Term
| What are the main causes of Acne? |
|
Definition
Increased Sebum Production
Bacterial Growth
Sloughing of Keratinocytes
Inflammation |
|
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Term
| What is the prevalance of ance and when does it normally start? |
|
Definition
80% of people ages 11-30
starts with puberty |
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Term
| What is the primary factor starting the cascade of events that leads to acne? |
|
Definition
|
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Term
| What are non-inflammatory lesions? |
|
Definition
Open and Closed comedones
(Blackheads and Whiteheads) |
|
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Term
| What are inflammatory lesions? |
|
Definition
| Papules, Pustules, Nodules and Cysts |
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Term
Inflammatory or Non inflammatory
1) More severe
2) initial lesions
3) Predominant in Mild ance |
|
Definition
1) More severe- inflam.
2) initial lesions: non-inflam.
3) Predominant in Mild ance:non-inflam. |
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Term
| What gives blackheads its color? |
|
Definition
| melanin, oxidized lipids, cellular debris |
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Term
| Explain the order of events leading to acne |
|
Definition
Hyperkeratinization in cells around the hair
Blocks the sebaceous follicle
Sebum accumulates (bacteria and androgens enhance sebum prod.)
Microcomedo formed |
|
|
Term
Open or Closed Comodone
1) blocks a dilated follicle
2) can become larger inflammatory lesions
3) doesnt protrude through the skin
4)Blackhead |
|
Definition
1) blocks a dilated follicle- open
2) can become larger inflammatory lesions-closed
3) doesnt protrude through the skin-closed
4) Blackhead-open |
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Term
Mild, Moderate, Severe
1) Few, Non-inflammatory lesions
2) inflamm. and non-inflamm lesions, nodulocystic
3) numerous inflam. papules and non-infl. lesions |
|
Definition
1) Mild
2) Sever
3) Moderate |
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Term
|
Definition
| Based on the severity and presence of nodules |
|
|
Term
Papules, Pustules, Nodules
1) well defined, elevated, <1cm involving dermis and epidermis
|
|
Definition
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|
Term
Papules, Pustules, Nodules
firm palpable, round lesion up to 1cm occurring in dermis or hypodermis |
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Definition
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Term
Papules, Pustules, Nodules
elevated distinct superficial cavity filled with purulent fluid |
|
Definition
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Term
T/F
A higher % of Benzoyl Peroxide has been proven to be more effective |
|
Definition
FALSE
no evidence to support this and actually causes more irritation and adverse effects |
|
|
Term
| How does benzoyl peroxide work? |
|
Definition
| Releases free radicals and oxidizes bacterial proteins and lyses comodones |
|
|
Term
| What dietary and lifestyle changes can help acne? |
|
Definition
gentle nondrying cleansers
Avoid agressive scrubbing
less of a high carb diet or protein |
|
|
Term
What is the standardd of care for acne?
Topical
Oral
IV |
|
Definition
| Topical therapy (retinoid) |
|
|
Term
| What type of therapy should be used for Mild acne? |
|
Definition
| Topical retinoid + topical antibiotic |
|
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Term
| What is the progression of therapy as you go from mild to severe? |
|
Definition
| (topical retinoids+ topical abx), (oral abx +topical retinoid + BP), (oral isotrentinoin) |
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|
Term
T/F
All the topical trentinoin products are equally effective |
|
Definition
|
|
Term
T/F
Topical retinoids are Vitamin D derivatives |
|
Definition
|
|
Term
| How do Topical retinoids (trentinoins) work against acne? |
|
Definition
| affect differentiation of follicular cells which prevent the formtion of initial lesions |
|
|
Term
What are some ADE of topical tretinoins?
Drug interactions? |
|
Definition
Excessive dryness, erythema, pruritis(itching), scaling of the skin, photsensitization
No known significant drug interactions |
|
|
Term
T/F
It is the actual drug itself that causes topical tretinoins to be photosensitizing |
|
Definition
FALSE
The drug itself is not photosensitizing, but the thinning layer of the skin |
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Term
| Which topical retinoid may be more efficacious than trentinoin and is more stable with Benzoyl Peroxide? |
|
Definition
|
|
Term
Which topical retinoid is Pregnancy Category X?
What does this mean? |
|
Definition
Tazarotene
should NEVER use in a pregnant woman |
|
|
Term
| What is the synthetic topical retinoid? |
|
Definition
|
|
Term
What is the drug interaction with the use of Adapalene?
