyl peroxide
UW table. Inflammatory acne. Tx? moderate
add topical abs (clindamycin, erythromycin)
UW table. Inflammatory acne. Tx? severe
add oral antibiotics
UW table. Nodular (cystic) acne. CP?
Large (>5 mm) nodules that can appear cystic
nodules may merge to form sinus tracts with possible scarring
UW table. Nodular (cystic) acne. Tx? moderate
topical retinoid + benzoyl peroxide + topical antibiotics
UW table. Nodular (cystic) acne. Tx? severe
add oral antibiotics
UW table. Nodular (cystic) acne. Tx? unresponsive severe
ORAL ISOTRETIOIN
*check for pregnancy
M. topical retinoids photosensitivity. how looks, how prevent?
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
M. do not choose answers such as “avoidance of spicy/sweet foods” for acne
questions.
.
