what is Acne vulgaris? How to classify your acne? How to chose the best therapeutic agent to treat your acne? All these questions can be answered with this presentation.

1. Acne Vulgaris
Asmaa Y. Al-Mubarak
Hospital Pharmacy Course

2. Introduction
 Acne vulgaris is an inflammatory skin disorder of the pilosebaceous units
of the skin . Although most commonly seen on the face, acne can also be
present on the chest, back, neck, and shoulders
 The pilosebaceous unit of the skin consists of a hair follicle and the
surrounding sebaceous glands.
 Sebum is released by the sebaceous glands and naturally maintains hair
and skin hydration.
 Acne can cause psychological symptoms of stress, anxiety, frustration,
embarrassment, and even depression. Evaluating both physical and
psychological aspects of acne is imperative.

3. Etiology
• Acne is a multifactorial disease. Genetic, racial, hormonal, dietary, and
environmental factors have been implicated in its development
• Four major etiologic factors involved in the development of acne:
increased sebum production, due to hormonal influences;
alteration in the keratinization process and hyperproliferation of ductal
epidermis; bacterial colonization of the duct withPropionibacterium acnes (P.
acnes); and production of inflammation with release of inflammatory mediators
in acne sites.

4. Risk factors
• Nonmodifiable factors:
• 1-Gender: males during adolescence and females during adulthood/ female>male.
• 2-Age : adult between age 12 to 25 years.
• 3-Genetic factors.
• Modifiable Factors :
• Environmental factors : Heat and humidity may induce comedones (initial acne
lesion)
• pressure or friction caused by protective devices such as helmets, shoulder pads, or
pillows, and excessive scrubbing or washing can exacerbate existing acne by causing
comedones to rupture.
• emotional factores such as stress and anger.
• Diet : While the link between diet and acne has continued to be controversial, there is
evidence to suggest that high glycemic load diets may exacerbate acne (chocholate
,cola drinks,milk and milk products.)
• some types of cosmetics :Espeically which contain Isopropyl myristate, cocoa butter,
and fatty acids.
• Drugs: Systemic Corticosteroids, Topical(But not with Hydrocortisone), B12 injection ,
Antiepileptics and tuberculostatics ,Lithium.

5. Lesion Type: Acne
Vulgaris Can be
Noninflammatory
or Inflammatory
• Mild Acne: either open (Black Comedon) or closed (White
Comedon) , there is no inflammation , treated by Topical Agents
• Moderate Acne : Red color comedon with inflammation , treated by
Topical antibiotics + Topical Retinoids + Systemic Antibiotics .
• Severe Acne : Presence of nodules / cyst / scar with inflammation
, treated with Oral Isotretinoin.

6. Diagnosis
• The diagnosis of acne vulgaris is clinical observation . Lesion cultures
may be warranted when treatment regimens fail to rule out other
skin infections.
• Most clinicians describe acne as mild (few noninflammatory lesions),
moderate (many inflammatory lesions) or severe (numerous severe
inflammatory lesions and evidence of scarring).

7. MANAGEMENT:
• Acne treatment regimens should be based on acne severity and type of acne lesion.
Other factors such as response to previous treatment, patient preference, cost and
adherence should also be considered.
• Mild Acne: treated by Topical Agents .
• Moderate Acne : treated by Topical Agents + Systemic Antibiotics .
• Severe Acne : treated with Oral Isotretinoin.
• Improvement of symptoms following induction therapy occurs gradually, sometimes
taking 6 to 8 weeks for results to be physically apparent.
• Patients need to be educated on continual treatment compliance during this time
and should not get discouraged if acne lesions appear to worsen before getting
better.

