CAS 608 Block 3
Definition of Acne
also known as acne vulgaris
Acne vulgaris is an inflammatory skin disease affecting 40-50 million people in the US.
The term vulgaris means "common" or "affecting the masses."
Page 5: Pathophysiology of Acne
Acne is an inflammatory disease of the pilosebaceous unit in the dermis.
Includes increased sebum production, follicular colonization by Cutibacterium acnes, alteration in keratinization process, and release of inflammatory mediators.
Page 7: Clinical Presentation of Acne
Different subtypes of acne based on exacerbating factors like acne cosmetica, acne excoriee, and chloracne.
Factors like hormone-induced acne, hydration-induced acne, and stress can worsen acne.
Page 9: Terminology
Definitions of terms like comedo(ne), whitehead, blackhead, papule, pustule, and nodule/cyst in acne lesions.
Page 12: Grading and Classification of Acne
Acne classified as mild, moderate, or severe based on the number of papules, pustules, and nodules.
Severe acne can lead to scarring.
Page 15: Treatment Goals
Goals include eliminating visual lesions, preventing relapse, and treating complications like scarring.
Non-pharmacologic and pharmacologic treatments are used.
Page 17: Non-Pharmacologic Treatment
Involves identifying exacerbating factors, cleansing the skin, staying hydrated, using facial toners, and adjusting diet.
Avoid harsh soaps, stay hydrated, and reduce high glycemic index foods.
Page 20: Adapalene Gel 0.1% (Differin Gel)
Topical retinoid used for mild acne treatment.
Mechanism of action includes modulating cell differentiation and inflammation.
Side effects include redness, dryness, and itching.
Page 22: Benzoyl Peroxide 2.5-10%
Keratolytic and antibacterial properties against C. acnes.
Used for mild acne and in combination with other products for moderate to severe acne.
Clinical pearls include starting at low strength and testing on a small area initially.
Page 24: Benzoyl Peroxide Counseling Points
Avoid contact with clothes or hair
May bleach fabric or hair
Avoid excessive sun exposure and use sunscreen
Minor improvement with daily application
Adjust number of applications until mild peeling occurs
Maximum lesion reduction after 8-12 weeks
Do not use simultaneously with topical retinoid
Page 25: Hydroxy Acids
Less potent option when other acne products cannot be used
Moderately effective
Keratolytic agents: Alpha hydroxy acids (AHAs) and beta hydroxy acids (BHAs)
Page 26: Alpha Hydroxy Acids
Types: Lactic acid, Glycolic acid, Citric acid
OTC Strength: 4-10%
Mechanism of Action: Keratolytic
Useful as peel-based product post-acne control for scarring and hyperpigmentation
Common side effect: Skin dryness
Page 27: Beta Hydroxy Acids
Salicylic acid
OTC Strength: 0.5-2%
Mechanism of Action: Comedolytic
Mostly used in cleansers; less potent therapy for intolerant patients
Contraindications: Patients with diabetes or poor circulation
Common side effects: Skin dryness
Counseling: Wear sunscreen
Page 28: Sulfur
Strength: 3-10%
Mechanism of Action: Keratolytic and antibacterial
Effective in resolving existing comedones
Continued use may cause blackheads
Common side effects: Noticeable odor, dry skin
Page 29: Sulfur/Resorcinol Combination
Enhances sulfur's effect
Primarily keratolytic, fostering cell turnover
Resorcinol not effective alone
Common side effects: Brown scaling in darker-skinned patients, skin dryness
Page 30: Comparison of Nonprescription Topical Anti-Acne Agents
Adapalene 0.1%
Comedolytic, anti-inflammatory, keratolytic
Benzoyl peroxide 2.5%-10%
Antibacterial, comedolytic, keratolytic
Salicylic acid 0.5%-2%
Comedolytic
Sulfur 3%-10%
Antibacterial, keratolytic
Resorcinol 2% with sulfur 3%-8%
Antibacterial, keratolytic
Page 31: Formulation Comparison
Bars and liquids
Leave minimal active ingredient residue
Gels
Most effective, remain longest, beneficial for oily skin
Solutions
Beneficial for oily skin, may cause contact dermatitis
Creams/Lotions
Less irritating, suitable for dry or sensitive skin
Ointment
Not recommended,