Therapeutics - Acne Flashcards
true or false
acne can be inflammatory or non inflammatory
true
true or false
acne is self limiting
true
true or false
there is mortality associated with acne
false - there’s not
differentiate between inflammatory acne lesions vs noninflammatory acne lesions
noninflammatory are open (blackheads) and closed (comedones)
inflammatory are papules/pustules/nodules (cysts)
there is NO universal grading system in place for acne
that being said, what’s the closes system we have
basing on the number and type of lesions, extent, regions, quality of life, severity (0-4 with 0 being clear)
what is the 5 point ordinal scale to quantify the severity of acne
0 is clear
4 is severe
true or false
in general, oral therapies are first line in mild and moderate acne
FALSE
topical is first line for mild-moderate
oral therapies reserved for moderate -severe (oral=systemic)
differentiate between papules vs pustules vs nodules
papules are raised regions with no pus
pustules have pus
nodular can cause scarring without even any manipulation (touching)
when picking the VEHICLE for topical acne treatment - what is a very important consideration
SKIN TYPE
dry oily or normal?
true or false
when choosing an acne product, we should only be considering the product
FALSE
product and vehicle
what is an issue with some OTC things for acne
abrasive soaps for example are irritating and can limit ability to tolerate other therapies
name a drug that can INDUCE acne lesions
topical or oral corticosteroids
name 4 drugs that can WORSEN acne
lithium
isonaizid
hydantoin
rifampin
cosmetics containing ___ or ___ may worsen acne
lanolin or oil
for women, what is a likely determinant that the acne is hormone related
oligomenorrhea or hirstuism + acne may be caused by polycystic ovarian disease or late-onset adrenal hyperplasia — increased androgen production
true or false
certain hormonal contraceptives can worsen acne
TRUE
name 2 physical complications of acne
scarring and hyperpigmentation
is acne considered chronic?
yes
even tho most ppl outgrow it, especially if hormonal
TRUE OR FALSE
cleaning the face as much as possible throughout the day can help to reduce acne
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
what does “noncomedogenic” mean
water-based cosmetics that don’t clog the pores
in choosing a soap for acne, avoid ones with high ____ content
oil
true or false
medicated and antibacterial soaps and astringents have no benefit in acne
true
explain the preferred methods of cleansing for inflammatory acne vs noninflammatory acne
for non-inflammatory, a mildly abrasive cleaner is okay - but nothing too crazy
for inflammatory - use GENTLE SOAPS
which 2 vehicles are good for use in the winter and why
creams and lotions bc of their moisturizing nature
which 2 vehicles are good for ANY skin type
explain why
washes and soap
they don’t stay on the skin for a long time and don’t affect the oilyness or dryness
***which vehicle should NEVER be used in acne patients
OIL
too occlusive and does the opposite of what we want
skin type for creams vs lotions
creams - normal
lotion - normal-dry
which vehicle is most convenient to use
soaps
skin type for gels
oily-normal
has drying effects
name 2 vehicles that are best for pts with sensitive skin
washes and lotions
skin type for foams
oily-normal
also drying like gels
name the 2 classes of topical therapy used in acne
antimicrobial
comedolytics
is the main action of benzoyl peroxide as an antimicrobial or comedolytic
mainly antimicrobial
for ALL acne, what is 1st line treatment
topical retinoids/benzoyl peroxide are equally considered 1st line
as MONOtherapy
if doesnt work, add the one not used at 1st
true or false
topical antibiotics are 1st line for mild acne
not really
Bp and retinoids are preferred and should be tried 1st
name the 3 strongly recommended “fixed dose” topical combinations
topical AB and retinoid
topical retinoid and BP
topical retinoid and topica; antibiotic
name 3 topical agents that are only conditionally recommended
clascoterone
salicylic acid
azelaic acid
only treatment for acne conditionally recommended against
pneumatic broadband light added to adapalene
what is the concern with systemic antibiotics used for acne and what do we recommend to combat this
ANTIBIOTIC RESISTANCE
thus - never use as monotherapy. add benzoyl peroxide or some other topical treatment (not another AB)
antibiotics for acne - whether systemic or topical - should NEVER be used alone
true
1st line systemic antibiotic for moderate-severe acne
doxycycline
what is the close 2nd to doxycycline
minocycline
_____ is preferred over azithromycin as a systemic antibiotic for acne
doxycycline
aside from topical treatments, name 3 other categories potentially that can be used for moderate-severe acne
systemic antibiotics
hormonal agents
isotretinoin
name 3 hormonal agents that can potentially be used for moderate-severe acne
combined oral contraceptives
spironolactone
intralesional corticosteroids (adjunctive for larger acne papules at risk of scarring)
name 4 potential systemic antibiotics for moderate-severe acne
doxycycline
minocycline
sarecycline
azithromycin (not preferred)
is isotretinoin given with other topical agents
NO
once you start this, you come off EVERYTHING ELSE
last line acne treatment
isotretinoin
what is recommended to be monitored when a patient is on isotretinoin
liver function tests and lipids
true or false
pts on spironolactone should always monitor their potassium levels
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
patients with ____ or ____ should be considered cnadidates for isotretinoin
psychosocial burden or scarring
which is preferred for isotretinoin - daily dosing or intermittent dosing
daily
sulfur is an OTC topical product marketed for acne
is it recommended?
no recommendation - evidence is insufficient
what is the recommendation for salicylic acid
conditionally recommended (not strong)
OTC - topical glycolic acid, sodium sulfacetamide, resorcinol, tea tree oils
what is recommendation
no evidence sufficient to develop recommendation
caution with salicylic acid
it is an irritant that may exacerbate inflammatory lesions
if excess irritation occurs while a patient is on a topical sulfur or salicylic acid, what should they do?
discontinue and contact md
true or false
topical retinoids are first line treatment for inflammatory AND noninflammatory acne
TRUE
topical retinoids can be used in combo with __ or ___ for mild-moderate acne (both inflamma and non)
BP or topical antibiotic
Retin-A vs Retin-A micro
retin-a micro has a better side effect profile
tretinoin vehicles in order of increasing potency
least potent - liquid
creams
most potent = gels
aside from tretinoin, name 3 other topical retinoids
adapalene
tazarotene
tritarotene
explain what does topical retinoids should be started on and why
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
patient education with topical retinoids
-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
why is it that patients on topical retinoids burn more easily
the thickness of the stratum corneum is reduced
what time of day should topical retinoids be applied at
bedtime
if someone is using a topical retinoid and benzoyl peroxide, what is a counseling point
their application should be separated
(unless it’s adapalene)
true or false
adapalene can be applied immediately after washing
TRUE
this and micro are the only topical retinoids – all the others have to wait 30mins
tazorotene
any benefits over adapalene or tretinoin? anything that’s worse?
it may be more efficacious than adapalene and tretinoin, but has more side effects
is adapalene contraindicated in pregnancy
NO - category C – shown to have adverse effects in animal fetus but not human yet
tazarotene IS teratogenic
what is unique about tritarotene
it selectively targets gamma RAR
thus, potentially has better efficacy and reduced skin irritation – but clinical evidence still lacking
what is the most expensive topical retinoid
tritarotene
