Podcast
Questions and Answers
What is the most common lesion associated with mild acne?
What is the most common lesion associated with mild acne?
- Inflammatory cysts
- Abscesses
- Open comedones (blackheads) (correct)
- Closed comedones (whiteheads)
What initiates the onset of acne in adolescents?
What initiates the onset of acne in adolescents?
- Dietary changes
- Use of oil-based cosmetics
- Increased production of androgens (correct)
- Exposure to sunlight
Which antibiotic is specifically identified as a principal agent for acne treatment?
Which antibiotic is specifically identified as a principal agent for acne treatment?
- Tetracycline
- Clindamycin
- Isotretinoin (correct)
- Dapsone
How do topical retinoids primarily function in acne treatment?
How do topical retinoids primarily function in acne treatment?
What is the primary concern with using Dapsone in combination with benzoyl peroxide?
What is the primary concern with using Dapsone in combination with benzoyl peroxide?
Which factor is NOT considered a contributing factor to acne development?
Which factor is NOT considered a contributing factor to acne development?
What is a recommended nonpharmacologic treatment for mild acne?
What is a recommended nonpharmacologic treatment for mild acne?
Which of the following topical agents is considered a keratolytic agent?
Which of the following topical agents is considered a keratolytic agent?
What is the primary therapeutic goal of acne treatment?
What is the primary therapeutic goal of acne treatment?
Which patient education point is crucial when using topical acne drugs?
Which patient education point is crucial when using topical acne drugs?
Which medication is associated with a high risk of severe structural and cognitive defects in a developing fetus?
Which medication is associated with a high risk of severe structural and cognitive defects in a developing fetus?
What type of acne treatment is typically used for individuals with moderate acne?
What type of acne treatment is typically used for individuals with moderate acne?
How long does it typically take for the benefits of acne medications to become maximal?
How long does it typically take for the benefits of acne medications to become maximal?
What is a significant requirement for women taking isotretinoin?
What is a significant requirement for women taking isotretinoin?
Which of the following conditions must be monitored regularly when treating patients with isotretinoin?
Which of the following conditions must be monitored regularly when treating patients with isotretinoin?
What adverse effect is specifically associated with isotretinoin that requires immediate medical attention?
What adverse effect is specifically associated with isotretinoin that requires immediate medical attention?
What medication is often prescribed as a hormonal agent to manage acne?
What medication is often prescribed as a hormonal agent to manage acne?
What should a patient on isotretinoin avoid to minimize the risk of adverse effects?
What should a patient on isotretinoin avoid to minimize the risk of adverse effects?
What is the main mechanism by which hormonal agents help in acne treatment?
What is the main mechanism by which hormonal agents help in acne treatment?
What aspect should be monitored in patients regarding isotretinoin therapy in terms of mental health?
What aspect should be monitored in patients regarding isotretinoin therapy in terms of mental health?
Which of the following is a mechanism by which estrogens help manage acne?
Which of the following is a mechanism by which estrogens help manage acne?
Why is spironolactone typically added to the treatment regimen for acne?
Why is spironolactone typically added to the treatment regimen for acne?
What is a significant consideration when prescribing spironolactone?
What is a significant consideration when prescribing spironolactone?
Which agents are recommended for acne treatment in patients older than 12 years?
Which agents are recommended for acne treatment in patients older than 12 years?
What should be verified before prescribing retinoids to pregnant women?
What should be verified before prescribing retinoids to pregnant women?
What potential side effects are associated with topical Dapsone in pregnant women?
What potential side effects are associated with topical Dapsone in pregnant women?
Why is hormone therapy not recommended for prepubertal children with acne?
Why is hormone therapy not recommended for prepubertal children with acne?
What caution should be exercised when using topical salicylic acid during breastfeeding?
What caution should be exercised when using topical salicylic acid during breastfeeding?
What is an important guideline when considering acne treatments for older adults?
What is an important guideline when considering acne treatments for older adults?
What is the primary reason for the use of estrogen-containing oral contraceptives (OCs) in managing acne?
What is the primary reason for the use of estrogen-containing oral contraceptives (OCs) in managing acne?
Flashcards
Acne
Acne
A common skin condition, usually starting in puberty, characterized by blocked pores, inflammation, and lesions.
Comedones
Comedones
Plugged pores, either open (blackheads) or closed (whiteheads).
Blackheads (Open Comedones)
Blackheads (Open Comedones)
A type of comedone, where the pore opening is open, and sebum oxidation creates the dark appearance.
Whiteheads (Closed Comedones)
Whiteheads (Closed Comedones)
A type of comedone, where the pore opening is closed, and the plug is hidden beneath the skin's surface.
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Acne Treatment (NonPharmacological)
Acne Treatment (NonPharmacological)
Gentle cleansing, avoiding irritants (abrasives, harsh soaps), and avoiding oil-based products.
