PCOL Acne (Maize) Flashcards
Keratolytics
benzoyl peroxide
sulfur
salicylic acid
Benzoyl peroxide products
Clearasil, Fostex, Oxy-10
Benzoyl peroxide mechanism of action
converted to benzoic acid - a potent oxidizing agent in the skin
Benzoyl peroxide pharmacological effect:
- ____ keratinocytes
- increases ____ rate of keratinocytes
- prevents ____ of follicles
- antibacterial activity against ____
- loosens
- turnover
- closure
- P. acnes
Benzoyl peroxide side effects
- drying & peeling of skin
- burning, blistering, scaling, edema
- no systemic side effects
Sulfur products
Fostril, Liquimat, combination products
Sulfur mechanism of action
forms hydrogen sulfide when applied to skin
Sulfur pharmacological effect H–S:
- causes inflammation which promotes ____ and ____ of plugs
- ____ properties due to inactivation of ____ enzymes
- peeling; unblocking
- antibacterial; bacterial
Sulfur side effects
redness, irritation, peeling, odor, comedogenic (acne-producing)
Salicylic acid mechanism of action
lowers skin pH, increasing the hydration of keratin, facilitating the loosening and removal of keratinized skin cells
Salicylic acid pharmacological effect:
- promote shedding of ____ ____
- effects range from ____ to ____ (dependent on ____)
- stratum corneum
- peeling; desquamation; concentration
Salicylic acid concentrations:
- for dandruff, acne and psoriasis?
- for wart and corn removal?
- 3-6% (6% may cause skin damage)
- up to 40%
Salicylic acid side effects
- irritation and inflammation of normal skin
- salicylism
Acne antibiotic drugs:
tetracycline, minocycline, doxycycline, clindamycin, erythromycin
metronidazole
azelaic acid
Acne antibiotic mechanism of action (except metronidazole)
reduces P. acnes by inhibiting protein synthesis (bacteriostatic) and decreases the percentage of free fatty acids
Tetracycline brand names
Achromycin, Sumycin, Topicycline
Tetracycline unique mechanism
decreases keratin in the sebaceous pores
Tetracycline side effects (oral)
GI: N/V/D
pseudomembraneous colitis
Tetracycline:
- ____ and ____ are discolored and ____ is impaired in the young (binds to ____; can’t give with milk, antacids, aluminum…)
- ____ for fair-skinned people
- increased incidence of ____
- little use of ____ tetracycline
- bones; teeth; growth; calcium
- photosensitivity
- superinfections
- topical
Monocycline brand name?
Doxycycline brand name?
They may be more efficacious than ____
Side effects?
- Minocin
- Vibramycin
- tetracycline
- ototoxicity and darkening of skin and teeth more than tetracycline
Erythromycin brand names
E-mycin, Ery-tab, A/T/S, Erycette, T-Stat, Ery-Sol, Benzamycin
Erythromycin side effects
- oral?
- topical?
- N/V/D, epigastric pain, CYP3A4 inhibition
- burning and drying, especially when combined with benzoyl peroxide
Metronidazole brand names
Flagyl, Metrogel
Metronidazole mechanism of action
unknown, but used for acne rosacea instead of acne vulgaris
inhibits growth of Demodex brevis
Metronidazole side effects:
- N/V/D
- peripheral ____ with prolonged use
- ____ reaction (headache, copious ____, ____tension, possible death)
- ____ in animals
- burning, stinging, drying
- neuropathy
- disulfuram; vomiting; hypo
- carcinogenic
- burning, stinging, drying
Azelaic acid brand name
Azelex
Azelaic acid pharmacological effect
antimicrobial action, reduction in the thickness of the stratum corneum, anti-wrinkle
Azelaic acid side effects
- pruritis, burning, stinging, tingling
- erythema, dryness, rash
Retinoids
vitamin A
tretinoin
adapalene
isotretinoin
Vitamin A is necessary for cell ____, ____ and ____ of epithelial cells, the ____ system and vision.
Deficiency results in ____ and keratotic skin.
High and low ____ give the same effect on skin, eyes and birth defects.
growth; differentiation; homeostasis; reproduction
hyperplastic
doses
Tretinoin brand names
Retin-A, Renova, Avita, Retin-A Micro
Tretinoin and isotretinoin mechanism:
- Direct?
- Indirect?
- homo- or hetero-dimer retinoid-receptor complexes bind to RARE and either promote or inhibit protein transcription
- one receptor complex binds a transcription factor preventing it from binding to TRE on the DNA
Tretinoin and adapalene pharmacological effects:
- Decreases ____, promotes ____, increases the ____ and reduces the ____ of keratinocytes
- the change in protein transcription has ____ and ____ activity
- Reduces the thickness of the ____ ____
- proliferation; differentiation; turnover; cohesiveness
- anti-inflammatory; anti-proliferative
- stratum corneum
Tretinoin side effects
- blistering, peeling, crusting, burning, edema
- photosensitizing
- might get worse before it gets better
- no known systemic side effects
Adapalene brand name
Differin (topical)
Adapalene mechanism of action
same as other retinoids except it binds to RAR beta and gamma (leading receptor in skin) receptors only
Adapalene side effects
erythema, scaling, dryness, pruritis, burning
Isotretinoin brand name
Accutane (oral)
Isotretinoin pharmacological effect:
- decreases ____ ____ size
- decreases ____ production
- reduces ____ by inhibiting ____ release from macrophages
- reduces ____
- sebaceous gland
- sebum
- inflammation; prostaglandin
- keratinization
Isotretinoin common side effects
- Common: inflammation of lips, epitaxis, itching of skin and nose, xerosis, conjunctivitis, xerophthalmia
- Less common: skin rash, peeling on palms and soles, photosensitization, alopecia, arthralgia
Isotretinoin CNS side effects
- persistant headache
- lethargy, fatigue, depression, psychosis, suicidal ideation
Isotretinoin ophthalmic effects
- conjunctivitis, blurred/tunnel vision, diplopia,
- reduction of night vision (rare)
- optic neuritis, cataracts, papiledema (rare)
Isotretinoin effects of blood lipids:
- increase ____ and plasma ____ levels
- reduces ____ levels
- triglycerides; cholesterol
- HDL
Retinoids are ____ which are signaling molecules that control the ____ pattern of differentiation, making it a ____.
morphogens; spatial; teratogenic
Push for retinoid removal from market due to
birth defects, teen suicide and 50% greater risk of Crohn’s disease
Pseudomembranous colitis, a side effect of ____ and ____ (antibiotics), may lead to a ______ caused by C. ______.
tetracycline; clindamycin; superinfection; difficile
Clindamycin brand names
Cleocin, Cleocin T, C/T/S
Clindamycin oral side effects:
- ____ colitis (____infection)
- N/V/D
- impaired ____ function
- ____ (rare)
- pseudomembraneous colitis; super
- liver
- neutropenia
Clindamycin topical side effects
- dryness or peeling of skin
- contact dermatitis