What type of topical product is this? |
|
Definition
| It is a topical retinoid (vitamin A derivative) that may enhance the adverse effects of retinoid-like compounds |
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|
Term
How should tretinoins be administered with benzoyl peroxide?
Is there any exception? |
|
Definition
They should not be administered together and should be seperated by 12 hrs.
The exception is the microsphere verion of the tretinoin that is more stable |
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|
Term
T/F
When treating acne, one must avoid using acne multiple products? |
|
Definition
FALSE
it is good to use products that combat acne in different ways such as a topical retinoid (keratin) and topical abx (p.acnes) |
|
|
Term
T/F
you should only use oral therapy for acne if absolutely necessary |
|
Definition
|
|
Term
| How do the topical abx work against acne? |
|
Definition
| That inhibit P.acnes and reduce inflammatory response |
|
|
Term
T/F
Use of topical clinamycin or erythromycin alone is not usually recommended |
|
Definition
TRUE
should be combined with other products
ex. benzomycin and benzoclin |
|
|
Term
T/F
Erythromycin and Clindamycin are Pregnancy category X |
|
Definition
FALSE
Category B
relatively safe in pregnant women |
|
|
Term
What product is often mixed with topical abx?
Why? |
|
Definition
Benzoyl Peroxide
it improves efficacy and reduces bacterial resistance |
|
|
Term
Why is Azelex not the first line of therapy?
What type of therapy is it? |
|
Definition
Not enough clinical data to suport its use
Topical, Azelaic Acid |
|
|
Term
| What is aczone and how does it work? |
|
Definition
Topical abx containing dapsone
works by interfering with bactial production of folic acid |
|
|
Term
| What are the 1st line oral abx for acne? |
|
Definition
Tetracyclines (tetracycline,Minocycline & Doxycycline)
& Bactrim (sulfamethoxazole/trimethoprim) |
|
|
Term
| How do the oral abx work against acne? |
|
Definition
| Work against P.acnes and prevent nodules from forming |
|
|
Term
Which is preferred, doxycycline or minocycline?
|
|
Definition
|
|
Term
| What are major precautions with tetracyclines? |
|
Definition
Photosensitivity
Preg Cat. D (tooth discoloration)
Risk X with oral retinoic acid (mimic brain tumor) |
|
|
Term
T/F
Azithromycin is NOT preffered for tx of acne |
|
Definition
TRUE
should be saved for URTI's, not widely used for acne |
|
|
Term
| Why isnt oral erythromycin used as first line of treatment? |
|
Definition
|
|
Term
| What precautions should be taken with oral Macrolides? |
|
Definition
| QT prolongation, substrates and inhibitors of CYP3A4 |
|
|
Term
| What is used for severe acne? |
|
Definition
|
|
Term
| What are the baseline evaluations for isotretinoin? |
|
Definition
| Lipid panel, CBC, Pregnancy test (2 neg) |
|
|
Term
What is the only therapy that impacts every underlying feature of acne?
How long is treatment? |
|
Definition
|
|
Term
| How does isotretinoin work? |
|
Definition
| reduces sebaceuos gland size, reduces sebum producation, impacts keritinization, changes composition of sebum so that its not a good medium for P.acnes, inhibits P.ances |
|
|
Term
| Why does the labeling for isotretinoin say not to use with an oral contraceptive if a woman must be on 2 types of contraceptives? |
|
Definition
| It is to target women of childbearing age, and indicate it should not be used if a woman is likely to become pregnant. MUST USE 2 forms of contraceptives |
|
|
Term
| What are the risks with isotretinoin use? |
|
Definition
| suicidal ideations, 20% spontaneous abortion |
|
|
Term
What type of therapy and alternative?
Mild-Comedonal |
|
Definition
1st- topical retinoid
Alt- Azelaic Acid or Salicylic Acid |
|
|
Term
What type of therapy and alternative?
Mild-Papular/Pustular |
|
Definition
1st- Topical retinoid +Topical antimicrobial
Alt- alternative topical retinoids and antimicrobials |
|
|
Term
What type of therapy and alternative?
Moderate-Papular/Pustular |
|
Definition
1st- Oral abx + topical retinoid +/- BP
Alt for females- oral antiandrogen+ topical retinoid/azelaic acid +/-BP |
|
|
Term
What type of therapy and alternative?
Moderate- Nodular |
|
Definition
1st-Oral abx + topical retinoid + BP
Alt- Oral isotretinoin or alternatives of the above
Alt for females- oral antiandrogen+ topical retinoid +/- oral abx +/- alt. antimicrobial |
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