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IOS 9 Exam 2


Etiology of acne is Increased sebum production, Sloghing of keratinocytes, bacterial growth (P. acne), inflammation
Pathophysiology of acne is Follecular canal widens and increase in cell production. Sebum mixes with excess loose cells in canal to form keratinous plug. Resulting lesion black head "open comedo (melanin). Inflammation or trauma may lead to white head "closed comedo". or pustle
Open comedo is black head, Composed of melanin pigment caused by sebum mixing with excess loose cells in the follicular canal to for a keratinous plug
Closed comedo is If the plugged follicle stays below the surface of the skin, the lesion is called a closed comedo, or whitehead.
Nodule is Nodules are inflamed, pus-filled lesions lodged deep within the skin.
Papule The mildest form of inflammatory acne is the papule, which appears on the skin as a small, firm pink bump.
Pustule Like papules, pustules are small round lesions; unlike papules, they are clearly inflamed and contain visible pus.
Treatment goals of acne therapy Prevent euptions and reduce lesion, minimize SE, improve skin appearance & QAL, relieve discomfort, minimize scarring
Tretinoin MOA (retinoid) Increases cell turnover in follicular wall, decreases cohesiveness of cells, extrusion of existing comedones and inhibit the formation of new comedones, decreases number of cell layers.
Alapalene MOA (retinoid) Selective affinity for retinoic acid receptor (RAR), comedolytic, keratolytic, anti-inflammatory
Tazarotene MOA (retinoid) Prodrug converted to active form tazarotenic, selectivly bind to RAR, comedolytic, keratolytic, and anti-inflammatory
Topical Antibiotics used in acne Macrolides (inhibit P acne), Azelaic acid (antibacterial, anti-inflammatory, comedolytic)
Systemic antibiotics used in acne 1st line Macrolides, tetracyclines ,minocycline, doxycycline, 2nd line-bactrim
Systemic therapy:Hormonal therapy Considered 2nd line: Ortho-tricyclen, Estrostep FDA indicated: but acceptable progesins :norgestimate, desogestrel, drosperinone
Hormnones decrease acne (MOA) Decrease free testosterone thes decrease sebum production by inhibitin ovarian production of androgens
Systemic therapy: Spironolactone Considered 2nd line:\/*Used for acne resistant therapy in females
Systemic 1st line for severe recalcitrant nodular/conglobata acne Isotrentinoin (Brands-Accutane, Amensteem, Claravis, Sotret)
Prior to RX of Isotretinoin female patients must Had 2 HCG clear and on birth control, base line and at 2 and 4 week labs: CBC, LFT's, Lipids (TG) and then monthly HCG tests, as well as iPLEDGE program and birth control 1 month after treatment
MOA of Isotrintnoin All 5: induce atrophy of sebaceous gland, decrease sebum production, inhibit P. ances, inhibit inflammation , alter keratinization
Before supplying isotrentnoin a Pharmacist must obtain Obtain from a registered whole saler, fill for max 30 days, not dispense if RX> 7 days, obtain risk management authorization, provide pt with isotretinoin med guide at each visit
Medications that contribute to acne corticosterioids, azathiopurine, cyclosporine, isonaizid, lithium, phenytoin, barbiturates
Product potency rank Gel> solution> cream> lotion
Creams are prefered for patients with dry skin
Gels are prefered for patients with oily skin since they are the most drying and irrtating
Treatment effects begin 6-8 weeks of continous use to provide initial improvement, may get worse before better, can be aggrevated by chocolate, wash BID, use sunscreen, avoid popping
Mild acne characteristics Comedones are main lesions. Papules and pustules may be present but are small and few <10
Moderate acne characteristics Moderate number of (10-40) papules and pustules. Moderate number of comedones (10-40)
Moderately severe acne characteristics Numerous papules and pustules (40-100) usually with many comedones (40-100) and the occassional larger (5) deeper nodular inflammed lesion. Usually face, neck, chest, back
Very severe acne characteristics Nodulocystic acne and acne conglobata with severe lesions, many painful nodular/pustular lesions along with many smaller papules, pustules and comedones
OTC Benzoyl Peroxide MOA Bacteriacidal but watch clothes bleaching, and dry skin and irritation
Salicylic acid MOA Is a keratolytic (very potent at high concentrations) and comedolytic, watch dry skin due to ETOH carrier
Sulfer MOA It is a keratolytic and comedolytic but has bad odor and stains
Created by: liza001



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