Unit 1 Acne Treatment Flashcards by Lyndsey Maves

What is the most common skin disease?

Acne Vulgaris

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Acne Vulgaris affects what age range most?

12-25yrs

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Who is more prone to develop acne vulgaris? Males or Females?/

Both genders are equally prone as well as race and ethnicity

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More the more androgens the less sebum is produced.

T or F

False; the more androgens = more sebum produced

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How are comedomes formed?

Excess sebum + sloughing of keratinocytes

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Acne vulgaris is caused by

a. virus
b. fungus
c. bacteria
d. all of the above
e. none of the above

c. Bacteria

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What is the bacteria that causes acne vulgaris?

Propionibacterium acnes (P. acnes)

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How does the inflammatory response begin in a patient with acne vulgaris?

P. acnes convert sebum to free fatty acids

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Where are the most common locations one would develop acne vulgaris?

face, neck, back, shoulders

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Follicular plugging takes about \_\_\_ weeks to evolve into 
an inflammatory lesion.
a. 2 weeks
b. 3 weeks
c. 4 weeks
d. 6 weeks 
e. it happens instantaneously

c. 4 weeks

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What takes longer to form? An inflammatory lesion or a closed comedone?

Inflammatory lesion

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A closed comedone is also known as.

A whitehead

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An open comedone is also known as.

A blackhead

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What are the goals in prescribing an acne treatment?

eliminate existing lesions & prevent new lesions from developing
decrease discomfort
prevent or minimize scarring

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You tell a patient you want them to use mild, noncomedogenic facial soap bid, avoid oily skin products and acne lesion manipulation. What type of specific treatment is this called?

Nonpharmacologic Treatment

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What are some predisposing factors that will help the provider make the best pharmacological treatment?

severity, lesion types, scarring, skin discoloration, previous treatment history, patient tolerance

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How long does it take for a pt to see improvement with their acne treatment?

Can take up to 6 yo 8 weeks to see results (reduce or prevent new eruptions)

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Once beginning a treatment for acne vulgaris, it is common a pt will see flare initially? T or F? Explain

True. The initial lesions may resolve more rapidly causing an increase in flare up.

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Open and closed comedones would be considered inflammatory or noninflammatory lesions?

Noninflammatory lesions

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Describe mild acne vulgaris.

Noninflammatory lesions (open and closed comedones)
     or 
Noninflammatory lesions (backheads &amp; whiteheads)

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List the types of Topical Retinoids (both generic and there trade name).

Generic Trade

Tretinoin *Retinin - A
Adapalene *Differin
Tazarotene *Avage, Tazorac

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List the Topical Retinoid that is a contraindication in pregnancy.

G -Tazarotene

T - Avage, Tazorac

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What are the adverse effects for someone given Tretinoin or Retin-A?

erythema, dryness, burning, photosensitivity

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What is the mechanism of action for Tretinoin or Retin-A?

Vitamin A analog (retinoid)
increases cell turnover in follicular wall resulting in resolution of existing comedones & inhibition of new comedones formation
anti-inflammatory effects

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When is the best time to tell your pt to use the topical cream Tretinoin or Retin-A?

qhs - qohs | after washing area with mild,noncomedone cleanser

Why is qhs the best time to use Tretinoin or Retin-A?

Because it is deactivated by sunlight

What do all these topical retinoids have in common? | Tretinoin, Adapalene, Tazarotene

They are all taken qhs

What is the MOA (mechanism of action) for Adapalene? | Trade - Differen.

MOA: Retinoid-mimetic, may have anti-inflammatory properites

What is another alternative topical retinoid cream that has better tolerability to Tretinoin? What are the cons?

G: Adapalene T: Differen | Cons- more expensive

What is another alternative topical retinoid cream that is more irritating than Tretinoin? What is it's cost?

G: Tazaroten T: Avage, Tazorac $240

What is the MOA (mechanism of action) of Tazarotene?

MOA: New generation retinoid, anti-inflammatory effects

Benzoyl Peroxide cream is what type of medication? Is this a Generic medication or Trade?

Topical Antimicrobial- Generic

What is the Trade Name for Topical Benzoyl Peroxide?

Benzagel

What is the dosage for someone Rx w/ Benzoyl Peroxide/Benzagel? And when should they take it

2.5-5% gel; qday - bid

What is the MOA for Benzoyl Peroxide / Benzagel?

MOA: nonantibiotic antibacterial & exfolliant (comedolitic)

This medication may bleach your fabric? a. Tetracycline b. Dapsone c. Erythromycin d. Benzoyl peroxide e. Tretinoin

d. Benzoyl Peroxide

What is the most frequent adverse affect for Benzoyl Peroxide? T: Benzagel

AE: Local irritation & dryness

List some mild acne topical antimicrobial medications we have studied in class. Generic and Trade Names.

Generic Trade Benzoyl Peroxide Benzagel Clindamycin Cleocin -T Erythromycin Ery

How often should mild acne vulgaris topical agents be given?

qday -bid

What is the MOA of Clindamycin and Erythromycin?

