Acne pt 2

Question 1

oral antibiotics for acne treatment

when to use

mechanism of action

response time

adverse effects

additional notes

Answer 1

• when to use
  
  • reserved for moderate/severe acne
• mechanism of action
  
  • targets C. acnes and is anti-inflammatory
• response time
  
  • allow at least 6-8 weeks to see if effective
  • duggest disc at 3-6 months if endpoints achieved and switch to topical therapy
• adverse effects
  
  • bacterial resistance
  • upset stomach
  • photosensitivity
  • vaginal candidiasis
• additional notes
  
  • decrease absorption of iron, aluminim, bismuth, calcium ,mg
  • can decraese effectiveness fo oral contraceptives
  • do not use in pregnancy

Question 2

doxycyline for acne treatment

Answer 2

oral antibiotic

100mg daily

*must use sunscreen

Question 3

minocylicne for acne treatment

Answer 3

*not really used much because of side effects

• 100mg daily (50mg maintenance)
• can cause Hyperpigmentation of skin and mucous membranes (blue), diziness
• take on empty stomach BUT can take w/ food if upsets stomach
• consider LDTs and antinuclear factor faseline Q3-4 months

Question 4

tetracycline for acne treatment

Answer 4

• 500 mg twice daily (250-500 mg daily maintenance)
• take on empty stomach to avid decrease in absorption

Question 5

Combines oral contraceptive for acne treatment

Answer 5

• exerts an antiandrogenic effect
• useful is experience flare ups during mestrual cycle
• response time is 3-6 months

Question 6

spironolactone for acne treatment

Answer 6

• Mechanism is to exert an antiandrogenic effect
  
  • Dose 25-200 mg/day orally
• Adverse effects:
  
  • Hyperkalemia,diuresis, irregular menses, breast tenderness, nausea, headache, fatigue, dizziness, feminization of male sex fetus (contraception required)

Question 7

isotretinoin for acne treatment

when to use

MOA

Response time

Directions

Answer 7

• When to use
  
  • reserved for severe acne and scarring acne
• MOA
  
  • binds to nucelar retinoid receptors and affects transcription factors resulting in various dermal changes
    
    • reduces sebaceous gland size and sebum products
    • targets sebum exretion, keratinization, inflammation C. acnes
• Response time
  
  • clinical worsening for first few weejs posible, but then improves
• Directions
  
  • take with high fat meal to enhacne abs
  • Epuris is marketed with or without food

Question 8

adverse efects of isotretinoin

Answer 8

• adverse
  
  • teratogenic *must be stoped at least 1 month prior to becoming pregnant
    
    • small amounts are found in semen but not indicated any risk of harm to a fetus
  • Common
    
    • Mucocutaneous dryness (ocular, oral, nasal), myalgia, arthralgia, headache, photosensitivity, dry hair, nail fragility
  • Uncommon-Rare
    
    • hypertriglyceridemia, pancreatitis, mood disorder, possibly suicide ideation, pseudotumor cerebri (with tetracyclines)

Question 9

special considerations for isotretinoin

Answer 9

• Baseline and monthyl pregnancy screening
  
  • 2 reliable contraception methods must be used during and 1 month after d/c
• Monitoring
  
  • CBC< LFT, every 3 months
• Allow 7 day washout after stopping tetracyclines before starting isotretinoin due to risk of pseudotumor cerebri
• must use sunscreen SPF 30
• generally avoid other topicals due to icnreased drying effect

Question 10

what basic care measures shoudl you educate acne patints on

Answer 10

• use oil free makeup, try to avoid multiple layers -> wash all off at night
• harispray can clog pores
• mild moisturizer can help increase tolerance to topical agents
• use sunscreen with minimum SPF30
• suggest strategies to manage stress if this is a contributing factor
• patient may benefit from keeping a diary/record of progession of acne and response to treatment

Question 11

non pharm managemnt of acne

Answer 11

• Cationic bond strips
  
  • dirt/oil is anionic, strip is activated by water and adheres to moleulces and removed htem when peel off strip
  • temporary improvement in skin appearance
• Comedone extraction
  
  • Efficacy may be enhanced if pretreated with a peeler (i.e. glycolic acid, salicylic acid)

Question 12

describe scarring

Answer 12

• permanent change in fibrous tissue
• can cause a loss or damage of local tissue or increase tissue
• treat with cosmetic lasers, dermabreadion, or toher procedures

Question 13

whe to follow up on acne treatment

Answer 13

2-3 months

• monthly for oral isotretinoin

Question 14

new trans in acne treatment

Answer 14

• Tea tree oil
  
  • low quality evidence
• Zinc
  
  • MOA is not well understood but acts on inflammatory processes
  • oral doses used in studies results in GI side effects -> not practical
  • topical zinc ineffective
  • conflicint evidence and low strength rec
• retinol
  
  • sig lower potency when compared to retinoic acids
• Phtotodynamic therapy
  
  • limited evideance