Term
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Definition
| chronic inflammatory disorder of pilosebaceous unit due to increased androgen production --> increased sebum production & increased production & sloughing of keratinocytes; bacterial colonization & growth (Propionibacterium acnes); immune-mediated inflammation |
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Term
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Definition
| open comedones (blackheads) & closed comedones (whiteheads) |
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Term
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Definition
| papules, pustules, nodules, cysts (abscesses) |
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Term
| Exacerbating Factors with Acne |
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Definition
| cosmetics; mechanical irritation/obstruction; climate; occupational/environmental exposures; medications (anabolic steroids, corticosteroids, isoniazid, phenytoin, lithium, phenobarbital, cyclosporine, tetracycline); NO LONGER CONSIDERED FACTORS: diet, stress |
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Term
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Definition
| preominantly non-inflammatory lesions; few to several papules/pustules; NO nodules |
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Term
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Definition
| few to numerous non-inflammatory lesions; several to many papules/pustules; few to several nodules |
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Term
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Definition
| few to numerous non-inflammatory lesions; many to extensive papules/pustules; MANY nodules |
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Term
| Nonpharmacological Treatment of Acne |
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Definition
| wash face twice daily but no more than that - use warm water & mild, nonmoisturizing soap; Avoid exacerbating factors (comedogenic cosmetics, drugs, environmental factors); Avoid touching acne-effected areas; Do not pick/pop lesions |
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Term
| benzoyl peroxide [Neutrogena, Clearasil, Proactiv - OTC; Brevoxyl, Triaz, Zoderm - RX] |
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Definition
| 1st line agent; used to treat inflammatory & non-inflammatory lesions; MoA: antimicrobial, anti-inflammatory, keratolytic/comedolytic; ADRs: skin irritation - dryness, burning, erythema, peeling, contact dermatitis (middle of road irritation); Effective & inexpensive; Can use in Combo with topical retinoids & antibiotics; Application: 1-2 times daily (no more than BID); gels (most potent), creams/lotions (intermediate), washes/cleansers (limited efficacy) |
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Term
| Procedure for applying Benzoyl Peroxide |
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Definition
| wash face & pat dry; wait 20-30 min before applying medication; use only a thin layer; for external use only |
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Term
| topical retinoids (tretinoin [Avita, Retin-A], adapalene [Differin], tazarotene [Tazorac]) |
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Definition
| 1st line agents against inflammatory & non-inflammatory lesions; more effective for non-inflammatory than BP; Used in combo with BP & topical antibiotics; MoA: keratolytic/comedolytic, anti-inflammatory; ADRs: skin irritation (most irritating): dryness, erythema, pruritis, burning; photosensitivity, hypo/hyperpigmentation; Do not use during pregnancy: Cat. C (tretinoin, adapalene) & Cat. X (tazarotene) |
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Term
| tretinoin [Avita, Retin-A] |
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Definition
| topical retinoid; 0.025% - 0.1% gel, cream, solution; liquid polymer & microsphere are less irritating; Application: once daily or every other day to clean, dry skin; titrate |
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Term
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Definition
| topical retinoid; Cream 0.1%, Gel 0.1%, 0.3%; Equally effective at 12 wks, less irritating, less pigmentation changes than tretinoin; Application: once daily to clean, dry skin |
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Term
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Definition
| topical retinoid; Cream 0.05%, 0.1%; Gel 0.05%, 0.1%; Slighly more effective than tretinoin, equally as effective as adapalene, MORE irritating --> 2nd line agent; Application: once daily to clean, dry skin |
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Term
| Topical Antibiotics (erythromycin 2% [Eryderm, Erygel], clindamycin 1% [Evoclin, Cleocin], Combo products: BenzaClin, Duac [BP + clindamycin], Benzamycin [BP + erythromycin] |
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Definition
| 1st line: mild inflammatory lesions; 2nd line: moderate inflammatory lesions; Combo products with BP or topical retinoids; no superiority seen; MoA: antimicrobial, anti-inflammatory, keratolytic/comedolytic; ADRs: skin irritation; Application: twice daily to clean, dry skin; |
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Term
| azelaic acid [Azelex 20% cream, Finacea 15% gel] |
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Definition
| 2nd line agent for mild inflammatory & non-inflammatory lesion; Useful for BP/topical retinoid intolerant pts, pregnancy (cat. B), & hyperpigmentation (lightens skin); MoA: antimicrobial, keratolytic/comedolytic, anti-inflammatory; ADRs: skin irritation (less than BP, retinoids), hypopigmentation, less photosensitivity than retinoids; Application: BID to clean, dry skin |
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Term
| salicylic acid [Neutrogena, Stridex] |
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Definition
