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77 Cards in this Set
- Front
- Back
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Which age group is most affected by acne?
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12-24
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What are some common etiologies of acne?
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- androgens: increase sebum production
- disturbances in keratinization: comedos formation in sebaceous gland (distribution on face, chest shoulder, back). - microbes: propionibacterium - inflammation: rupture of follicle, will see papules, pustules, nodules, "cytsts". |
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Name the two types of comedones.
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Open comedone: black heads
Closed comedone: white heads |
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What are white heads?
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Closed comedone: white heads
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What are black heads?
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Open comedone: black heads
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What is the name of the microbe that causes acne?
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Propionibacterium acne: gram + diphtheroid, normal flora of the skin.
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Why do propionibacterium acne live in sebaceous follicle?
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they depend on tiglycerides in sebum for nutrition.
In teenagers, androgen stimulate sebacous follicles that allows stable populations of Propionibacterium acne to grow. |
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When you see women with very bad acne, what should you worry about?
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- significantly elevated androgens
- may need to think other diseases such as polycystic ovarian cancer |
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What can serve as a better correlate with sexual maturity than age?
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acne
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What happens when the sebaceus follicles rupture?
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Inflammation:
- P. acne produces chemotactic factors, enzymes -> activate complement - neutrophil releases hydrolytic enzymes |
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T/F: Severity of acne maybe related to inherited variations in hypersensitivity to P. acnes.
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T.
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Is there inheritance in acnes?
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Yes. Some people have hyperhypersensitivity to P. acnes, resulting in severe inflammatory response.
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What type of acne lesion is this?
- papules, pustules, nodules, "cysts". |
inflammatory lesions
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What type of acne lesion is this?
- open comedones - closed comedones |
non-inflammatory
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What type of acne lesion is this?
- despressed, pitts - hypertrophic keloidal |
scarrs
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Do acnes always leaves scarrs?
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No. Noninflammatory acnes are nonscarring. So don't pick them!
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What is the general principle of treating acne?
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- determine the extent and severity
- be sensitive to psychosocial aspects of acne |
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Does diet play a role in acne?
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generally no
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How long does it usually take for acne treatment to work?
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6-8 wks
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T/F. Frequently washing face aids in getting rid of acnes.
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F. Too much washing decreases normal floral that protects the skin from other infections.
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Name the three topical retinoids.
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- Tretinoin
- Adapalene - Tazarotene |
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Mechanism of Tretinoin.
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All-trans-retinoic acid
- comedolysis - normalization of follicular epithelium maturation - anti-inflammatory |
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Adverse effect of Tretinoin.
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- irritation
- photosensitivity *no increased fetal abnormalities |
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When is the best time to use tretinoin?
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at bedtime, so no photosensitivity effects.
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Mechanism of Adapalene.
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naphthalene derivative (non-vitA retinoid)
- normalize follicular keratinization - anti-inflammatory |
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Adverse effect of Adapalene.
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- minimal irritation
* light stable |
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Mechanism of Tazarotene.
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Synthetic acetylenic retinoid
- normalize follicular keratinization - anti-inflammatory |
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Adverse effect of Tazarotene.
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- more irritating
* but more efficacious |
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Rank the following in increasing effectiveness in treating acne?
- tretinoin - adapalene - tazarotene |
- adapalene
- tretinoin - tazarotene |
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Rank the following in increasing adverse effects in treating acne?
- tretinoin - adapalene - tazarotene |
- adapalene
- tretinoin - tazarotene |
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What is a good topical acne treatment for sensitive skin?
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- adapalene: minimal cutaneous irritation
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Which topical acne drug is very useful for treating hyperpigmentation caused by acne and has minimal adverse effects?
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Azelaic acid (naturally occuring dicarboxylic acid):
- direct anti-P. acnes activity - comedolytic - inhibit tyrosinase in proliferative melanocytes. |
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What is this drug?
- direct anti-P. acnes activity - comedolytic - inhibit tyrosinase in proliferative melanocytes. |
Azelaic acid (naturally occuring dicarboxylic acid)
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Mechanism of Azelaic acid.
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- direct anti-P.acne
- camedolytic - inhibit hyperpigmentation by inhibiting tyrosinase in proliferative melanocytes |
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Adverse effects of Azelaic acid.
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Not much
- low incidence of burning, irritation, erythema/scaling |
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When is monotherapy of tpoical anti-microbial useful?
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mild forms of inflammatory acne
They are usually used in combination with comedolytics. |
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What is this drug?
- bacteriostatic - comedolytic |
benzoyl peroxide
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Mechanism of benzoyl peroxide.
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- bacteriostatic
- comedolytic |
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Adverse effects of benzoyl peroxide.
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- irritation
- contact dermatitis - can bleach clothing *no microbial resistance |
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What is this drug?
Adverse effects: - irritation - contact dermatitis - can bleach clothing |
benzoyl peroxide
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Name the three commonly used topical antimicrobial drug for acne.
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- erythromycin: work on 50s, stops protein synthesis
- clindamycin: work on 50s, stops protein synthesis - sodium sulfacetamide: competitive inhibition of condensation of para-aminobenzoic acid with pteridine precursors. |
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T/F: Resistance to erythromycin usually confers cross resistance to clindamycin.