8. Nonpharmacological:
• Patients should be counseled to avoid aggressive skin washing and to use a non-fragranced opaque
or glycerin soap or soapless wash twice daily.
• Scrubbing should be minimized to prevent follicular rupture.
• Cationic-bond strips that become activated by water are available. The dirt and oil in the pores are
anionic. As the strip dries, the cationic-bond binds the anionic dirt and removes it when the
strip is peeled off.
• Furthermore, discourage the use of abrasive cleansers and manipulating or squeezing lesions to
minimize scarring. Use of an oil-free, noncomedogenic moisturizer may improve the tolerability of
topical drug therapy.
• low-glycemic-load diet.
• control stress.
• Prevention of cosmetic acne: The patient should restrict cosmetic use to products labeled oil-free
rather than water-based, Including makeup, moisturizers or sunscreens
• Shaving using a safety razor, the beard should be softened with soap and warm water or shaving gel,
Strokes should be in the direction of hair growth, shaving each area only once.
• Before exposure to sunlight, patients with acne should apply sunscreens (sun protection factor [SPF]
15). Sunscreen should be applied as the first product.
• Because the action of most therapeutic acne agents is to dry the skin, the use of moisturizers is
counterproductive

9. Pharmacological therapy

10. Topical Agents
• Benzoyl peroxide
• Retinoids
• Antibacterial
• Azelaic Acid
• Dapsone
• Keratolytic

11. Benzoylperoxide
• MOA: increases the rate of epithelial cell turnover and helps
to unclog blocked pores. It also has antibacterial activity
against P. acnes.
• Dosage Forms :1%–10%, Various Lotion, gel, foam, pads
over the counter and prescription products.
• Side Effects: Excessive drying, peeling, erythema, allergic
contact sensitization /dermatitis ,Bleaching of
hair ,Photosensitivity
 If severe irritation or an allergic reaction develops,
benzoyl peroxide should be discontinued

12. • Counseling:
-
‫ت‬ ‫حتى‬ ‫واالنتظار‬ ‫بلطف‬ ‫تجفيفها‬ ‫ثم‬ ‫بالماء‬ ‫وشطفها‬ ‫الصابون‬ ‫من‬ ‫والقليل‬ ‫الدافئ‬ ‫بالماء‬ ‫المصابة‬ ‫المنطقة‬ ‫غسل‬
‫جف‬
‫الحساسة‬ ‫المناطق‬ ‫عن‬ ‫واالبتعاد‬ ‫المنطقة‬ ‫ودهن‬ ‫كافية‬ ‫كمية‬ ‫وضع‬ ‫يتم‬ ‫ثم‬ ‫تماما‬
.
-
‫الموضعية‬ ‫االستجابة‬
‫تدريجيا‬ ‫الجرعة‬ ‫وزيادة‬ ، ‫الجرعة‬ ‫على‬ ‫تعتمد‬
‫يتحملها‬ ‫جرعة‬ ‫اعلى‬ ‫الى‬ ‫الوصول‬ ‫حتى‬
‫المري‬
‫ض‬
.
-
‫التعرض‬ ‫تجنب‬
‫الشمس‬ ‫لضوء‬
‫مباشر‬ ‫بشكل‬
.
-
‫استخدام‬
‫واق‬
‫ي‬
‫بها‬ ‫الموصى‬ ‫الواقية‬ ‫والمالبس‬ ‫الشمس‬
.
-
‫بيروكسايد‬ ‫البنزويل‬ ‫استخدام‬ ‫إيقاف‬ ‫يجب‬ ، ‫تحسسي‬ ‫تفاعل‬ ‫أو‬ ‫حاد‬ ‫تهيج‬ ‫حدوث‬ ‫حالة‬ ‫في‬
‫باستشارة‬
‫الطبيب‬
.
-
‫للشعر‬ ‫مالمسته‬ ‫وتجنب‬ ‫األخرى‬ ‫المخاطية‬ ‫واالنسجة‬ ‫والفم‬ ‫للعينين‬ ‫مالمسته‬ ‫تجنب‬
.
-
‫المستمر‬ ‫الترطيب‬
.
• Pregnancy Category C (
‫والرضاعة‬ ‫الحمل‬ ‫في‬ ‫آمن‬
)
 Brands : Benoxyphil 5% - 10% , Panoxyl 5% , benzac 5%
 Administration : A typical regimen for benzoyl peroxide is to apply the product to
clean, dry skin no more than two times a day.
 The strength and dosage form selected may vary from patient to patient depending on
acne severity and the sensitivity of the patient’s skin.