| 2nd line agent limited to non-inflammatory lesion; less effective than topical retinoids & BP; MoA: keratolytic/comedolytic, anti-inflammatory (minor); ADRs: skin irritation - burning, peeling, scaling; Systemic: dizziness, HA, confusion; Application: 1-4 times daily to clean, dry skin |
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Term
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Definition
| 250-500 mg BID x 1-2 months then 500 mg qd; take on EMPTY STOMACH; ADRs: GI intolerance, photosensitivity, yeast infection; C/I: pregnancy, age <8 yrs old |
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Term
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Definition
| #1 oral antibiotic of choice; standard: 100-200 mg daily, then 50 mg daily; submicrobial: 20 mg qd or 40 mg bid; ADRs: GI intolerance, photosensitivity, yeast infections; More effective but more photosensitivity than tetracyclines |
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Term
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Definition
| 50-100 mg BID, then 50-100 mg daily; ADRs: paresthesias, seizure, vestibular toxicity, hepatic failure, interstitial nephritis, hypersensitivity syndromes, skin/tissue/gum discoloration; More effective than tetracyclines, more effective than doxycycline, MORE SIDE EFFECTS than either |
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Term
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Definition
| tetracycline, doxycycline, minocycline |
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Term
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Definition
| 2nd line antibiotic for acne; Dose: 1 g/day in divided doses (250-500 mg q6-12h); take with food; ADRs: GI intolerance, rash, cardiac arrhythmias; CYP3A4 inhibitor |
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Term
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Definition
| take 500 mg three times weekly; pulse therapy; ADRs: GI intolerance, rash; limited clinical data; Advantages: less photosensitivity, less resistance |
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Term
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Definition
| 1st line agent for severe inflammatory lesions (nodules/cysts); useful for treatment resistant acne; use limited by ADRs & cost; only agent to induce remission for months or years after 1-2 cycles; MoA: decrease sebum production, keratolytic/comedolytic, antimicrobial, anti-inflammatory; ADRs: teratogenic (Preg. Cat. X), dermatologic |
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Term
| oral isotretinoin [Accutane, Amnesteem, Claravis, Sotret] |
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Definition
| Dosing: 0.5-2 mg/kg/day in 2 divided doses; Duration: 15-20 wks OR until 70% decrease in cyst count; for optimal results, cumulative dose = 120-150 mg/kg; Monitoring: monthly pregnancy test, LFTs & lipid profile; |
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Term
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Definition
| computer-based risk management program designed to further public health goal to eliminate fetal exposure to isotretinoin; ensures that: no female pt starts isotretinoin therapy if pregnant, no femail pt on isotretinoin therapy becomes pregnant; Rx requirements: telephone, fax, & electronic Rxs allowed; give max of 30 days supply; |
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Term
| Prescription Window for Females of Child Bearing Potential |
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Definition
| 7 days to bring in, fill, & pick up Rx; starts on day pregnancy test drawn |
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Term
| Prescription Window for non-FCBPs (all other pts) |
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Definition
| drop off, fill, and pick up Rx within 30 days; starts on day of office visit |
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Term
| Pharmacist responsibilities for iPLEDGE program |
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Definition
| obtain authorization & RMA # prior to dispensing; record RMA # on prescription; dispense max 30 days supply; record "DO NOT DISPENSE TO PATIENT AFTER" date on Rx bag sticker; do not dispense meds outside the prescription window; Give med guide to pts with each fill |
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Term
| oral contraceptives [Ortho Tri-cyclen, Estrostep, Yaz] |
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Definition
| 2nd line agents for moderate inflammatory lesions in women; estrogen improves acne --> MoA: decrease sebum production, keratolytic/comedolytic; ADRs: N/V, spotting/breakthrough bleeding, VTE |
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Term
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Definition
| 1st line: BPO or TR; 2nd line: alternate TR or AA or SA; Alternatives for females: TR; Maintenance: TR |
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Term
| mild papular/pustular treatment |
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Definition
| 1st line: TA + TR or TA + BPO; Alternatives: alternate TR + alternate TA/AA; Alternatives for females: TA + TR or TA +BPO; Maintenance: TR |
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Term
| moderate papular/pustular treatment |
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Definition
| 1st line treatment: OA + TR +/- BPO; ALternatives: alternate OA + alternate TR +/- BPO; Alternatives for Females: AN + TR/AA +/- TA; Maintenance: TR +/- BPO |
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Term
| moderate nodular treatment |
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Definition
| 1st line: OA + TR +/- BPO; Alternatives: alternate OA + alternate TR +/- BPO/AA or OI alone; Alternatives for Females: AN + TR +/- OA +/- alternative TA; Maintenance: TR +/- BPO |
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Term
| Severe nodular/conglobata treatment |
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Definition
| 1st line: OI; Alternatives: OA (high dose) + TR + BPO; Alternatives for Females: AN (high dose) + TR +/- alternate TA; Maintenace: TR +/- BPO |
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