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What nonpharm or alternative therapies have proven to be drastically effective?
Herbal and alternative therapies (primarily _____) is well tolerated and effective BUT....
tea tree oil
SLOWER onset o action than other topical therapies
Does diet impact acne?
Initial treatment is aimed at _____ and duration of therapy varies depending on __ and __
reducing lesion count
severity and treatment response
Oily skins should use what topical dosage forms?
Gels, solutions, lotions
Normal skin types should use what topical dosage forms?
gels, solutions, lotions, and creasm
Dry skin types should use what topical dosage form?
Lotions and creams
___ is a good dosage form for hair-bearing areas
___ therapy is primarily used in mild to moderate scene. ____ therapy is required in patients with moderate to severe acne
Name the topical Retinoids?
Tretinoin, Adapalene, Tazarotene
Which of the TRs is the least irritating?
Which of the TR has a pregnancy category X rating?
All TR agents cause skin irritaion, dryness, flaking, but __ formulations are more tolerable
__ have sun-sensitivity because they thin the stratum corneum so less of a barrier; cousle to wear sunscreen
___ is generally recommended as the first line agents for comedogenic and mild to moderate inflammatory acne
What is preferred agent for acne maintenance?
TRs to minimize antibiotic use
Topical Retinoids may take up to how long to see an effect? and therapy should be contiued for how long?
Continue therapy until no new lesions develop
Topical Retinoids accelerate resolution of ___
post inflammatory hyperpigmentaiton
Which of the TRs is the most effective? What about it limits it use?
Tazarotene, MOST irritating
Topical retinoids may have a transient worsening of symptoms initially but resolve in ___-
2-4 weeks with continued treatment
How are TRs dosed?
Once daily; in the afternoon because of irritation
Should patients apply TRs to spots or entire face?
Entire face; do not spot treat
___ can bleach hair, skin and clothing
Efficacy of BPO seen with __ and __ percent . Increasing the concentration leads to ___
higher incidence of side effects with minimal benifiet
BPOs are useful in what type of acne?
Comedonal and inflammatory acne
Is BPO bactericidal
When __ is used in combo with oral or topical antibiotics it decreases and prevents antibacterial resitance
__ is the most COST effective agent in acne management
How often is BPO dosed?
Wat should you advise patients just starting BPO about applying med?
Wash away drug after a few hours when first initiating therapy to help skin grow to tolerate it
DO NOT use __ and __ simultaneously.
If patient is using a BPO and TR how should you counsel them>
Do not use simultaneously. BPO oxidizes tretinoin and makes it less effective. Use BPO in morning and TR at night
What topical treatment should you avoid contact with eyes and mucous membranes?
Azelaic acid 20% cream
Which topical product has isolated reports of hypo pigmentation?
Azelaic acid 20%
Azelaic acid is effective for both __ and ___ acne
mild to moderate inflammatory
__ can improve acne induced post-inflammatory hyperpigmetation
Azelaix acid has no likelihood of __, __ or __
bacterial resistance, systemic adverse effects, or photosensitivity
Azelaic acid is considered a __ line agent in the treatment of mild to moderate inflammatory acne and comedonal acne in patients who cannot tolerate BPOs or TR
2nd or 3rd line
Does Topical Dapsone 5% increase you risk for hemolytic anemia?
NO; only in those taking ORAL dapsone, but this is not a problem in TOPICAL
Is testing for G6PD deficiency necessary in topical Dapsone use?
NO; just with oral
There is a questionable decrease in hemoglobin with the use of what topical product?
-Cautoin in those with anemia- monitor
What is a tolerability issue that patients do not like with Dapsone 5% topical use?
Temporary yellow to orange skin and hair discoloration when used with BPO
Also leaves gritty dirty feeling on patients skin
Dapsone can be used for mild-moderate inflammatory acne and comedonal acne. The greatest improvemen is seen in ___
Is Dapsone 5% contraindicated in Sulfa allergy?
NO; Sulfone derivative not Sulfonamide; topical Dapsone is not contraindicated with sulfa allergy
What is the dosing of Dapsone and for how long?
Twice a day for at least 12 weeks
Using Salicyclic acid topically for acne. What is the toxicity you are worried about?
Risk of salicylic toxicity with repeated widespread use on highly permeable skin
Salicyclic acid is considered __ line agent because __ properties are less potent than TR and BPOs
If using a salicylcic acid containing cleanser, what should you counsel the patient?
Medication is only active as long as product is on skin (leave on for several minutes)
What are some safety issues with using topical clindamycin?
Pseudomembranous colitis and hypersensitivity
__ directly supresses P.acnes
Topical Antibiotics must be used with ___. Why?
to minimize and prevent resistance; NOT recommended to use as single agent
Topical Antibiotics are __ line agent. Why?
concerns with resistance
Can sulfacetamide be used in a sulfa allergy patient?
NO; topical antibiotic
__ is associated with tooth discoloration and reduced bone growth in childern < __ and pregnant women
Which oral antibiotics are associated with fetal and infant toxicity
TCNs and Bactrim
Which oral antibiotic is associated with Bone marrow suppression, SJS, TEN
Which oral antibiotic is associated with Bacterial resistance, GI upset, C.diff?