13. • MOA: stimulate epithelial cell turnover and aid in unclogging
blocked pores. also exhibit anti-inflammatory properties
through the inhibition of neutrophil and monocyte chemotaxis.
• using topical retinoids in combination with benzoyl peroxide or
topical antibacterial agents is preferred for inflammatory acne
lesions.
• Side Effect: peeling, redness, or unusual dryness of the
skin
- Topical retinoids include:
A.Tretinoin :
• Brands:Acnelin 0.5 mg/1g Cream , Acretin 0.025% / 0.05%
Cream , Optimal 0.025% Gel and 0.05% Cream , Acticare
1.2% , 0.025% (clindamycin , tretinoin) Gel.
• Pregnancy Category: C (Possibly teratogenic,Use cautiously
in pregnancy)
B.Tazarotene ( Tazorac)- NOT Available in Jordan.
• Pregnancy Category: X ,Teratogenic
• Use in pregnancy is contraindicated.
Retinoids:

14. C. Adapalene:
(First choice of topical retinoid)
• Brands: Differin 0.1% cream 0.1% gel
SureCure 0.1% gel
• SE: Photosensitivity.
• Counseling for Retinoids:
-
‫تماما‬ ‫تجف‬ ‫حتى‬ ‫واالنتظار‬ ‫بلطف‬ ‫تجفيفها‬ ‫ثم‬ ‫بالماء‬ ‫وشطفها‬ ‫الصابون‬ ‫من‬ ‫والقليل‬ ‫الدافئ‬ ‫بالماء‬ ‫المصابة‬ ‫المنطقة‬ ‫غسل‬
‫ثم‬
‫الحساسة‬ ‫المناطق‬ ‫عن‬ ‫واالبتعاد‬ ‫المنطقة‬ ‫ودهن‬ ‫كافية‬ ‫كمية‬ ‫وضع‬ ‫يتم‬
.
-
‫الكريم‬ ‫وضع‬
/
‫المرهم‬
‫ا‬ً‫ي‬‫يوم‬ ‫واحدة‬ ‫مرة‬
‫قبل‬
‫من‬ ‫ا‬ً‫ء‬‫بد‬ ، ‫النوم‬
‫جرعة‬
‫الفعالية‬ ‫منخفضة‬
,
‫العال‬ ‫لنتائج‬ ‫وفقا‬ ‫القوة‬ ‫زيادة‬ ‫تبدأ‬ ‫ثم‬
‫ج‬
.
-
‫ان‬ ‫الممكن‬ ‫من‬
‫سلبية‬ ‫فعل‬ ‫ردود‬ ‫تحدث‬
‫موضعية‬
‫وعادة‬ ، ‫االستخدام‬ ‫من‬ ‫أسابيع‬ ‫أربعة‬ ‫إلى‬ ‫أسبوعين‬ ‫أول‬ ‫في‬ ‫األرجح‬ ‫على‬
‫تتناقص‬
‫المستمر‬ ‫االستخدام‬ ‫مع‬
-
‫الشمس‬ ‫لضوء‬ ‫التعرض‬ ‫تقليل‬
‫مباشر‬ ‫بشكل‬
-
‫الشمس‬ ‫واقي‬ ‫استخدام‬
‫كل‬ ‫التجديد‬ ‫مع‬
4
‫ساعات‬
‫به‬ ‫الموصى‬ ‫الواقية‬ ‫والمالبس‬
‫المستمر‬ ‫الترطيب‬ ‫مع‬ ‫ا‬
-
‫أن‬ ‫يجب‬
‫نخبر‬
‫المرضى‬
‫الممكن‬ ‫من‬ ‫انه‬
‫تحسن‬ ‫مع‬ ، ‫العالج‬ ‫من‬ ‫األولى‬ ‫القليلة‬ ‫األسابيع‬ ‫في‬ ‫عادة‬ ‫الشباب‬ ‫حب‬ ‫أعراض‬ ‫تدهور‬
‫في‬ ‫يحدث‬
3
‫إلى‬
4
‫أشهر‬
.
-
‫ت‬
‫استخدام‬ ‫جنب‬
‫االدوية‬ ‫هذه‬
‫من‬ ‫األصغر‬ ‫األطفال‬ ‫في‬
12
‫الحوامل‬ ‫والنساء‬ ‫ا‬ً‫م‬‫عا‬
.
-
‫الد‬ ‫من‬ ‫الثالث‬ ‫او‬ ‫الثاني‬ ‫اليوم‬ ‫في‬ ‫به‬ ‫البدء‬ ‫ويتم‬ ‫بالعالج‬ ‫البدء‬ ‫من‬ ‫باسبوعين‬ ‫قبل‬ ‫اختبار‬ ‫باجراء‬ ‫حمل‬ ‫وجود‬ ‫عدم‬ ‫من‬ ‫التأكد‬
‫ورة‬
‫القادمة‬ ‫الشهرية‬

