Common Skin Conditions - Acne, Urticaria, and Rosacea

Practice flashcards covering the pathophysiology, clinical presentation, and pharmacological treatment plans for Acne Vulgaris, Urticaria, and Rosacea based on the lecture by Jason Yamaki, PharmD, PhD.

When does acne most commonly start?

During puberty

What increase in activity causes acne?

Androgen & sebaceous gland

What is the first stage of acne progression?

Sebaceous gland produces sebum

What is the second stage of acne progression?

Increased follicular keratinization

What is the third stage of acne progression?

Follicular colonization by Cutibacterium

What is the fourth stage of acne progression?

Inflammatory mediators

Which specific bacterium is responsible for follicular colonization in acne?

Cutibacterium acnes

What type of acne is open comedo?

Mild

What type of acne is closed comedo?

Moderate

What type of acne is papule?

Moderate

What type of acne is pustule?

Severe

What type of acne is comedonal acne?

Non-inflammatory

What do androgens lead to?

Increased sebaceous gland size & activity

What leads to increased sebaceous gland size and activity?

Androgens

What does Adhesion of epidermal cells leads to?

Keratinous plug

What does increased sebum leads to?

Open/closed comedone formation

What is difficult to drain, whitehead?

Closed comedone

What is plug extends to upper canal, blackhead?

Open comedone

What does C. acne release?

Chemokines

What happens when chemokines are released?

Recruitment of neutrophils

What does C. acne produce?

Enzymes

What does C. acne producing enzymes lead to?

Increased permeability of follicular wall

What can increased permeability of follicular wall lead to?

Rupture, release of keratin, lipids, free fatty acids into dermis

What can acne inflammatory lesions lead to?

Pustules, nodules, cysts

Which areas of the body are most commonly affected by Acne Vulgaris?

Face, back, upper chest, shoulders

What is the goal of treatment for Acne Vulgaris?

Treat early to avoid permanent scarring, Reduce spreading of disease, Reduce emotional stress, Maintain remission of disease

What is acne vulgaris treated as?

Chronic disease

What do treatments of acne target?

All 4 mechanisms of acne development

What should be done for maintenance therapy & life-style modification?

Balanced, healthy diet, stress control

What is the life cycle of acne?

C acnes proliferation → Inflammatory response → abnormal sebum → abnormal keratinization of follicle

What do pharmacologic agents target for non-inflammatory acne?

Keratinization

What has the highest evidence of use for non-inflammatory acne?

Topical retinoids

What are the first-line pharmacologic treatments for mild-moderate comedonal non-inflammatory acne?

Benzoyl peroxide and topical retinoids (such as Adapalene).

What is a second drug to use for non-inflammatory acne?

Azelaic acid

What are alternatives to adapalene?

Tazarotene & tretinoin

What drug class Comedolytic agents that unblock pores, anti-inflammation effects?

Topical retinoids

What drug class Work synergistically with topical antibiotics to allow entry and eradicate bacterial infiltration (if present)?

topical retinoids

What drug class has the side effect of skin dryness?

Topical retinoids

What drug class has the side effect of Redness?

Topical retinoids

What drug class has the side effect of Scaling of skin?

Topical retinoids

What drugs has the side effect of Photosensitivity?

Adapalene, Tretinoin, Tazarotene, Minocycline, Doxycycline, Isotretinoin

What drug class has the severe side effect of Skin discoloration?

Topical retinoids

What drug class has the severe side effect of Swelling of skin?

Topical retinoids

What drug class has the severe side effect of Swelling of skin?

Topical retinoids

What drug class has the severe side effect of Blistering of skin?

Topical retinoids

What drug has the side effect of dry skin?

Adapalene, Tretinoin, Tazarotene, Benzoyl peroxide

What drug should has sensitivity to sun?

Adapalene

What drugs has fetal harm potential?

Adapalene, Tretinoin, Tazarotene

What drugs has increased risk of sunburn?

Tretinoin

Which topical retinoid requires a pregnancy test within 2 weeks of use?

Tazarotene

What drug has the MOA of a competitive inhibitor of 5-alpha reductase, inhibiting the conversion of testosterone to 5-dihydrotestosterone; it also normalizes keratinization and has anti-inflammatory and anti-bacterial effects?

Azelaic Acid

What drug is an alternative to first choice of non-inflammatory acne?

Azelaic Acid

What drug can lead to hypopigmentation?

Azelaic Acid

What drugs are safe in pregnancy for acne?

