Acne Medications

factors of acne pathophysiology

follicular hyperkeritinzation

bacteria infiltration

sebum production

androgens

inflammation

2 groups of topical acne meds

topical retinoids

topical antimicrobials

list the topical retinoids

adapalene

tazarotene

tretinoin

triafotene

topical antibiotics

benzoyl peroxide

clinadmycin

erythromycin

dapsone

what do retinoids bind to

retinoic acid receptors

RAR alpha/beta/gamma

retinoids binding RAR receptors has what effect

reduced follicular occlusion through decreasing keratinocyte differentiation and cohesion

effects of retinoids (3)

-reduced follicular occlusion

-down-regulation of TLR-2

-enhance penetration of other topicals

most effective comedolytic agent

tretinoin

first line agent for inflammatory and non-inflamm acne

tretinoin

adverse effects of tretinoin

photosensitivity

dry skin

scaling

eryhtema

burning

topical drug that is a metabolite of vitamin A

tretinoin

retinoid-like naphthoic acid compound

adapalene

tazarotene targets _

RAR-beta and RAR-gama

trifarotene targets which receptors

RAR-gamma

how do topical retinoids help photoaging

-increase collagen production

-induce epidermal hyperplasia

-decrease keratinocyte atypia

benzoyl peroxide has _ effects

keratolytic + antibacterial

mainstay therapy for inflammatory acne

benzoyl peroxide

side effects of BPO

skin irritation

bleaching

contact dermatitis

clindamycin MOA

binds 50S ribosomal subunit -> inhibits protein synthesis

erythromycin MOA

binds P site of 50S ribosomal subunit -> inhibits protein synthesis

which topical antibiotic binds the P site of 50S ribosomal subunit

erythromycin

clindamycin and erythromycin are used for what kind of acne

mild to moderate inflammatory acne

dapsone MOA

competes with PABA

inhibits folic acid synthesis

dapsone can be used for what type of acne

inflammatory AND non-inflammatory

what combination causes yellow/orange discoloration of the skin?

dapsone + BPO

azelaic acid MOA

inhibits protein synthesis

normalizes keratin process

decreases microcomedo formation

azelaic acid can be used for what kinds of acne

inflammatory AND non-inflammatory

azelaic acid adverse effect

hypopigmentation

_ causes less irritation than BPO

azelaic acid

salicylic acid MOA

keratolytic

salicylic acid side effect

skin irritation

clascoterone MOA

androgen receptor inhibitor

clascoterone side effects

redness

itching

dry skin

HPA axis suppression

cabtreo components

clindamycin

adapalene

benzoyl peroxide

best topical medications for mild to severe acne

adapalene

tretinoin

systemic therapy for acne

oral tetracycline antibiotics

oral antibiotics for acne

doxycycline

minocycline

seracycline

trimethoprim/sulfa (bactrim)

tetracycline MOA

binds 30S ribosomal subunits

inhibits neutrophil chemotaxis and cytokines

when are oral antibiotics generally used

acne that is refractory to topical agents

specific side effects of minocycline

dizziness

impaired spermatogenesis

tetracyclines side effects

GI adverse effects

vaginal candidadis

photosensitivity

hyperpigmentation

intracranial HTN

tetracyclines should not be used in _ (and why?)

children and pregnant women

*inhibits tooth and bone development

narrow spectrum tetracycline

sarecycline

trimethroprim/sulfa. MOA

competes with PABA to inhibit folic acid synthetis

inhibition of dihydrofolate reductase

oral estrogen effect

decreases the formation of ovarian and adrenal androgens

suppresses sebum production

only oral contraceptives containing _ can worsen acne

norethindrone

newer progesitins

desogestrel

norgestimate

drospiernone

spironolactone MOA

antagonizes aldosterone receptors in the DCT

blocks androgen receptors

inhibits sebum production

less cytokine secretion

oral retinoid for acne

isotretinoin

most effective treatment for severe nodulocystic acne

isotretinoin

isotretinoin MOA

reduces sebum production -> less C. acnes colonization

keratolytic

anti-inflammatory

how long does isotretinoin treatment last

20-24 weeks

at lower dose of isotretinoin, what % require retreatment

20%

at higher dose of isotretinoin, what % require retreatment

10%

how long are contraceptives required for isotretinoin

-one month before

-during

-2 months after

labs needed for isotretinoin

TGs

LFTs

what must be discontinued when taking isotretinoin

other acne drugs

Vit A

main side effects of isotretinoin

angular cheilitis

dry skin

conjunctivitis

initial treatment of acne

topical SA and BPO

drug that can treat acne and psoriasis

tazarotene

retinoids that can be used in pediatric patients

tazarotene

trifarotene

key point of why BPO is used

has not been shown to induce bacterial resistance

clindamycin monotherapy is not recommended because of _

development of bacterial resistance

which drug has a similar structure to dihydroxytetosterone

clascoterone

benefit of sarecycline over other tetracyclines

less likelihood of resistance

OCPs that are approved for acne

Ortho-Tri-cyclen

Yaz

spironolactone side effects

breast tenderness

irregular menstrual cycle

low blood pressure