What bacteria is the cause of acne?
What factors and medications cause or exacerbate acne?
- oil-based cosmetics
- oral contraceptives w/ progestin
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
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
How are mild and moderate acne treated?
OTC products or prescription topical agents
How is severe acne treated?
OTC products as adjunts to Rx tx
What are the topical therapies for acne?
- Benzoyl peroxide
- Salicylic acid
- Sulfur or Sulfur-resorcinol
- Topical retinoids
- Axelaic acid
- Dapsone 5%
What is the most widely used product of choice for acne?
What are the SE of benzoyl peroxide?
- skin sloughing
- stinging or burning
- may bleach hair/fabric
How can SE be reduced when using benzoyl peroxide?
start low (2.5%)(especially in fair-skinned)
What are the SE of salicylic acid?
What are the SE of sulfur?
- color and odor of sulfur
- comedogenic when used long-term
- resorcinol produces dark brown scale
What are the SE of topical retinoids?
Which topical treatment is good for post-inflammatory hyperpigmentation?
What are the uses for creams and lotions?
- normal to dry skin
- less drying effect
What are the uses of gels?
- oily skin
- more drying effect
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
What are the oral tx for acne?
- antibiotics (TCNs, Macrolides, Sulfa)
- oral contraceptives
- oral retinoids
What are the SE of antibiotics used in acne?
- vaginal candidiasis
- GI effects
What are the SE of oral contraceptives used in acne?
- breast tenderness
- mood swings
What are the SE of spironolactone?
- irregular menses
- breast tenderness
What are the SE of oral retinoids?
- worsen acne initially
- severe dryness - mouth, nose, eyes, lips, skin
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
What are the tx for warts?
- salicylic acid
- duct tape
What is the first-line tx for self-tx of warts?
What types of cryotherapy are used for warts?
- liquid nitrogen (physician's office)
- dimethyl ether/propane mixture (OTC)
When is OTC cryotherapy CI for wart self-tx?
- < 4yo
- pregnant or breastfeeding women (no studies)
- Diabetes or poor circulation
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
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
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
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)
Which tinea infections are not self-treatable?
tinea capitis and tinea unguium
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
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)
Which tinea infections take longer to treat?
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