Term
| What are the 4 pathogenic factors of acne? |
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Definition
- Increase in sebum
- Obstruction - abnormal keratinization
- P. acnes bacteria - breaks down sebum into fatty acid
- Inflammation - papules, pustules, cysts |
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Term
| What factors can contribute to acne? |
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Definition
- Hormones - testosterone
- Hydration - humidity and sweat
- Irritation - acne mechanica
- Cosmetics - acne cosmetica
- Drug induced - acne medicamentosa |
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Term
| What medications can worsen acne? |
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Definition
- P - Phenytoin
- I - Isoniazid
- M - Moisturizers
- P - Phenobarbital
- L - Lithium
- E - Ethionamide
- S - Steroids |
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Term
| What are the 4 classifications of acne? |
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Definition
- Mild - comedones, but <10 papules
- Moderate - Comedones, 10-40 papules
- Moderately severe - 40+ comedones, 40+ papules, <5 nodular lesions. Face, chest, back
- Severe - Many nodular lesions, painful |
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Term
| When should an acne patient be referred to a dr? |
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Definition
- Moderate-severe cases w/ evidence of papules, pustules, cysts.
- Exacerbating factors, evidence of scarring
- Possible rosacea |
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Term
| What is the basic daily regimen for all acne patients? |
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Definition
- Wash face gently BID
- Soap-free cleanser: Cetaphil or CeraVe
- Minimize exacerbating factors |
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Term
| When is benzoyl peroxide used in acne? |
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Definition
- Use starting for mild, can use all the way up to severe. Gel is the most drying
- Use for 8-12 weeks, results in as little as 5 days. Photosensitizing. |
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Term
| When is azelaic acid used in acne? |
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Definition
| Less effective than benzoyl peroxide - an alternative if BP is not tolerated |
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Term
| When is benzoyl peroxide used in acne? |
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Definition
A well tolerated agent for mild acne if BP not tolerated.
**Tea tree oil as good as BP, BP is more irritating |
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Term
| When are topical steroids used in acne? |
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Definition
| Reduce inflammation and scarring risk - for nodulocystic acne. Triamcinolone cream |
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Term
| When are topical retinoids used in acne? |
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Definition
Tretinoin - added in moderate acne to BP. Reduces scarring and hyperpigmentation
**Acne flare on start, clear in 8-12 weeks.
Apply a pea sized amount QHS. Do not overuse to avoid peeling |
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Term
| When can adapalene or Tazarotene/Tazorac be used in acne? |
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Definition
Can be substituted for tretinoin in moderate acne. Better tolerated
**Still use BP wash BID |
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Term
| When are topical antibiotics used in acne? |
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Definition
When inflammatory lesions are seen - treats P. acnes. HAVE to use with BP to prevent resistance
**Do not use with oral abx |
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Term
| When is Dapsone/Aczone used in acne? |
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Definition
In combo with a topical retinoid - Age 12+ years. Do not use if taking oral bactrim
- CeraVe wash + Dapsone + RetinA |
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Term
| When are oral abx used in acne? |
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Definition
Up to moderately severe - not effective for nodulocystic. Goal to take less than 6 months
- Doxycycline 100 mg BID 30 min before meals
- Minocycline - 2nd line due to AE
- Bactrim - 1 BID when doxy not tolerated
**Doxy --> Bactrim --> Mino -->E-mycin |
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Term
| When is oral contraceptives used in acne? |
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Definition
3 products:
- Norgestimate and ethinyl estradiol - Ortho-Tri-Cyclen
- Norethindrone and ethynyl estradiol - Estrostep
- Drospirenone and ethinyl estradiol - Yasmin, Yaz
For acne in teens, adults, and PCOS - decreases androgens |
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Term
| When is Isotretinoin used in acne? |
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Definition
For Severe nodular acne - the only tx associated w/ permanent remission. Pregnancy category X
**Can only use cetaphil wash, not BP or anything else.
AE: drying of mucosa, sloughing, arthritis, photosensitivity. Check LFTs. Do not donate blood! |
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