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31 Cards in this Set

  • Front
  • Back
Acne
etiology
Hormones could play a factor

Over secretion of oil
Increase sebum production
p.acnes (?)
Abnormal keretinization
inflammation
Acne
Exacerbating Factors
Environmental: Tars, petroleum derivatives, hot and sweating…
Cosmetic: oil clogging pores
Emotional: stress, adrogens and sebaceus glands play a part
Hormonal: pituitary tumor (rare) , and others…
Medications: testosterone, any type of hormone, P-phenytoin, I- isoniazid, M- moisturizers, P- phenobarbital, L- lithium, E- ethionamide, S- steroids
Genetics: if both parents had acne= yes
Types of acne lesions
Open comedo
Closed comedo
Papules
Pustules
Nodules
Cysts
grading classification I
I- least severe (comedonal) less than 10 lesions on face, no inflammatory lesions, does not lead to scarring
grading classification II
II- papular 10 to 25 papules - not only on the face, but on the truck also. Could be mild scarring, inflammatory lesions, <5mm
grading classification III
pustular > 25 pustules, moderate scarring, visable perulent core
grading classification IV
severe, pustular cystic, extensive, causes scarring, inflammatory lesions > 5mm
acne
non-pharm treatment
cleansing
Cleansing: frequent washing, gently without scrubbing as any irritation will make it worse, 2 times a day, not hot water (warm only), use a soap with no moisturizer. Use a soft cloth…
acne
non-pharm treatment
avoid- minimize cause
Avoid/minimize causes: don’t touch your face. Oil, bacteria, viruses are all over your hands. Don’t pop them, they will go away on their own. Makeup, avoid dirt dust and chemicals. Avoid oil in any way. Avoid some foods that might cause them. Choose water bases products.
acne
OTC pharm treatment
Benzoyl Peroxide

Salicylic Acid

Sulfur

Sulfur/Resorcinol
RX Pharm treatment for acne
Retinoids

Topical or Systemic Antibiotics

Hormonal

Oral Isotretinoin

Combo therapy
Azelaic Acid
when used:
patients that are not tolerant of benzyl peroxide (harsh, bleaching…)
Azelaic Acid
Positives
Does not cause bacterial resistance, doesn’t cause photosensitivity, not systemic
Azelaic Acid
negative:
cause a little skin lightening
Topical Retinoids
1st line, unless they have severe nodule or cystic acne
Can you use topical retinoids in combo?
Can use in combo if inflammation is present
Topical Retinoids
maintenance:
use regularly until it clears up. Can be very drying and cause flaking of the skin, makes it uncomfortable. In this case you can stop using it or reduce the amount used.
Topical Retinoids
tretinoin, adapalene, tazarotene
Topical Retinoids
Adverse reactions
dry skin, peeling of the skin, burning…
Topical Antibiotics
benefits
Benefit: local effect (not systemic) a better choice in females b/c it can decrease the effectiveness of birth control, can cause yeast infections…
topical antibiotics and acne
examples
erythromycin and clindamycin ( mixed and have specific expiration dates ) 6 to 8 weeks and there could be resistance potential.
Oral Antibiotics
Used if it has spread to more than just the face. When the severity is high.
which oral antibiotics are used
Ery, clinda, doxy, tetra,

Brand name bactrim- not the first you want but can be used if the others are not an option
Hormonal
Steroids
Increasing estrogen
Spironalctone- anti androgen effect.
Oral Isotretinoin
Accutane (brand name of isotretinoin)
Oral Isotretinion
side effects:
birth defects, suicidal tendency, mood swings. Can alter liver enzymes and function. Can give hyperlipidemia, diabetes, osteoporosis.
iPLEDGE
Computer based program to help prevent the side effects.

Patient, pharmacist, doctor, manufacture all play an important role. To help prevent fetal exposure.
iPLEDGE
patient compliance
Females must not become pregnant before, during, and 1 month after therapy
Females:
Before the initial Rx must have 2 negative pregnancy tests
1 at MD office and 1 at a certified laboratory office
Each month, must have a negative pregnancy test at a certified laboratory office
2 forms of effective contraception (1 month before, during, and 1 month after therapy)
Must fill Rx within 7 days
iPLEDGE
RPh compliance
iPLEDGE website or toll-free line must be contacted to input information from prescription
7 day window to fill Rx
Blister packs must stay intact
Medication guide given upon dispensing
which formulation to use:
Creams: skin dry, sensitive, non irritating

Gels: drying effect, oily skin,

Lotion: between cream and gel, good for all skin types

Solution: close to gel, has drying effect and good for oily skin
Case study
P- do you know what’s causing this?
P- have you tried anything to treat it?
Q- describe the symptoms- in case it is somewhere that you can’t see
R- is it spreading anywhere else?
S- where is it?
S- how bad are they?
T- when did it start?
A – do you have anything else going on?