1. Kill bacteria in follicles 2. effective for pupulopusturlar lesions 3. Anti-inflammatory Properties

Why is Clindamycin and Erythromycin more beneficial than BPO?

Less irritating; less drying

What type of vehicle is BPO?

Alcohol

How often should a patient use Azelaic Acid cream for mild acne vulgaris?

20% cream bid

What is the MOA of Azelaic acid?

1. Interferes with bacterial DNA synthesis (kills bacteria) | 2. Anti-inflammatory, not primary irritant

List the side of affects to using Azelaic Acid.

1. Local irritation 2. pruritis 3. possible burning

What is the generic drug for Aczone (Trade Name)

Dapsone

Is Dapsone a topical cream, ointment or gel?

Gel

What is the dose for Dapsone?

5% gel bid

What is the MOA for Aczone?

1. believed to interfere w/ chemotactic migration of neutrophils and interrupt the inflammatory cascade 2. Believed to help reduce the formation of neutrophil-generated destructive oxygen-bearing molecules which irritate the skin

What is the Adverse Effect of using Daspsone?

oiliness/peeling (19%), dryness (16%), erythema (13%) at the application site

Give an example of a TA drug and TR drug used together for mild acne vulgaris.

TA - BPO | TR - Tretinoin

A pt diagnosed with inflammatory papules and pustules with some noninflammatory lesions. Would be described as what type of acne?

Moderate Acne

What type of category drug(s) are used for moderate acne?

Topical Retnoids + Oral Antibiotics +/- BPO

What are the 3 first line defense oral antibiotics that can be used for Moderate acne vulgaris? List the Generic and Trade Names.

Generic Trade * Doxycycline *Adoxa * Minocycline *Minocin * Tetracycline *Sumycin

What medication is a second line for moderate acne vulgaris?

Generic: Erythromycin Trade: Ery-Tab

What is a 3rd line medication for moderate acne vulgaris?

Generic: Trimethoprim-sulfamethoxazole Trade: Septra, Bactrim

These medications are all Tetracycline medications?

Doxycycline, Minocycline, Tetracycline

This medication should not be used in children

1st Line Medications - Tetracyclines | Moderate Acne Vulgaris - Oral Antibiotics

If a child less than 8 years or a female who is pregnant or nursing is given Doxycycline, what will be the consequences?

Secondary permanent tooth discoloration; abnormalities in bone formation

What are the Adverse Effects in a patient who may take a first line medication for moderate acne vulgaris?

photosensitivity, GI upset, pseudomotor cerebri (benign intracranial HTN)

When should a patient take Tetracycline?

on an empty stomach (1 hr before or 2 hr after meals); interacts w/ dairy, Ca, Fe, Mg, Zn

This medication causes abnormal pigmentation, vertigo, rarely a severe drug Rxn (lupus-like Rxn).

Minicycline - an OA for moderate acne vulgaris

What medication will cause GI upset and cutaneous reactions?

Erythromycin

When would a pt be given Trimethoprim-sulfamethoxazole ( Septra/ Bactrim). Be specific.

Pt- Dx w/ moderate acne vulgaris | For those who cannot tolerate TCNs or erythromycin in cases of resistance to TCNs and erythro

Why would it be beneficial to give a patient Doxycycline over Minocycline?

Because Doxycycline: 1. taken qday vs Mino as day-bid 2. doesn't cause abnormal pigmentation, vertigo, or severe drug rxn 3. cheaper

What is the MOA of oral contraceptives?

Androgen levels correlate w/ sebum production. | OC's decrease unbound (free) biologically active androgens. (ie. free testosterone)

What 3 Oral contraceptives are FDA approved?

1. Ortho Tri-Clclen 2. Estrostep 3. Yaz

Norgestimate (triphasic)/0.35 mg ethinyl estradiol) is the chemical make up of what medication?

Ortho Tri-Cyclen

Norethindrone acetate (triphasic)/ ethinyl estradiol) is the chemical make up of what medication?

Estrostep

3mg drospirenone/ 20 mcg ethinyl estradiol is the chemical make up of what medication?

Yaz

When is it a good indication to give a patient an oral contraceptive medication for acne vulgaris?

When they are sexually active! It also helps treat moderate acne vulgaris.

What are some adverse effects a patient prescribed might experience?

Nausea, wt. gain, breast tenderness, increased risk of thromboembolism, stroke, MI, HTN, DVT

Oral contraceptives may have potential drug interactions with what type of medication given for acne vulgaris? What is the pathophysiology explanation behind this interaction?

OC may interact to OA's. OA's will decrease active estrogen absorption

When given a patient an oral contraceptive, how long would you tell them the therapy may take for them to see improvements in their acne?

2-4 months (therapy needed)

Inflammatory lesions and scarring with some noninflammatory lesions is what type of acne vulgaris?

Severe Acne Vulgaris

What is the difference between moderate acne vulgaris and severe acne vulgaris?

Scarring