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T.
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Mechanism of sodium sulfacetamide.
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restrict growth of P. acnes
- competitive inhibition of the condensation of para-aminobenoic acid with pteridine precursors. |
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When is systemic antibiotics indicated for acnes?
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If deep papules or nodules are present.
Mechanism: - redue the stimulus fro inflammation - dampen the inflammatory response |
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What are the most commonly used systemic antibiotics for acne?
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Tetracyclin: works on 30s, inhibits protein synthesis. Antibiotic and anti-inflammatory.
Erythromycin: works on 50s, stops protein synthesis. |
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Side effects of systemic antibiotics.
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- candida vaginitis
- gram negative folliculitis |
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When should tetracyclin be taken?
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empty stomach because its absorption is inhibited by polyvalent cations (iron, zinc, calcium).
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Side effects of tetracyclin.
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- GI disturbance
- chronic interstitial nephritis - hypersensitivity reactions: Steven Johnson syndrome, serum sickness like reaction - psudotumor cerebri (when used with isotretionin) - brown discoloration of teeth. - decreased efficacy for birth control |
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What is this drug?
Adverse effects: - GI disturbance - chronic interstitial nephritis - hypersensitivity reactions: Steven Johnson syndrome, serum sickness like reaction - psudomotor cerebri (when used with isotretionin) - brown discoloration of teeth. - decreased efficacy for birth control |
tetracyclin
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What side effects can a person get when taking tetracyclin with isotretinoin?
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pseudotumor cerebri
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Name the two lipophilic derivative of tetracyclin.
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doxycyclin:
- highest incidence of phototoxicity of all tetracyclins - may be taken with food minocycline - greater incidence of pseudotumor cerebri - side effects: drug-induced lupus, blue-black pigmentation. |
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What is this drug?
Adverse effects: - drug-induced lupus - blue-black pigmentation of nails, mucosa, skin |
minocycline
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Which tetracyclin has the highest phototoxicity?
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doxycyclin
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Which tetracyclin is least likely to have P acne resistance?
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minocycline
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Which drug has greater P. acne resistance, erythromycin or tetracyclin?
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erythromycin
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When an acne patient fail to respond to systemic antibiotics, what should you try next?
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ciprofloxacin or trimethoprim-saulfamexazole
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When is corticosteroid indicated for acne treatment?
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reserved for emergency (severe flare of nodular acne)
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If you have to use steroids for acnes, for how long should it be taken?
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limited to a maxium of several wks
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What can be done to prevent scarring from deep nodular lesions of acne?
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intralesional injection of low dose triamcinolone
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Mechanism of isotretinoin.
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(13-cis-retinoic acid)
- diretly inhibit sebum production - anti-inflammatory - inhibit comedo formation |
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What is this drug?
Mechanism - diretly inhibit sebum production - anti-inflammatory - inhibit comedo formation |
isotretinoin
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When is isotretinoin indicated for acne?
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severe recalcitrant nodulocystic acne
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If you have to use steroids for acnes, for how long should it be taken?
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limited to a maxium of several wks
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What can be done to prevent scarring from deep nodular lesions of acne?
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intralesional injection of low dose triamcinolone
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Adverse effects of isotretinoin.
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- mucocutaneous dryness
- mild musculoskeletal symptoms - teratogenic: must use contraception before therapy and one month follow up. - pseudotumor cerebri when used with tetracyclin. |
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What is the program that all isotretinoid providers and patients must register in order to be treated?
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iPledge
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What are the retinoid resistant lesions?
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- sinus tract
- epidermal cysts - keloids |
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When do isotrenitoin not work in acne patients?
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- retinoid resistant lesions (sinus tract, epidermal cysts,keloids)
- hyperandrogenism - patients on lithium or phenytoin (dupenylhydantoin) |
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Adverse effects of isotretinoin.
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- mucocutaneous dryness
- mild musculoskeletal symptoms - teratogenic: must use contraception before therapy and one month follow up. |
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Mechanism of isotretinoid.
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- sebum suppression (direct), with proportionate fall in p.acne.
- anti-inflammatory - inhibit comedo formation |
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When is hormonal therapy used in acne?
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- as adjunctive to lower androgen that increases sebum production
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Name some hormal adjunctive therapies used for acne treatment.
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- low progestin contraceptives: norgestimate, desogestrel, ethylnodiol diacetate in women.
- Spironolactone for men |
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Mechanism of spironolactone.
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Hormone.
- competitive inhibitor of dihydrotestosterone |
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Name some hormone therapy that are useful as adjunctives in acne treatment.
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- low progestin for women
- spironolactone for men |
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What is the treatment strategy for mild acne?
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- topical retinoid + topical antibiotic/benzoyl peroxide preparation
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What is the treatment strategy for moderate acne?
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- topical retinoid + topical antibiotic/benzoyl peroxide preparation
- systemic antibiotic |
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What is the treatment strategy for failure of treatment/scarring/relapsing/nodulocyctic acne?
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isotretinoin
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