15. Antibacterials:
• MOA : Topical antibacterials directly suppress P. acnes and are
first-line agents used in combination with benzoyl peroxide,
topical retinoids or azelaic acid for the treatment of mild to
moderate inflammatory acne.
• To reduce the likelihood of bacterial resistance, topical
antibiotics should never be used as monotherapy or as long-
term maintenance therapy .
1.Clindamycin:
• Brands: Clindaderm 1% solution , clindacin gel ,
Acticare )1.2% clindamycin phosphate ,0.025% tretinoin)
Gel .
• Administration: applied once or twice daily for 3 months
• SE:burning sensation of skin, exfoliation of skin, oily
skin, dryness, itching
• Counseling: -
‫تنشيف‬ ‫و‬ ‫صابون‬ ‫و‬ ‫دافئ‬ ‫بماء‬ ً‫ا‬‫جيد‬ ‫المنطقة‬ ‫غسل‬ ‫يجب‬ ‫المرهم‬ ‫وضع‬ ‫قبل‬
‫المنطقة‬
.
-
‫بعد‬ ‫التحسن‬ ‫مالحظة‬ ‫يتم‬
6
‫تقريبا‬ ‫العالج‬ ‫من‬ ‫اسابيع‬
-
‫يجب‬
‫استخدامه‬ ‫وقف‬
‫اإلسهال‬ ‫حدث‬ ‫إذا‬ ‫الطبية‬ ‫العناية‬ ‫وطلب‬ ‫الفور‬ ‫على‬
.
-
‫البنزويل‬ ‫مع‬ ‫دمجه‬ ‫يتم‬ ‫أن‬ ‫يجب‬
‫بيروكسيد‬
‫الموضعي‬
-
‫وتجنب‬ ‫الكحول‬ ‫على‬ ‫الحتواءه‬ ‫حراري‬ ‫مصدر‬ ‫من‬ ‫بالقرب‬ ‫استخدامه‬ ‫عدم‬
‫للعين‬ ‫مالمسة‬
.

