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Acne - Coggle Diagram

- - - - General sale; 2.5%, 5%, 10% Gel
      - Antiseptic - kills skin surface bacteria (does not cause bacterial resistance) that cause acne and softens and removes outer layers of the skin; reduces redness, soreness and inflammation and it helps to unplug blocked pores (reduces no. of comedones)
      - Adverse effects: skin irritation; dryness; hypersensitivity reactions
      - Dose: initially apply once daily removing after 2h for 3 days, then apply once daily at night and leave overnight for 3 days, then apply twice daily if necessary; start treatment with lower-strength preparations
      - Monitoring: redness or burning sensation of skin, dry skin or peeling = use it less often and use an oil-free moisturiser (for dryness + peeling); blisters = stop using benzoyl peroxide and see your doctor or pharmacist
      - Education points: avoid excessive exposure to sunlight; avoid medicated, abrasive or alcohol-based soaps/cosmetics; may bleach fabrics or hair; ensure skin is clean and dry before applying; avoid contact on eyes, nose, lips, sensitive areas of neck
    - - Prescription; 0.1% Cream or Gel
      - Retinoid analogue - regulates epithelial proliferation and differentiation, reduces follicular occlusion, has dermal anti-inflammatory properties, and may reduce sebum production and size of sebaceous glands (which also inhibits growth of bacteria)
      - Dose: apply thinly once daily in the evening to clean and dry skin; review treatment after 3 months
      - Adverse effects: local reactions; drug-induced photosensitivity reactions; acne flare
      - Monitoring: contact dermatitis, acne flare, swelling of face or eyelids, conjunctivitis, hypersensitivity reactions = tell doctor or pharmacist immediately
      - Education points: protect your skin from sunlight - do not use sunbeds; avoid contact on eyes, nose, lips; avoid abrasive cleaners, astringent cosmetics (such as those containing alcohol), and other preparations to treat acne; allow peeling (resulting from other irritant treatments) to subside before using a topical retinoid; do not donate blood during treatment with adapalene and for at least 4 weeks after discontinuing therapy
    - - Prescription; 0.025%, 0.05% Cream
      - Retinoid analogue - refer to Adapalene
      - Dose: apply once daily at night to clean dry skin; on first night apply for 5 mins before washing off, on second night apply for 10 mins, then increase treatment time by 30 mins every night until 2h application time reached, thereafter leave on overnight
      - Adverse effects + Education points: same as Adapalene
  - - - Prescription; 50mg, 100mg tablets
      - Tetracycline antibiotic - primarily bacteriostatic, inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit
      - Dose: 50–100 mg once daily
      - Adverse effects: nausea, vomiting, diarrhoea, dysphagia, oesophageal irritation
      - Monitoring: skin rash, fever, swelling, or other ‘allergic-type’ reaction; sharp pain while swallowing, or pain in your throat or chest; a pulsing headache, ringing in the ears, or feel dizzy = tell doctor or pharmacist immediately
      - Education points: take with food; swallow whole with plenty of fluid, while sitting or standing. Remain sitting upright or standing for at least 30 minutes afterwards; don't take indigestion remedies, or medicines containing iron, calcium, or zinc, 2h before or after; protect your skin from sunlight - don't use sunbeds; don't use if pregnant or under 12 yrs
  - - - Prescription; 5mg, 10mg, 20mg, 30mg, 40mg capsules
      - Retinoid analogue - synthetic stereoisomer of tretinoin (vit. A derivative) - refer to Adapalene
      - Adverse effects: dryness of skin, lips, eyes, pharyngeal and nasal mucosa; headache; myalgia; arthralgia; raised plasma-triglyceride conc, serum-cholesterol conc, blood-glucose conc and serum-transaminase conc; haematuria; proteinuria; thrombocytopenia; thrombocytosis; neutropenia; anaemia; mood changes
      - Dose (severe nodulo-cystic and conglobate acne resistant to other therapy): initially 500 micrograms/kg daily (in 1–2 divided doses) for 2–4 weeks, increased if necessary to 1 mg/kg daily, for 16–24 weeks (repeat treatment course after a period of at least 8 weeks if relapse after first course); maximum cumulative dose 150 mg/kg per course
      - Dose (Moderate acne unresponsive to topical therapy or with scarring): 10–20 mg daily until all acne lesions have resolved (usually 3–5 months), then reduce to half the daily treatment dose for a further 4 months to avoid relapse and scarring
      - Monitoring: blood testing of pregnancy (effective contraception must be used - highly teratogenic), serum lipids, liver function; mood changes (esp. depression)
      - Education points: avoid concurrent use with tetracyclines (increased risk of intracranial hypertension), vit. A, topical keratolytic or exfoliative antiacne agents and the mini-pill; protect skin from sunlight - don't use sunbeds; take with or just after food, or a meal; avoid wax epilation (risk of epidermal stripping), dermabrasion, and laser skin treatments (risk of scarring) during treatment and for at least 6 months after stopping; may experience decreased night vision so use caution if driving or operating any vehicle at night; don't donate blood during treatment nd for at least 1 month after discontinuing therapy