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Acne Treatment (Topical Drugs)
Acne Treatment (Topical Drugs)
Antibiotics (benzoyl peroxide, clindamycin, erythromycin, dapsone) and retinoids (tretinoin, adapalene, tazarotene) applied directly to the skin.
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Acne Treatment (Keratolytic Agents)
Acne Treatment (Keratolytic Agents)
Substances that promote the shedding of skin cells, for instance, benzoyl peroxide, azelaic acid, and salicylic acid.
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Acne Treatment (Isotretinoin)
Acne Treatment (Isotretinoin)
A powerful oral medication, frequently used for severe acne.
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Acne Treatment (Oral Antibiotics)
Acne Treatment (Oral Antibiotics)
Drugs taken by mouth, such as doxycycline and minocycline, used for moderate to severe cases.
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Acne Treatment(Hormonal Agents)
Acne Treatment(Hormonal Agents)
Combination oral contraceptives (OCs) and spironolactone used for unresponsive acne.
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Isotretinoin for Acne
Isotretinoin for Acne
A powerful topical retinoid for severe acne, but carries a high risk of birth defects and other serious side effects in women of childbearing age.
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Isotretinoin Side Effects
Isotretinoin Side Effects
Potential side effects include vision changes (night blindness), increased sun sensitivity, possible cognitive or structural defects in the developing fetus, and risk of spontaneous abortion. Close blood and mental health monitoring is essential.
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iPLEDGE Program
iPLEDGE Program
A strict risk management program for isotretinoin, preventing pregnancies among women taking the medication.
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Acne Treatment: Key Considerations
Acne Treatment: Key Considerations
Baseline data like blood counts, glucose, lipids, liver function tests, and mental health assessment crucial before starting therapy.
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Acne Treatment Monitoring
Acne Treatment Monitoring
Regular monitoring of lipids and liver function tests, particularly in women of childbearing age, is necessary.
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Acne Treatment High-Risk Patients
Acne Treatment High-Risk Patients
Women of childbearing age who may have difficulty adhering to birth control, those not yet fully grown; those with a history of diabetes or high cholesterol, or mental illness, require special care.
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Acne Treatment Therapeutic Goal
Acne Treatment Therapeutic Goal
Reduce acne severity, minimize nodular lesions, and prevent scarring.
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Hormonal Acne Treatment
Hormonal Acne Treatment
Combination oral contraceptives and spironolactone are often used to treat acne by decreasing androgen activity and sebum production.
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Adverse Effects Minimization
Adverse Effects Minimization
Advise patients on sun protection measures, increased ambient lighting during night vision issues, and discontinuing treatment if adverse effects occur.
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Approved OCs for acne
Approved OCs for acne
Four specific OCs, Estrostep, Ortho Tri-Cyclen, Beyaz, and Yaz, are approved for treating acne in women.
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Spironolactone for acne
Spironolactone for acne
Spironolactone is an androgen antagonist that blocks androgen receptors, reducing acne in women. It's usually added to the regimen after an OC proves inadequate.
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When NOT to use Spironolactone
When NOT to use Spironolactone
Spironolactone is teratogenic, meaning it can harm a developing fetus. Therefore, contraception is necessary before starting Spironolactone.
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Retinoids for children
Retinoids for children
Retinoids are generally not recommended for children under 12 years old, EXCEPT for Atralin (tretinoin gel) which can be used by children aged 10 years and older.
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Acne treatment during pregnancy
Acne treatment during pregnancy
Benzoyl peroxide and topical salicylic acid are the preferred acne treatments during pregnancy due to their safety profile. Other agents, including retinoids, may be harmful to the fetus.
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Dapsone for breastfeeding mothers
Dapsone for breastfeeding mothers
Both oral and topical dapsone are associated with complications in newborns. While not contraindicated, caution is advised during breastfeeding.
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Azelaic acid during breastfeeding
Azelaic acid during breastfeeding
The manufacturer advises against breastfeeding with azelaic acid gel and foam, while the cream manufacturer advises caution. The amount of systemic absorption is minimal, but effects on newborns are unknown.
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Hormone therapy for older adults
Hormone therapy for older adults
Hormone therapy is not recommended for acne treatment in older adults due to safety and efficacy concerns regarding estrogen and progestin.
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Safety of topical medications in older adults
Safety of topical medications in older adults
Benzoyl peroxide, sulfacetamide, dapsone, azelaic acid, and salicylic acid have no special requirements for use in older adults, although their effectiveness and safety in managing acne are not fully established.
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Acne: Pathophysiology, Treatment, and Considerations
- Prevalence: Acne is the most common dermatologic condition, affecting 85% of teenagers and often persisting into adulthood. It is typically more prevalent and severe in males.
- Onset: Usually begins during puberty due to increased androgen production.
