Ance and Fungal Infections

Causes of Acne

multifactorial

• genetics

• gender

• diet

Acne Cosmetica

+description, location, cause

Noninflammatory comedones

face, chin, cheek

oil based cosmetics, moisturizers, pomades, and other health and beauty products

Acne Excoriee

+description cause

Constant picking, squeezing, or scratching at the skin

causes acne to look worse

Acne Mechanica

+cause

Local irritation from clothing, headbands, helmets, or other devices

Chloracne

+cause

Acneiform eruption caused by exposure to chlorine compounds

Drug-induced Acne

+cause

anabolic steroids, bromides, corticosteroids, phenytoin

Hormone-induced Acne

+cause

hormonal alterations, increased androgen levels (by medical conditions, pregnancy, or medications)

Hydration-induced Acne

+cause

Decrease in size and prevention of loosening of comedones caused by high-humidity environments and prolonged sweating

Occupational Acne

+cause

dirt, vaporized cooking oils, or certain industrial chemicals

Stress- and extreme emotion-induced Acne

expression of neuroendocrine modulators and release of CRH

Nonpharmacologic Acne Therapy

Cleanse skin

Hydrate

Facial Toners

Exacerbating Factors

Foods in high glycemic index

Adapalene

+OTC?, moa, age range, directions, ADEs, therapeutic effect timeline, when to contact PCP

nonprescription

moa: modulates epithelial cell differentiation, keratinization, and inflammation

indication:> 12 yrs

First line topical treatment

Directions:

• apply thin layer of the product once daily

• Protect from sun exposure

ADEs: Redness, dryness, itching, burning

• diminishes after first month

Full therapeutic effect: 8-12 weeks after treatment initiation

If symptoms worsen in 3 months - contact PCP

• or if pregnant

• allergic reactions

Benzoyl Peroxide

+OTC?, moa, indication+age range, benefit, formulation w/%, directions, ADEs, therapeutic effect timeline

Nonprescription

moa: introduces O2 into the environment, killing P. Acnes which can live in an oxygen-free environment

indicated: > 12 yrs

• mild acne

not carcinogenic

available in 2.5-10% as gel, wash, or cream

directions: apply sparingly to 1-2 small affected areas over the first 3 days

avoid contact with clothes (bleaching)

Counseling:

• applications can be increased or decreased until a mild peeling occurs

• results in 5 days - 3 weeks

• max lesion reduction after 8-12 weeks of use

ADEs: mild erythema and scaling during the first few days, usually subsides within 1-2 weeks

Sulfur

+OTC?, moa, indication, dose duration, benefits, ADEs

Nonprescription

Moa: natural exfoliating acids that occur in sugar cane, milk, and fruits → glycolic, lactic, and citric acids

• less potent

• used when other products are not tolerated

Dose duration: once every 15 days for 4-6 months

Less ADEs have moisturizing and humectant properties

Provides protection from the sun, inhibits UV B radiation-induced formation of sunburn cells

Resourcinol

+moa, effects

Keratolytics (soften skin/wart remover) fostering cell turnover and desquamation

• produces a reversible dark brown scale

Hydroxy acids

+OTC?, moa, indication, formulations, benefits, duration of dosing

ALpha Hydroxy Acids (AHAs)

less potent — for patients who can’t tolerate other topical agents

moa: exfoliating acids

available in 4-10% any higher is in prescriptions

benefits: assist with scarring and hyperpigmentation

duration of dosing: once every 15 days for 4-6 months

Which populations with acne concerns should be referred to a PCP?

Pregnant and pediatric

What are exclusion for self treatment of acne?

Rosacea

mod-severe acne

exacerbating factors: drugs, mechanical irritation, comedogenic

Tea Tree Oil

+use, properties, spectrum

Complementary and alternative medicine for acne and fungal skin infections though there are mixed results

antibacterial and anti fungal properties

S.aureas - sensitive

Zinc

+use, formulation, properties, spectrum, ADEs

Complementary and alternative medicine for acne

Oral Formulation

bacteriostatic against P. acnes

ADE: N/V, diarrhea

Vitamin A

+use, formulation, properties, spectrum, ADEs

Complementary and alternative medicine for acne

Retinol (naturally occurring)

ADE: xerosis (dry skin) and chelitis (chapped lips)

Nicotinamide

+use, properties

Complementary and alternative medicine for acne

form of niacin

water-soluble

Clotrimazole/miconazole nitrate

+moa, indication + duration, strengths, directions, DDIs

moa: inhibits biosynthesis of ergosterol (and other sterols) and by damaging the fungal cell membrane (fungistatic/fungicidal)

indication: clotrimazole 1%, miconazole 2% BID

• tinea pedis and tinea corporis : BID X 4 weeks

  • first choice txt for pedis

• tinea cruris: BID x2 weeks

DDI: warfarin

Terbinafide

+moa, indication + duration, strengths, directions, DDIs

moa: antifungal squalene epoxidase inhibitor → deficiency in ergosterol → cell death

• releases itching, cracking, and scaling

indication: 1%

• tinea cruris and tinea corporis: QD x 2 weeks or as directed

• tinea pedis: BID x 1 week, QD x4 weeks, or as directed

  • note ability to cure in one week!

  • stubborn, hides between the toes

NO DDIs

Tolnaftate

+moa, indication + duration, directions, problem, DDIs

moa: unknown, maybe disrupts hyphae

• treats dry and scaly lesions

only nonprescription approved for both preventing and treating fungal infections

problem: relapse after discontinuation

• inadequate duration

• nonadherence

• oral anti fungal more appropriate

indication: tinea pedis and corporis : 4-6 weeks

• applied sparingly BID x 2-4weeks

no DDIs

Clioquinol/Undecylenic Acid

+moa, indication + duration, directions, ADEs

moa: prevents fungal growth

indication: clioquinol 3% and Undecylenic Acid — nonprescription

• BID x 4 weeks

less effective for scalp and nails

ADEs: local skin irritation and burning sensation

Salts of Aluminum

+moa, indication + duration, directions, ADEs

moa: no direct anti fungal properties

• antibacterial activity (depends on potency)

indication: aluminum acetate + other topical antifungals —> tinea pedis

• acute cases should be used less than a week

ADEs: low tox, topical use (not around eyes)

Bitter orange

+use, durations, ADEs

can be used as a complimentary therapy in fungal skin infections

1-4 weeks

mild, local irritation

Garlic

+use

can be used as a complimentary therapy in fungal skin infections

• as effective as terbinafine 1% cream

Exclusions for self treatment of fungal infections

cause unclear

unsuccessful initial treatment

nails/scalp involved

face, mucus membranes, genitalia involved

signs of bacterial infection

execessive exudation

immune deficiency, diabetes, systemic infection

fever, malaise