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Intro to D&D Final > Therapeutics - Acne > Flashcards

Therapeutics - Acne Flashcards

1
Q

true or false

acne can be inflammatory or non inflammatory

A

true

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2
Q

true or false

acne is self limiting

A

true

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3
Q

true or false

there is mortality associated with acne

A

false - there’s not

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4
Q

differentiate between inflammatory acne lesions vs noninflammatory acne lesions

A

noninflammatory are open (blackheads) and closed (comedones)

inflammatory are papules/pustules/nodules (cysts)

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5
Q

there is NO universal grading system in place for acne

that being said, what’s the closes system we have

A

basing on the number and type of lesions, extent, regions, quality of life, severity (0-4 with 0 being clear)

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6
Q

what is the 5 point ordinal scale to quantify the severity of acne

A

0 is clear

4 is severe

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7
Q

true or false

in general, oral therapies are first line in mild and moderate acne

A

FALSE

topical is first line for mild-moderate

oral therapies reserved for moderate -severe (oral=systemic)

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8
Q

differentiate between papules vs pustules vs nodules

A

papules are raised regions with no pus

pustules have pus

nodular can cause scarring without even any manipulation (touching)

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9
Q

when picking the VEHICLE for topical acne treatment - what is a very important consideration

A

SKIN TYPE

dry oily or normal?

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10
Q

true or false

when choosing an acne product, we should only be considering the product

A

FALSE

product and vehicle

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11
Q

what is an issue with some OTC things for acne

A

abrasive soaps for example are irritating and can limit ability to tolerate other therapies

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12
Q

name a drug that can INDUCE acne lesions

A

topical or oral corticosteroids

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13
Q

name 4 drugs that can WORSEN acne

A

lithium
isonaizid
hydantoin
rifampin

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14
Q

cosmetics containing ___ or ___ may worsen acne

A

lanolin or oil

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15
Q

for women, what is a likely determinant that the acne is hormone related

A

oligomenorrhea or hirstuism + acne may be caused by polycystic ovarian disease or late-onset adrenal hyperplasia — increased androgen production

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16
Q

true or false

certain hormonal contraceptives can worsen acne

A

TRUE

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17
Q

name 2 physical complications of acne

A

scarring and hyperpigmentation

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18
Q

is acne considered chronic?

A

yes

even tho most ppl outgrow it, especially if hormonal

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19
Q

TRUE OR FALSE

cleaning the face as much as possible throughout the day can help to reduce acne

A

FALSE

over cleaning can cause irritation to the face

the SURFACE sebum and bacteria do not cause acne – only if they get inside it can cause complications

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20
Q

what does “noncomedogenic” mean

A

water-based cosmetics that don’t clog the pores

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21
Q

in choosing a soap for acne, avoid ones with high ____ content

A

oil

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22
Q

true or false

medicated and antibacterial soaps and astringents have no benefit in acne

A

true

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23
Q

explain the preferred methods of cleansing for inflammatory acne vs noninflammatory acne

A

for non-inflammatory, a mildly abrasive cleaner is okay - but nothing too crazy

for inflammatory - use GENTLE SOAPS

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24
Q

which 2 vehicles are good for use in the winter and why

A

creams and lotions bc of their moisturizing nature

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25
Q

which 2 vehicles are good for ANY skin type

explain why

A

washes and soap

they don’t stay on the skin for a long time and don’t affect the oilyness or dryness

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26
Q

***which vehicle should NEVER be used in acne patients

A

OIL

too occlusive and does the opposite of what we want

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27
Q

skin type for creams vs lotions

A

creams - normal

lotion - normal-dry

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28
Q

which vehicle is most convenient to use

A

soaps

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29
Q

skin type for gels

A

oily-normal

has drying effects

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30
Q

name 2 vehicles that are best for pts with sensitive skin

A

washes and lotions

31
Q

skin type for foams

A

oily-normal

also drying like gels

32
Q

name the 2 classes of topical therapy used in acne

A

antimicrobial

comedolytics

33
Q

is the main action of benzoyl peroxide as an antimicrobial or comedolytic

A

mainly antimicrobial

34
Q

for ALL acne, what is 1st line treatment

A

topical retinoids/benzoyl peroxide are equally considered 1st line

as MONOtherapy
if doesnt work, add the one not used at 1st

35
Q

true or false

topical antibiotics are 1st line for mild acne

A

not really

Bp and retinoids are preferred and should be tried 1st

36
Q

name the 3 strongly recommended “fixed dose” topical combinations

A

topical AB and retinoid

topical retinoid and BP

topical retinoid and topica; antibiotic

37
Q

name 3 topical agents that are only conditionally recommended

A

clascoterone
salicylic acid
azelaic acid

38
Q

only treatment for acne conditionally recommended against

A

pneumatic broadband light added to adapalene

39
Q

what is the concern with systemic antibiotics used for acne and what do we recommend to combat this