- Location: Typically develops on the face, neck, chest, shoulders, and back.
- Mild Acne: Characterized by open comedones (blackheads) and closed comedones (whiteheads). Open comedones form when sebum and keratin combine to create a plug in the pore (oxidation of sebum causing a black appearance). Closed comedones form when pores become blocked by sebum and scales beneath the skin's surface.
- Severe Acne: Characterized by abscesses and inflammatory cysts. Increased sebum production and rapid turnover of follicular epithelial cells block pores. The presence of propionibacterium acnes (a microbe) which converts sebum into irritant fatty acids, and releases chemotactic factors promoting inflammation, intensifies symptoms.
Acne Treatment
- Non-pharmacologic: Gentle, non-irritant cleansing soaps can reduce surface oiliness. Avoid harsh scrubbing or abrasives. Avoid oil-based makeup or moisturizers. Comedo extraction, dermabrasion, etc., may be used in some cases, but dietary changes will not improve acne.
- Pharmacologic:
- Topical: Topical antibiotics (benzoyl peroxide, clindamycin, erythromycin, dapsone) and topical retinoids (tretinoin, adapalene, tazarotene). Topical retinoids are vitamin A derivatives, and are crucial for acne treatment as they can unplug existing comedones, prevent new ones, reduce inflammation, and improve other topical agent penetration. Adapalene is the first topical retinoid approved for over-the-counter use for those 12 years and older.
- Keratolytic agents: Help shed the outermost skin cells and include Benzoyl peroxide, Azelaic acid, and Salicylic Acid.
- Oral: Oral antibiotics (doxycycline, minocycline, tetracycline, erythromycin) are used for moderate to severe acne, suppressing P. acnes growth and inflammation. Oral retinoids (isotretinoin) are the principal agent for severe cases.
- Hormonal agents: Combination oral contraceptives (OCs) and spironolactone are used to reduce androgen activity, leading to decreased sebum production.
Patient Education for Acne Medications
- General precautions: Avoid sunlight, sunlamps, and tanning beds. Don't use harsh soaps or scrubs. Wash and dry skin before application and wash hands after use. Keep medications away from the eyes, mouth, and mucous membranes. Report severe irritation.
- Specific considerations: Avoid using benzoyl peroxide with dapsone. Women of childbearing age must strictly adhere to birth control using two reliable methods for isotretinoin.
Isotretinoin (Oral Retinoid)
- Black Box Warning: Associated with a high risk of birth defects and spontaneous abortion in developing fetuses, and should have strict, rigorous risk management in all transactions to ensure a woman is not pregnant, or becomes pregnant, while taking the medication. Patient education is essential.
- Monitoring: Perform blood tests and other assessments as needed.
- High-risk patients: Women capable of pregnancy who aren't adherent to birth control, younger patients who haven't reached full height, those with pre-existing diabetes mellitus or hyperlipidemia, or a history of depression or other mental illness.
- Adverse effects: Potential visual changes (especially night vision), sun sensitivity, psychological effects.
Key Prescribing Considerations & Treatment Goals
- Goal: To control acne, reduce nodular lesions, and prevent scarring.
- Baseline Data: CBC, glucose, lipid panel, liver function tests.
- Monitoring: Lipid and liver function tests every two weeks, then less frequently as needed. Verify birth control adherence for women of childbearing age. Assess for vision, mood, and pain changes.
- High-risk patient identification: Individuals mentioned above with critical factors
- Evaluating therapeutic effects: Look for reduction in nodular lesions and improvements to skin condition.
- Minimizing adverse effects: Advise avoidance of prolonged sunlight exposure.
Hormonal Agents
- Combination Oral Contraceptives (OCs): Effective for managing acne in women aged 15+, who need contraception. Their mechanism of action is related primarily to estrogen which suppresses ovarian androgen production and increases sex hormone-binding globulin, thus reducing androgen availability and thereby sebum production. Improvement can take 6+ months.
- Spironolactone: An androgen antagonist that blocks steroid receptors, including those for aldosterone and sex hormones. Used in combination with oral contraceptives if needed, and added after oral contraceptives are not adequate. It can cause menstrual irregularities, breast tenderness, and hyperkalemia.
Patient-Centered Care Across the Lifespan
- Children: Retinoids not recommended for <12 years, with exceptions. Other topical medications are suitable for >12 years but hormone therapy is not recommended prepubertally.
- Pregnant Women: Benzoyl peroxide and topical salicylic acid are the preferred OTC treatments. Retinoids are teratogenic. Avoid systemic sulfonamides as they are associated with complications in neonates.
- Breastfeeding Women: Caution is advised, particularly with systemic topical medicines such as oral or topical dapsone, due to unknown amounts excreted in breast milk.
- Older Adults: Safety and efficacy not established for all medications.
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