16. 2.Erythromycin:
• Brands: Akne-Mycin 2% solution,1% emulsion,2%
ointment, Zineryt 40mg/ml Lotion, Spotex 4% gel
• Administration :applied once or twice daily for 3
months
• SE: Burning, peeling, dryness, pruritus,
erythema,desquamation.
• Safe in pregnancy : B
• Counseling:
-
‫بعد‬ ‫التحسن‬ ‫مالحظة‬ ‫يتم‬
6
‫تقريبا‬ ‫العالج‬ ‫من‬ ‫اسابيع‬
.
-
‫إذ‬ ‫الطبية‬ ‫العناية‬ ‫وطلب‬ ‫الفور‬ ‫على‬ ‫عن‬ ‫التوقف‬ ‫يجب‬
‫حدث‬ ‫ا‬
‫االسهال‬
-
‫دافئ‬ ‫بماء‬ ً‫ا‬‫جيد‬ ‫المنطقة‬ ‫غسل‬ ‫يجب‬ ‫المرهم‬ ‫وضع‬ ‫قبل‬
‫و‬
‫المنطقة‬ ‫تنشيف‬ ‫و‬ ‫صابون‬
.
-
‫البنزويل‬ ‫مع‬ ‫دمجه‬ ‫يتم‬ ‫أن‬ ‫يجب‬
‫بيروكسيد‬
‫الموضعي‬
-
‫على‬ ‫الحتواءه‬ ‫حراري‬ ‫مصدر‬ ‫من‬ ‫بالقرب‬ ‫استخدامه‬ ‫عدم‬
‫للعين‬ ‫مالمسة‬ ‫وتجنب‬ ‫الكحول‬
.

17. • Zineryt contains 40mg/ml Erythromycin and Zinc acetate 12mg/ml : zinc
acetate increases efficacy of erythromycin and provide moisturizing
effect.
• Reconstitution : mix solution on Powder.
• CI: Hypersensitivity to erythromycin, other macrolide antibiotics,
zinc acetate
• Storage: after reconstitution 8 weeks in fridge.
Can we use Clindamycin with Erythromycin???
No, there’s DDI Erythromycin may diminish the therapeutic effect
of Clindamycin (Topical). Risk X: Avoid combination

18. Azelaic Acid :
 MOA: Antibacterial and anti-inflammatory properties, and ability to
stabilize keratinization.
 an effective alternative in the treatment of mild to moderate acne in
patients who cannot tolerate benzoyl peroxide or topical retinoids.
 Least effective (weak)
• Brands:Azeclear 20% cream , Azelderm 20% cream, Skinoren 20%
• S.E : Erythema, skin irritation,tingling.
• Pregnancy Category: B.
• Administration: apply twice daily, with improvement of symptoms
seen in 4weeks.

19. Dapsone(NOT available in Jordan):
• MOA: a sulfone drug, has antimicrobial and anti-inflammatory properties
• Aczone 5% gel
• SE: Dryness, erythema, oiliness, and peeling .
 Does not have a risk of phototoxicity.
• Administration: applied in a thin layer to the affected areas twice daily.
• Pregnancy: not recommended.

20. Keratolytics: (peeling, Exfoliating agents)
 Sulfur, Resorcinol, and salicylic acid are not as effective as other topical agents, but can be used as
second-line therapies in the treatment of mild to moderate acne.
• less skin irritation than benzoyl peroxide or the topical retinoids, but several disadvantages exist,
Sulfur preparations produce an unpleasant odor when applied to the skin whereas Resorcinol may
cause reversible brown scaling.
• SE : Severe dryness
-Salicylic acid : Its keratolytic effect may enhance the absorption of other agents.
Available As gel , lotion , cleanser, pads, masks
Administration: Apply thin layer to affected area 1 to 3 times daily, Reduce to once daily or
every other day if dryness or peeling occur.
Contraindication : in children <2yrs,Hypersensitivity to the product.
Pregnancy Category: C , Can be used in pregnancy.
SE : Itching ,Burning, photosensitivity.
Brands: Salidex , Salibet , Diprosalic , Algesal Baume.
-Sulfur : often combined with salicylic acid or Resorcinol.
Pregnancy Category: C
SE: unpleasant odor , satin clothes.