Azelaic Acid, Benzoyl Peroxide

What drug leads to comedolysis and desquamative (removal) action of cells and antibacterial action?

Benzoyl Peroxide

What drug improves both inflammatory and non-inflammatory lesions in acne?

Benzoyl Peroxide

What is a unique precaution for Benzoyl peroxide regarding household items?

Bleach hair or fabric

What drug can bleach hair or fabric for acne?

Benzoyl Peroxide

What drug may cause skin peeling for acne?

Benzoyl peroxide

What do retinoids target in non-inflammatory acne?

Hyperkeratinization

What do benzoyl peroxide do in non-inflammatory acne?

Keratolytic

What do azelaic acid do in non-inflammatory acne?

normalizes keratinocyte activity, anti-androgen, anti-inflammatory

What drug is first line therapy for mild-moderate inflammatory acne?

Fixed dose combination of adapalene & benzoyl peroxide; Fixed dose combination of topical clindamycin & benzoyl peroxide

What is an alternative therapy for mild-moderate inflammatory acne?

Different topical retinoid w/ other antimicrobial agent

What is wide-spread disease for mild-moderate inflammatory acne?

Combination of systemic antibiotic with benzoyl peroxide or Combination of systemic antibiotic with fixed dose combination of benzoyl peroxide + adapalene

What drug has the Main mechanism of action is to reduce C. acnes?

Topical erythromycin and clindamycin

What makes topical erythromycin and clindamycin more effective?

Addition of benzoyl peroxide or topical retinoids

Which topical antibiotic is preferred for acne due to its potency and lack of absorption?

Clindamycin

What drug is a Synthetic sulfone?

Dapsone

What drug can use in patients with sulfonamide allergy?

Dapsone

What drugs should you not use alone?

Topical erythromycin & clindamycin, dapsone

What is the first line topical antibacterial agent for acne?

Clindamycin phosphate/benzoyl peroxide or Adapalene/benzoyl peroxide

What drug should UV light be minimized in?

Adapalene/benzoyl peroxide

What drug should can lead to suburns?

Adapalene/benzoyl peroxide, Clindamycin phosphate/tretinoin

What drug are systemic antibiotic agents for acne?

Minocycline, Doxycycline

What drug should be avoided in isotretinoin use for acne?

Doxycycline

What is the first-line therapy for severe papulopustular acne / nodular / cystic acne?

Isotretinoin

What is the second-line therapy for severe papulopustular acne / nodular / cystic acne?

Alternative systemic antibiotics PLUS Fixed dose adapalene-benzoyl peroxide combination OR Combination of adapalene w/ azelaic acid

What is the alternative therapy for severe papulopustular acne / nodular / cystic acne?

Anti-androgen in combination with oral antibiotics; Topical treatments; Systemic antibiotics in combination with benzoyl peroxide

What drug is a Synthetic analog of Vitamin A?

Isotretinoin

What drug Inhibits sebaceous gland function and keratinization?

Isotretinoin

What drug has the side effect of anemia?

Isotretinoin

What drug has the side effect of increased LFTs?

Isotretinoin

What drug has the side effect of Thrombosis of blood vessels?

Isotretinoin

What drug has the side effect of Neutropenia?

Isotretinoin

What drug has the side effect of Thrombocytopenia?

Isotretinoin

What drug has the side effect of Optical neuritis?

Isotretinoin

What drug has the side effect of Depression, aggressive behavior, injury due to suicide attempt, psychotic disorder, and suicidal thoughts?

Isotretinoin

What drug shouldn’t be taken with tetracycline for acne?

Isotretinoin

What drug shouldn’t be taken with vitamin A supplements for acne?

Isotretinoin

What drug shouldn’t be taken with St. John’s Wort for acne?

Isotretinoin

What drug can risk of scarring may occur with hair removal?

Isotretinoin

What is the box warning for Isotretinoin?

Pregnancy

What can Isotretinoin lead to when a person is pregnant?

Birth defects

What program must prescribers, pharmacies, and patients register with to use Isotretinoin?

The iPLEDGE Risk Evaluation and Mitigation (REMS) Program

What drug is specific for women for acne?

Anti-androgen compounds

What drug is Particularly, beneficial if acne is menstrual related, or ovarian disease related?

Oral contraceptive

What drug is Primarily used as antihypertensive agent through renal competitive aldosterone antagonist but can be used for acne?

Spironolactone

What drug has the side effect of Gynecomastia?

Spironolactone

What drug has the side effect of erectile dysfunction?

Spironolactone