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16 Cards in this Set
- Front
- Back
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Acanthosis Nigricans
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hyperpigmentation and velvety thickening of irregular folds of skin. Correlates with hyperinsulinemia and insulin resistance. labs: glucose, Hg AIC, fasting insulin, TSH, free T4
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Neonatal acne
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Newborn: response to maternal androgens, appears 2-4 weeks, lasts up to 4 months. Similar distribution as adol. Provide assurance, can use benzoyl peroxide
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Infantile:
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starts at 3-6 months, or at 1yr. usually worse, comedones and inflammatory cysts, can lead to scarring. r/t androgens Tx c topical BP and antibs, retinoids, If persists past 12 months check endocrine
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Acne Patho:
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85% adol’s. sebaceous follicles become plugged with a plug of stratum corneum cells a blackhead, (from oxidized melanin with in the plug, not dirt). If obstruction is beneath the follicular opening a microcomedone or closed or white head.
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•Mild inflamm acne
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few to several pap’s, pusts and no nodules. (Tret/then add BP, c or s top ant)
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Moderate inflamm acne
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several to many pap’s pust’s, few to several nod’s. (Tret highest, top ant with BP and orals, take until inflamm gone
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•Severe inflam acne
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: numerous pap’s pusts, many nod’s. consider accutane
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benzoyl peroxide
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(must try this first per insurance) Bleaches use in the am, try 3-4 months.
BP 4% creamy wash kit covered by Medicaid) BP 5, 10%, gel/wash QAM (142,227) |
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topical retinoid
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They loosen sebum by changing the oil chem of the skin. They can increase collagen and pump up fine lines. Turns over skin, loosens black heads. Start treatment TIW , may get worse at beginning. Watch dryness and peeling
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Tretinoin, or
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•Retin A: 0.025, 0.05, 0.1, (45/3) Use in mild cases, for moderate cases advance to highest dose possible, (.1% cream can lessen scars takes 6-8 weeks)
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•Differin,(
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adapalene) 0.1, 0.3% (more $)(not sun sensitizing) takes 3 months to work, pea size amt, (Epiduo is adapalene and BP)
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Retin A micro
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, 0.04, 0.1%, 15, 45g, is less sun sensitizing, $$, needs insurance
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Topical Antib’s: used for mild inflamm acne
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Benzamycin 5% gel 23.3 or 46.6 to acne prone areas QAM, start MWF then QD
Benzaclins 5% (25, 50) often not covered/ Clindamyacin, Erythromyacin, Benzoyl Peroxide (helps orals keep working), Benzomycin gel (fridge) Duac also clinda like benzaclins but more of a lotion and less irritating. |
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Moderate inflamm acne: same as mild but add an oral.
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• Oral Antib’s can take 3-6 months,
Used when failing topicals, no benefit seen for 6-8 weeks. 1. Doxycycline: 50 or 100mg’s BID, with full glass of water and food, most sun sensitive. go to mino in summer, preg cat. D. 2. Minocycline 50 or 100 mg, QD or BID, watch sun sensitivity, ask about jt. Pain, muscle pain, HA, visual change, bluish tints., fatigue, dizziness 3. Possible alternatives: Erythromycin EES 400 BID, (ok to use in kids <8yr), Azith 250mg 2 tabs d1, then 1 tab QOD or 1 z packQ 2 weeks, or Bactrim, 80/400, 160/800mg BID watch risk of SJS Can try Hormonal therapy for girls if still failing. Hormonal acne/ mouth distrib. After achieving 90% decline in new lesions then stop orals and continue topicals. See pg 20. |
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Severe : Accutane
se and dose |
•Accutane: SE: 3 heads (psyche/depression,, HA, blurry vision) 2 chest (Chest pain, breathing diffs) 2 abd (abd. pain,NVD(crohns)bloody stools), 1., achy joints, Dose: approx. 1mg/kg/day. Sometimes start at 40. Total cumulative dose of 150mg/kg.
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accutane recommendations and labs
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• No additional Vit A, check: CBC, LFT’s, FLP, no elective surgeries for 1 year due to impaired skin healing, no piercings,
•Goal in 3 months is a 50% reduction in new zits. |