21. Oral Agents
• Antibacterial
• Isotretinoin
• Hormonal agents

22. That use in moderate to severe acne can be effectively treated with oral antibiotics,
especially when treatment with topical therapy has failed.
Use of oral antibiotics should be limited to short periods of time, ideally 3 months or less.
the use of topical antibiotics in combination with oral antibiotics is should be avoided.
Assessment of response to oral antibiotics after (6 to 8)weeks of therapy is
recommended.
Tetracycline, doxycycline, and minocycline are the most commonly prescribed oral
antibiotics for acne.
Erythromycin, azithromycin, and trimethoprim (± sulfamethoxazole) are
appropriate second-line agents for use when patients cannot tolerate or have
developed resistance to tetracycline or its derivatives.
Antibacterial

23. Doxycycline
• MOA: Inhibits bacterial protein synthesis by binding with the 30S
ribosomal subunit.
• Trade name: Doxydar , Vibramycin , doxymid,Dumoxins,medomycin
Unidox ,
• Dosage form: 50,75,100 tab and cap ,200 delayed release tablet
• Dose: 100mg twice or 200 mg once per day
• S.E: diarrhea, photosensitivity, hives, discoloring of teeth.
• DDI : Isotretinoin (increase ICP ) X
• Food-Interaction: Doxycycline serum levels may be slightly
decreased if taken with high-fat meal or milk.
• Pregnancy Category : D (Cross the placenta)
• CI : Children <8 yrs, allery to tetracycline, pregnancy 2nd,3rd trimester.
• Monitor : CBC , KFT, LFT.
• Renal/Hepatic Impairment : There are no dosage adjustments provided
in the manufacturer's labeling.
• ROA : IV , PO
Tetracycline :

24. Counseling:
•
‫بساعتين‬ ‫بعده‬ ‫او‬ ‫بساعة‬ ‫االكل‬ ‫قبل‬ ‫يؤخذ‬ ‫ان‬ ‫بمعنى‬ ‫فارغة‬ ‫معدة‬ ‫على‬ ‫يؤخذ‬ ‫ان‬ ‫يجب‬
.
•
‫السوائل‬ ‫او‬ ‫الماء‬ ‫من‬ ‫كبيرة‬ ‫كمية‬ ‫مع‬ ‫الدواء‬ ‫تناول‬ ‫من‬ ‫البد‬
‫المرئ‬ ‫في‬ ‫تهيج‬ ‫يسبب‬ ‫قد‬ ‫النه‬
.
•
‫تناوله‬ ‫بعد‬ ‫النوم‬ ‫او‬ ‫االستلقاء‬ ‫يجب‬ ‫ال‬
‫ساعة‬ ‫نصف‬ ‫لمدة‬ ‫قائم‬ ‫وضع‬ ‫في‬ ‫ابقى‬
.
•
‫والحديد‬ ‫الكالسيوم‬ ‫وخاصة‬ ‫الفيتامينات‬ ‫او‬ ‫الحموضة‬ ‫أدوية‬ ‫وبين‬ ‫بينه‬ ‫الفصل‬ ‫يجب‬
‫والمغنسيوم‬
.
•
‫عن‬ ‫عمرهم‬ ‫يقل‬ ‫الذي‬ ‫االطفال‬ ‫قبل‬ ‫من‬ ‫استخدامه‬ ‫يمكن‬ ‫ال‬
8
‫االسنان‬ ‫اصفرار‬ ‫يسبب‬ ‫ألنه‬ ‫سنوات‬
•
‫للش‬ ‫التعرض‬ ‫عدم‬ ‫من‬ ‫التأكد‬ ‫بعد‬ ‫الدواء‬ ‫تناول‬ ‫يجب‬ ‫لذلك‬ ، ‫البشرة‬ ‫والتهابات‬ ‫الشمس‬ ‫حروق‬ ‫يسبب‬ ‫الدواء‬
‫لمدة‬ ‫مس‬
‫الشمس‬ ‫ضد‬ ‫واقي‬ ‫واستخدام‬ ‫االقل‬ ‫على‬ ‫ساعتين‬
.
•
‫الرضاعة‬ ‫او‬ ‫الحمل‬ ‫اثناء‬ ً‫ا‬‫تمام‬ ‫تناوله‬ ‫يمنع‬
.

