Acne
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| Etiology of acne is | Increased sebum production, Sloghing of keratinocytes, bacterial growth (P. acne), inflammation
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| 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
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| 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
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| Closed comedo is | If the plugged follicle stays below the surface of the skin, the lesion is called a closed comedo, or whitehead.
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| Nodule is | Nodules are inflamed, pus-filled lesions lodged deep within the skin.
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| Papule | The mildest form of inflammatory acne is the papule, which appears on the skin as a small, firm pink bump.
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| Pustule | Like papules, pustules are small round lesions; unlike papules, they are clearly inflamed and contain visible pus.
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| Treatment goals of acne therapy | Prevent euptions and reduce lesion, minimize SE, improve skin appearance & QAL, relieve discomfort, minimize scarring
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| 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.
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| Alapalene MOA (retinoid) | Selective affinity for retinoic acid receptor (RAR), comedolytic, keratolytic, anti-inflammatory
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| Tazarotene MOA (retinoid) | Prodrug converted to active form tazarotenic, selectivly bind to RAR, comedolytic, keratolytic, and anti-inflammatory
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| Topical Antibiotics used in acne | Macrolides (inhibit P acne), Azelaic acid (antibacterial, anti-inflammatory, comedolytic)
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| Systemic antibiotics used in acne | 1st line Macrolides, tetracyclines ,minocycline, doxycycline, 2nd line-bactrim
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| Systemic therapy:Hormonal therapy | Considered 2nd line: Ortho-tricyclen, Estrostep FDA indicated: but acceptable progesins :norgestimate, desogestrel, drosperinone
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| Hormnones decrease acne (MOA) | Decrease free testosterone thes decrease sebum production by inhibitin ovarian production of androgens
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| Systemic therapy: Spironolactone | Considered 2nd line:\/*Used for acne resistant therapy in females
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| Systemic 1st line for severe recalcitrant nodular/conglobata acne | Isotrentinoin (Brands-Accutane, Amensteem, Claravis, Sotret)
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| 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
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| MOA of Isotrintnoin | All 5: induce atrophy of sebaceous gland, decrease sebum production, inhibit P. ances, inhibit inflammation , alter keratinization
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| 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
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| Medications that contribute to acne | corticosterioids, azathiopurine, cyclosporine, isonaizid, lithium, phenytoin, barbiturates
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| Product potency rank | Gel> solution> cream> lotion
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| Creams are prefered for patients with | dry skin
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| Gels are prefered for patients with | oily skin since they are the most drying and irrtating
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| 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
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| Mild acne characteristics | Comedones are main lesions. Papules and pustules may be present but are small and few <10
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| Moderate acne characteristics | Moderate number of (10-40) papules and pustules. Moderate number of comedones (10-40)
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| 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
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| 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
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| OTC Benzoyl Peroxide MOA | Bacteriacidal but watch clothes bleaching, and dry skin and irritation
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| Salicylic acid MOA | Is a keratolytic (very potent at high concentrations) and comedolytic, watch dry skin due to ETOH carrier
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| Sulfer MOA | It is a keratolytic and comedolytic but has bad odor and stains
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