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What bacteria is the cause of acne?
Propionibacterium acnes
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What factors and medications cause or exacerbate acne?
- humidity
- sweating
- irritation
- friction
- dirt
- oil
- petroleum
- oil-based cosmetics
- menarche
- oral contraceptives w/ progestin
- Phenytoin
- Isoniazid
- Moisturizers
- Phenobarbital
- Lithium
- Ethionamide
- Steroids
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What are the classifications of acne?
- Mild: comedones only, < 10, localized to face only, no scars
- Moderate: 10-40 papules/pustules/comedones, mild lesions on trunk
- Moderately severe: 40-100 papules/pustules/comedones, <5 larger deeper nodules, face, chest and back involved
- Severe: Nodulocystic, painful lesions w/similar papules, pustules, comedones
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What are the nonpharmacologic tx for acne?
- wash face BID with warm soapy water
- No abrasive cleansers in inflammatory acne
- Avoid factors that exacerbate acne
- Use water based products
- apply dandruff tx 1" behind hairline
- Wear cotton t-shirt under sports uniform to absorb sweat and reduce friction
- shower immediately after athletic activities (salicylic acid useful)
- avoid headbands or caps for long periods
- do not pick or squeeze acne
- adhere to prescribed tx even if it gets worse initially
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How are mild and moderate acne treated?
OTC products or prescription topical agents
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How is severe acne treated?
OTC products as adjunts to Rx tx
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What are the topical therapies for acne?
- Benzoyl peroxide
- Salicylic acid
- Sulfur or Sulfur-resorcinol
- Triclosan
- Topical retinoids
- Axelaic acid
- Dapsone 5%
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What is the most widely used product of choice for acne?
benzoyl peroxide
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What are the SE of benzoyl peroxide?
- dryness
- peeling
- skin sloughing
- erythema
- edema
- stinging or burning
- photosensitivity
- may bleach hair/fabric
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How can SE be reduced when using benzoyl peroxide?
start low (2.5%)(especially in fair-skinned)
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What are the SE of salicylic acid?
- irritatiion
- dryness
- stinging
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What are the SE of sulfur?
- color and odor of sulfur
- comedogenic when used long-term
- resorcinol produces dark brown scale
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What are the SE of topical retinoids?
- irritation
- redness
- peeling
- flaking
- photosensitivity
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Which topical treatment is good for post-inflammatory hyperpigmentation?
Axelaic acid
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What are the uses for creams and lotions?
- normal to dry skin
- less drying effect
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What are the uses of gels?
- oily skin
- more drying effect
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What are the exclusions for self-treatment of acne?
- papules, pustules, nodules, cysts, and/or scarring
- severe recalcitrant acne
- exacerbating factors
- possible rosacea
- papular rash in the beard area of men
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What are the oral tx for acne?
- antibiotics (TCNs, Macrolides, Sulfa)
- oral contraceptives
- spironolactone
- oral retinoids
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What are the SE of antibiotics used in acne?
- photosensitivity
- vaginal candidiasis
- GI effects
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What are the SE of oral contraceptives used in acne?
- breast tenderness
- HA
- mood swings
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What are the SE of spironolactone?
- hyperkalemia
- irregular menses
- breast tenderness
- HA
- fatigue
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What are the SE of oral retinoids?
- worsen acne initially
- depression
- severe dryness - mouth, nose, eyes, lips, skin
- hypertriglyceridemia
- photosensitivity
- allopecia
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What is the nonpharmacologic tx for warts?
- wash hands before and after tx
- use separate towel for affected area
- do not probe, poke, or cut wart tissue
- if on sole of foot, cover wart area
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What are the tx for warts?
- salicylic acid
- cryotherapy
- duct tape
- imiquimod
- podofilox
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What is the first-line tx for self-tx of warts?
salicylic acid
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What types of cryotherapy are used for warts?
- liquid nitrogen (physician's office)
- dimethyl ether/propane mixture (OTC)
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When is OTC cryotherapy CI for wart self-tx?
- < 4yo
- pregnant or breastfeeding women (no studies)
- Diabetes or poor circulation
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How is duct tape used to treat warts?
- cover for 6d, remove, soak area in water, debride wart w/ clean emery board and reapply the next day
- repeat until gone or for 2mo
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What types of warts is imiquimod used to tx?
- genital warts:
- apply at bedtime and wash off in 6-10hrs 3x/wk
- may repeat weekly cycles up to 16wks
- recalcitrant warts:
- Apply 3x/wk for up to 16wks
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What are the exclusions for self-tx of warts?
- face, toenails or fingernails, anus and/or genitalia involved
- extensive warts at one body site
- painful plantar warts
- chronic, debillitating disease
- inability to follow directions d/t physical or mental impairments
- immunosuppressive meds or other meds that CI use of salicylic acid
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What are the types of tinea infections?
- tinea capitis (ringworm)
- tinea cruris (jock itch)
- tinea corporis (ringworm)
- tinea pedis (athlete's foot)
- tinea unguium (onychomycosis)
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Which tinea infections are not self-treatable?
tinea capitis and tinea unguium
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What are the nonpharmacologic tx for tinea infections?
- keep the skin clean and dry
- avoid sharing of personal articles
- avoid contact with persons with infected people or fomites
- wear loose-fitting clothing and shower after activity
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What are the OTC topical antifungals for tinea infections?
- benzylamines (Lotrimin ultra)
- imidazoles (Cruex, Desenex, Lotrimin AF)
- allylamines (Desenex max, Lamisil AT)
- miscellaneous (Tinactin, Cruex squeeze)
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Which tinea infections take longer to treat?
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What are the exclusions for self-tx of tinea infections?
- tinea unguium, tinea capitis
- tinea corporis involving large body areas
- unsure of what dermatological condition it is
- chronic or recurrent
- diabetes pts with foot problems
- foot color and appearance abnormal
- severe sudden pain with no apparent cause such as trauma
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