25. Erythromycin :
• MOA : It inhibits bacterial protein synthesis ,may be bacteriostatic or bactericidal
depending on the organism and drug concentration.
• Brands : Erythrodar , Erythrocin ,Rythromac
• Dosage form: 250,500 tablets
• Dose:250-500 mg twice daily then once daily.
• S.E: GI upset ,QT-prolong , torsade de pointes, rash, hypersenstivity reaction, N/V ,
Diarrhea.
• ROA : IV, PO
• CI : concomitant use with lovastatin, or simvastatin
• Limited to patient can’t use tetracycline : pregnant , child<8yrs.
• Counseling :
Macrolides
•
‫االكل‬ ‫بعد‬ ‫او‬ ‫فارغة‬ ‫معدة‬ ‫على‬ ‫يؤخذ‬
.

26. Drug Brand Dose Dosage Form ROA SE CI Monitorin
g
parameter
s
Counselin
g
Tetracyclin Tetradar 250-
500mg
twice
daily.
250,500
capsule
PO Hepatotoxi
city,
pericarditit
s,
exacerbate
SLE,
Anorexia
Severe
Renal,liver
disease
,Children <12
, pregnancy
,Breastfeed.
KFT,LFT,
temperatu
re
,WBC,CBC,
mental
status,
appetite
-
‫على‬ ‫الدواء‬ ‫اخذ‬
‫قبل‬ ‫فارغة‬ ‫معدة‬
‫او‬ ‫بساعة‬ ‫االكل‬
‫و‬ ‫بساعتين‬ ‫بعد‬
‫و‬ ‫بينه‬ ‫المباعدة‬
‫ادوية‬ ‫بين‬
‫الحموضة‬
‫اربع‬ ‫ل‬ ‫بساعتين‬
‫ساعات‬
.
Minocycline Vulga 50-100
mg twice
50,75,100
IR tablets/
capsule
IV,PO Dizziness,
fatigue,
tooth
discolor
Pregnancy,
Breastfeed,
children <13,
liver,renal
disease
LFT,BUN,s
erum Mg
in pts with
renal
impair
-
‫بدون‬ ‫او‬ ‫مع‬
‫االكل‬
,
‫مع‬
‫كبيرة‬ ‫كمية‬
‫الماء‬ ‫من‬
.
Azithromyci
n
Zomax
Zocin
Azomycin
Azox
Azimax
500 mg once
daily for 4
consecutive
days per
month for 3
consecutive
months
500 tablet IV , PO Diarrhea,
headache,
cough,
Increase
LDH
History of
chol.Jaundic
e,
hepatic
dysfunction
with azithro.
LFT, CBC
with
differentia
l.
-
‫بعد‬ ‫الدواء‬ ‫اخذ‬
‫بنصف‬ ‫االكل‬
‫ساعة‬
-
‫على‬ ‫اخذه‬ ‫اذا‬
‫يجب‬ ‫فاضية‬ ‫معدة‬
‫مباشرة‬ ‫يأكل‬ ‫ان‬
.
‫و‬ ‫بينه‬ ‫المباعدة‬ ‫و‬
‫ادوية‬ ‫بين‬
‫الحموضة‬
TMP-SMX Bactrim 400,80 -
800,160
mg one –
two times
daily
400/80,800
/160 tablet
IV , PO GI upset,
rash, possible
teratogenicity
Photosensitivi
ty
Pregnancy,
breastfeed,
sulfa allergy,
CBC, serum
potassium,
creatinine,
BUN
Minimize
exposure to
sun light and
sun lamps.
Sunscreen use
and protective
clothing
recommended

28. Retinoic Acid Derivative
Isotretinoin
Used as first-line therapy in patients with severe nodular acne due to clinical
effectiveness.
MOA : works on the four pathogenic factors that contribute to acne
development ; decrease sebum production , inhibit P.acne growth,reduce
inflammation.
should be continued for 6 months, but may be extended for patients with an
insufficient response.
Dosage form:10, 20, 30, 40 mg tablets.
Dose : Initial dose 0.5 to 1 mg/kg/day in two divided doses, Continue until a
total cumulative dose of 120 to 150 mg/kg is reached(monthly dose)
Max: 2mg/kg/day.
Brands: Roaccutane 10mg , 20mg capsule
Ruatine,isusopra,xeractan,curacne)
Isotrex gel 0.05%,Isotrexin(Iso+erythromycin)
*topical agents used at night*

