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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 |
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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 |
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Types of acne lesions
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Open comedo
Closed comedo Papules Pustules Nodules Cysts |
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grading classification I
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I- least severe (comedonal) less than 10 lesions on face, no inflammatory lesions, does not lead to scarring
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grading classification II
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II- papular 10 to 25 papules - not only on the face, but on the truck also. Could be mild scarring, inflammatory lesions, <5mm
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grading classification III
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pustular > 25 pustules, moderate scarring, visable perulent core
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grading classification IV
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severe, pustular cystic, extensive, causes scarring, inflammatory lesions > 5mm
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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…
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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.
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acne
OTC pharm treatment |
Benzoyl Peroxide
Salicylic Acid Sulfur Sulfur/Resorcinol |
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RX Pharm treatment for acne
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Retinoids
Topical or Systemic Antibiotics Hormonal Oral Isotretinoin Combo therapy |
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Azelaic Acid
when used: |
patients that are not tolerant of benzyl peroxide (harsh, bleaching…)
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Azelaic Acid
Positives |
Does not cause bacterial resistance, doesn’t cause photosensitivity, not systemic
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Azelaic Acid
negative: |
cause a little skin lightening
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Topical Retinoids
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1st line, unless they have severe nodule or cystic acne
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Can you use topical retinoids in combo?
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Can use in combo if inflammation is present
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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.
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Topical Retinoids
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tretinoin, adapalene, tazarotene
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Topical Retinoids
Adverse reactions |
dry skin, peeling of the skin, burning…
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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…
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topical antibiotics and acne
examples |
erythromycin and clindamycin ( mixed and have specific expiration dates ) 6 to 8 weeks and there could be resistance potential.
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Oral Antibiotics
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Used if it has spread to more than just the face. When the severity is high.
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which oral antibiotics are used
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Ery, clinda, doxy, tetra,
Brand name bactrim- not the first you want but can be used if the others are not an option |
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Hormonal
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Steroids
Increasing estrogen Spironalctone- anti androgen effect. |
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Oral Isotretinoin
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Accutane (brand name of isotretinoin)
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Oral Isotretinion
side effects: |
birth defects, suicidal tendency, mood swings. Can alter liver enzymes and function. Can give hyperlipidemia, diabetes, osteoporosis.
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iPLEDGE
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Computer based program to help prevent the side effects.
Patient, pharmacist, doctor, manufacture all play an important role. To help prevent fetal exposure. |
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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 |
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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 |
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which formulation to use:
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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 |
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Case study
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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? |