A

ANTIBIOTIC RESISTANCE

thus - never use as monotherapy. add benzoyl peroxide or some other topical treatment (not another AB)

40
Q

antibiotics for acne - whether systemic or topical - should NEVER be used alone

A

true

41
Q

1st line systemic antibiotic for moderate-severe acne

A

doxycycline

42
Q

what is the close 2nd to doxycycline

A

minocycline

43
Q

_____ is preferred over azithromycin as a systemic antibiotic for acne

A

doxycycline

44
Q

aside from topical treatments, name 3 other categories potentially that can be used for moderate-severe acne

A

systemic antibiotics
hormonal agents
isotretinoin

45
Q

name 3 hormonal agents that can potentially be used for moderate-severe acne

A

combined oral contraceptives

spironolactone

intralesional corticosteroids (adjunctive for larger acne papules at risk of scarring)

46
Q

name 4 potential systemic antibiotics for moderate-severe acne

A

doxycycline
minocycline
sarecycline
azithromycin (not preferred)

47
Q

is isotretinoin given with other topical agents

A

NO

once you start this, you come off EVERYTHING ELSE

48
Q

last line acne treatment

A

isotretinoin

49
Q

what is recommended to be monitored when a patient is on isotretinoin

A

liver function tests and lipids

50
Q

true or false

pts on spironolactone should always monitor their potassium levels

A

not really - not really useful unless at risk for hyperkalemia like if they’re old or have other medical comorbidities or medications that can cause it

51
Q

patients with ____ or ____ should be considered cnadidates for isotretinoin

A

psychosocial burden or scarring

52
Q

which is preferred for isotretinoin - daily dosing or intermittent dosing

A

daily

53
Q

sulfur is an OTC topical product marketed for acne

is it recommended?

A

no recommendation - evidence is insufficient

54
Q

what is the recommendation for salicylic acid

A

conditionally recommended (not strong)

55
Q

OTC - topical glycolic acid, sodium sulfacetamide, resorcinol, tea tree oils

what is recommendation

A

no evidence sufficient to develop recommendation

56
Q

caution with salicylic acid

A

it is an irritant that may exacerbate inflammatory lesions

57
Q

if excess irritation occurs while a patient is on a topical sulfur or salicylic acid, what should they do?

A

discontinue and contact md

58
Q

true or false

topical retinoids are first line treatment for inflammatory AND noninflammatory acne

A

TRUE

59
Q

topical retinoids can be used in combo with __ or ___ for mild-moderate acne (both inflamma and non)

A

BP or topical antibiotic

60
Q

Retin-A vs Retin-A micro

A

retin-a micro has a better side effect profile

61
Q

tretinoin vehicles in order of increasing potency

A

least potent - liquid

creams

most potent = gels

62
Q

aside from tretinoin, name 3 other topical retinoids

A

adapalene

tazarotene

tritarotene

63
Q

explain what does topical retinoids should be started on and why

A

start at VERY LOW DOSE (0.025%) as cream, micro, or adapalene either every other or every 3rd night

progressing as tolerated over 2-3weeks to NIGHTLY APPLICATION (goal)

concs can be increased if needed and tolerated

exacerbates acne at 1st

64
Q

patient education with topical retinoids

A

-will exacerbate at 1st – resolves in 3-6 weeks

mild-severe irritation occurs at 1st

redness, dryness, peeling

applied ONCE DAILY to completel dry skin at least 30mins after washing (for micro or adapalene - dont need to wait this long)

applied at bedtime, and apply sunscreen bc can burn more easily

65
Q

why is it that patients on topical retinoids burn more easily

A

the thickness of the stratum corneum is reduced

66
Q

what time of day should topical retinoids be applied at

A

bedtime

67
Q

if someone is using a topical retinoid and benzoyl peroxide, what is a counseling point

A

their application should be separated

(unless it’s adapalene)

68
Q

true or false

adapalene can be applied immediately after washing

A

TRUE

this and micro are the only topical retinoids – all the others have to wait 30mins

69
Q

tazorotene

any benefits over adapalene or tretinoin? anything that’s worse?

A

it may be more efficacious than adapalene and tretinoin, but has more side effects

70
Q

is adapalene contraindicated in pregnancy

A

NO - category C – shown to have adverse effects in animal fetus but not human yet

tazarotene IS teratogenic

71
Q

what is unique about tritarotene

A

it selectively targets gamma RAR

thus, potentially has better efficacy and reduced skin irritation – but clinical evidence still lacking

72
Q

what is the most expensive topical retinoid

A

tritarotene

73
Q
A

Intro to D&D Final (22 decks)

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