Term
| general definition of acne |
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Definition
an inflammatory disease of the sebaceous glands and hair follicles of the skin characterized by comedones, papules, and pustules
affects 90% of teen population
80% of patients are between 12-25 yo |
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Term
| factors that exacerbate acne |
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Definition
drugs
oil-based cosmetics
emotional stress
physical pressure (helmet, chin strap) because of constant irritation |
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Term
| drugs that exacerbate acne |
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Definition
androgenic steroids
corticosteroids
lithium (used with biopolar diseases)
anti-epileptics (phenytoin)
tuberculostatic drugs
oral contraceptives (especially those with androgenic steroids) |
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Term
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Definition
hair follicle plugged with sebum, keratin, and dead skin (sebum builds up)
-this creates a growth media and bacterial colonization begins in trapped sebum |
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Term
| if acne gets worse can get these 3 inflammatory lesions |
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Definition
papules - red, inflammed
pustules - yellow, inflammed
ruptured contents |
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Term
| examples of 2ndary lesions |
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Definition
excoriations
erythematous macules
hyperpigmented macules
scars |
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Term
| types of non-inflammatory lesions |
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Definition
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Term
| fact or fiction: foods such as pizza, chocolates, and sweets worsen acne |
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Definition
| fiction: not a lot of evidence but if you notice then avoid |
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Term
| fact or fiction: high glycemic-load diets may contribute to the development of acne or worsen the condition |
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Definition
| fiction: not an absolute, might be some truth bc in the world acne is worse of a problem where there is high carb diets |
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Term
| fact or fiction: stress can worsen acne |
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Definition
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Term
| fact or fiction: most patients with acne have an over production of androgens |
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Definition
| fiction: sebaceous glands are more sensitive to androgen |
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Term
| fact or fiction: comedone extraction is useful and results in immediate cosmetic improvement |
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Definition
| fact: will build up - if popped can cuase irritation but in a couple of days its better |
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Term
| fact or fiction: frequent cleansing of the areas affected by acne will enhance the control of lesion |
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Definition
| fiction: anymore than 2xs a day will not make acne any better |
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Term
| fact or fiction: acne is typically worse during summer months rather than winter months |
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Definition
| fiction: worse in winter but if high humidity can make it worse |
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Term
| fact or fiction: alcoholic based gels provide better penetration of active ingredients into the skin than do lotions or creams |
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Definition
| fact: it dies it up (dont want to use an ointment) |
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Term
| fact or fiction: topical preparation used to treat acne should be applied to the entire face and NOT just to the individual acne lesions |
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Definition
| fact: it takes 4-6 weeks to go full course. chances are will go into other places that are not cleaned |
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Term
| fact or fiction: delaying the treatment of acne can increase the risk of scarring |
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Definition
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Term
| fact or fiction: the use of polyester cleaning sponges can help with the removal of comedones |
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Definition
| fiction: can cause more irritation |
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Term
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Definition
whitehead: trapped contents, enlargement of gland, aka closed comedone
blackhead: tapped contents, dilated opening, melanin accumulates, aka open comedone |
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Term
brand: accutane
generic: ??? |
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Definition
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Term
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Definition
10, 20, 40 mg capsules
0.5 - 2 mg/kg/day in 2 doses (with food)) for 15-20 weeks
-some dermatologist recommend a cumulative dose 120-150 mg
-effectiveness increases with higher doses
-if acne flares after >2 months off tx, a 2nd course may be used |
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Term
| adverse effects of accutane |
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Definition
acne will get worse before it gets better
dry or chapped skin, nose, lips, and eyes
hair shedding
peeling of palms and soles
brittle nails
photosensitivity
arthralgias and myalgais
pregnancy cat = X
elevated liver transaminates (AST, ALT)
elevated triglycerides and cholesterol
HA, muscle aches, fatigue, mood changes
night blindness
risk of depression and suicide |
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Term
| Why is accutane category X and what must happen to reduce risk |
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Definition
highly teratongenic (18-23%)
extensive counseling before use
females must use 2 forms of birth control
must have 2 preggy test before and then every months |
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Term
| monitoring of pts on accutane |
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Definition
-LFTs and TG at baseline and q 2-4 weeks
-psychological screening
-assure BC use x 1 month before staring and 1-4 months after tx
-monthly urine pregnancy tests |
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Term
| counseling tips of accutane |
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Definition
-avoid pregnancy/proper use of contraceptives
-adverse effects
-do not take Vit A supp (includes nutr supp) bc increase of toxicity
-use moisturizer, lip balm, and artificial tears
-use of sunscreen
-take with food |
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Term
| examples of treating complications of acne |
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Definition
dermabrasion
chemical risk (70% glycolic acid)
laser resurfacing
costly |
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Term
| goals of therapy for acne |
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Definition
-decrease excessive production of sebum
-decrease abnormal desquanmation of epithelial cells in sebaceous follicles
-decrease proliferation of bacteria
-relieve discomfort, improve skin appearance, prevent scars, and minimize psychological stress |
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Term
| who must enroll in the ipledge program of accutane |
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Definition
patients, physicians, and pharmacies
dispensing occurs only after the pharmacist has recieved an authorization code |
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Term
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Definition
-pharmacist must have authorization # from iPledge program
-must distribute Accutane Medication Guide
-can only dispense a 30 day supply with no automatic refills
-pharmacists will get a "do not dispense after date" - 7 days past office visit
-assures females have had 2 negative preggy test before initial Rx
-females must have a negative pregnancy test every month while on therapy
-patients are registered and have been informed of risks |
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Term
| describe treatment follow up for any patient with acne |
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Definition
-2 to 4 months will be necessary to determine if a treatment regimen has been successful
-lengthening acne free periods is key
-going to take a while to know if therapy works |
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Term
| oral antibiotics used to treat moderate to severe acne |
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Definition
tetracycline
minocycline
doxycyline
erythromycin
azithromycin
TMP/SMZ (bactrim) |
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Term
| freq and strength of tetracycline |
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Definition
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Term
| freq and strength of minocycline |
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Definition
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Term
| freq and strength of doxycycline |
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Definition
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Term
| erythromycin (freq/strength) |
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Definition
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Term
| azithromycin (strength/freq) |
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Definition
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Term
| TMP/SMZ (Bactrim) (freq/strength) |
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Definition
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Term
| when is accutane use in therapy |
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Definition
| when pts have failed other treatments or when it relapses soon after discontinuing other therapies |
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Term
| overall purpose of accutane with therapy |
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Definition
-destorys comedones and prevents new ones from forming
-inhibits growth of bacteria
-decreases inflammation
-indicated for nodular/cystic, disfiguring scaring acne |
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