Where is oral antibiotics place in acne therapy?
Reserve for treatment resistant inflammatory acne
ADD recommends reserving oral ABX for ____ and limiting duration of use to ____
moderate to severe
Improvement in acne from oral antibiotics is generally seen in ___
Use __ in combo with oral antibiotics to decrease bacterial resistance
You can use TR with oral Abx to ___ and to ___
increase efficacy and decrease use of abx
__ is the more efficacious followed by __ and ____ (of the Oral antibiotics)
__ is the least photosensitizing of the 3 TCNs but can cause ____
Vertigo, Lupus-like syndrome, and skin discoloration
Save erythromycin for what patients? Why?
Patients who are recommended against using TCNs (Pregnancy and Children <8)
Resistance is most common with erthyromycin
You can advise patients on oral antibiotics to try ___ to minimize occurrence of vaginal candidiasis
Probiotics or yogurt
Tetracycline absorption is inhibited by?
Food, dairy products, antiacids, and iron
Should be taken on an empty stomach
Do you need to take Doxycycline or Minocycline on an empty stomach?
NO; taking it on in the fed state may decrease GI upset, must take separate of all divalent cations)
What are some safety issues associated with Isotretinoin?
What are the relative contraindications for Isotretinoin?
Isotretinoin may elevate what levels?
Cholesterol and TGs
If monitoring Isotretinoin and you notice patients cholesterol and TG levels have increased, is this reversible?
Yes, upon dose reduction or drug DC
Can Isotretinion cause bone abnormalities?
Yes decreased BMD and impairment of growth
What is most effective sebosuppressive agent?
Isotretinion is reserved for severe ___, ___, or acne resulting in _____
treatment resistant acne
physical or psychological scarring
Participation in __ is a must for all patients recieving Isotretinion
The iPLEDGE program requires monthly __ and commitment to use ____
2 forms of contraception
If any pregnancies occur while on Isotretinion, refer to ___
reproductive toxicity specialists
Treat up to __ weeks and discontinue sooner if acne resolution is ___% or greater when using Isotretinion
Isotretinion can only be prescribed by who?
By prescribers knowledgeable in its administration and monitoring and must be registered with iPLEDGE
After Isostretinion treatment, relapse may occur within first _years and is highest in those with _ acne and those receiving lower than the total recommended cumulative dose.
Acne may worse initially during Isostretinion treatment for first few weeks but can be managed with __
short course of steroids
When on Isostretinion you cannot donate blood for how long?
While on the med or within one month of stopping medication
Isostretinion require monthly monitoring of various adverse events (__, __, __, __)
Monitor __ and __ at baseline and at weeks 4 and 8 with Isostretinion
LFTs and lipids
Must screen for __ or __ before and during treatment with Isostretinion
Prescriptions for Isostretinion should only be for __ supply and should be filled within __
1 month supply
7 days of Rx date
Do not use Isostretinion with ___ because of increased risk of pseudotumor cerebri
Tetracyclines or Tigecycline
Isostretinion increases the clearance of what drug
Isostretinion decreases the effectiveness of ___
Who must be registered with iPLEDGE?
ALL patients, prescribing physicians, dispensing pharmacies, and wholesalers& manufacturers
How many forms of contraception must be used with Isostretinion?
Start at least 1 month prior to therapy and continue for up to 1 month after
With Isostretinion therapy a pregnancy test must be done in a CILA certified lab and results must be submited to ___ before __-
Pregnancy testing for Isostretinion: __ negative test prior to beginning therapy.
(second preformed at least 19 days after the first and during 5 days fo the mentustrual period immediately before starting)
Oral contraceptives may take up to how long before you began to see a significant reduction in acne
What dose of OCs appears to be the target for treatment of acne
low dose 20-35 mcg
OCs are a good treatment option for women with excess production of __, severe seborrhea, __, or __
Use __ generation progestins becuase they have less androgenic acitivity
Which progestin has antiandrogenic acitivty
What are the safety issues with Oral spironolactone therapy?
Cuation in renal impairment
Oral spironlactone may cuase __ in men and is often not used becuase of this
Spironolactone therapy may require ____ to see significant effect
Sprionolactone therapy is reserved for patients with __ or __
hyperandrogenism or PCOS
Oral Corticosteroids may have temporary benefit in those with _____, only use ___
severe inflammatory acne
very short burst of high dose
Oral corticosteriods may be a good choice in those with _____; use what dose
What are the four factors involved in the formation of acne?
Increased sebum production
Follicular hyperproliferation and abnormal desquamation
Sebum production is primarily driven by ___ activity
__ is the predominant androgen
The open come do has a brown or black appearance due to ___ accumulation
__ comedones are imporatant clinically becuase they can become larger, inflammatory lesions secondary to P.acnes activity
The presence of ___ comedones is diagnostic
Scars are a common result of __ acne lesion
What are the medications known to cause acne?
B Vitamins 2,6,12
What are some of the exacerbating factors?
Oil based cosmetics
Occulssive Hair Dyes
Exposure to dirt, cooking oil or grease
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