29. • S.E :.dryness of mucus membrane, peeling ,IBD, loss BMD , Depression,
Tachycardia , acne flare up at start of therapy, Teratogenicity and
Photosensitivity
Nasal sprays, lip moisturizers, may help to reduce drying of mucous
membrane Apply oil-free moisturizers to face to relieve drying of skin.
Renal Impairment : No dose Adjustment.
Hepatic Impairment : May reduce the dose.
CI: in pregnancy(Category X ),Breastfeeding ,Hepatic Impairment, concurrent
tetracycline therapy , hypersensitivity , excessive hyperlipidemia.
Laboratory monitoring:
pretreatment >CBC/ LFT /KFT / two pregnancy test should be negative
/glucose / fasting lipid profile
during treatment : LFT and lipid (TG) monthly or Biweekly until response is
established , pregnancy.

30. DDI
ISOTRETINOIN
↓ effect of : Estrogen derivative , Progestin contraceptives.
↑ effect of : Aminolevulinic acid
Drugs ↑ its Concentration :
-Alcohol , Folate , Iron , tetracycline , Vit A .

31. Counseling:
1
.
‫م‬ ‫ولتقليل‬ ‫الدواء‬ ‫امتصاص‬ ‫لزيادة‬ ‫دسمه‬ ‫الوجبة‬ ‫تكون‬ ‫أن‬ ‫يفضل‬ ‫مباشرة‬ ‫األكل‬ ‫بعد‬ ‫أو‬ ‫األكل‬ ‫مع‬ ‫يؤخذ‬
‫اثارة‬ ‫ن‬
‫المعدة‬ ‫على‬ ‫الجانبية‬
.
2
.
‫من‬ ‫اقل‬ ‫المتناولة‬ ‫الجرعة‬ ‫كانت‬ ‫اذا‬
80
‫فترتين‬ ‫على‬ ‫تأخذ‬ ‫ذلك‬ ‫من‬ ‫أكثر‬ ‫واحده‬ ‫مرة‬ ‫يأخذها‬ ‫مغ‬
.
3
.
‫بفترة‬ ‫وتكون‬ ‫العالج‬ ‫بداية‬ ‫في‬ ‫الحالة‬ ‫في‬ ‫سوء‬ ‫الدواء‬ ‫يسبب‬ ‫ان‬ ‫الممكن‬ ‫من‬ ‫ان‬ ‫المريض‬ ‫اخبار‬
6
-
8
‫اسابيع‬
4
.
‫تركه‬ ‫وعدم‬ ‫بالدواء‬ ‫االلتزام‬ ‫المريض‬ ‫على‬ ‫نؤكد‬
,
‫يجب‬ ‫اسبوعين‬ ‫من‬ ‫اكثر‬ ‫تناوله‬ ‫عن‬ ‫توقف‬ ‫حال‬ ‫وفي‬
‫كورس‬ ‫بدء‬
‫العالج‬ ‫من‬ ‫جديد‬
.
5
.
‫الجنين‬ ‫لدى‬ ‫وتشوهات‬ ‫اجهاض‬ ‫حدوث‬ ‫في‬ ‫يسبب‬ ‫حيث‬ ‫الحمل‬ ‫اثناء‬ ‫الدواء‬ ‫هذا‬ ‫تناول‬ ‫قطعيا‬ ‫يمنع‬
,
‫لذلك‬
‫قبل‬
‫باليوم‬ ‫للحمل‬ ‫فحصين‬ ‫اجراء‬ ‫يلزم‬ ‫تناوله‬
19
‫سالب‬ ‫الفحصين‬ ‫يكون‬ ‫ان‬ ‫على‬ ‫الشهرية‬ ‫الدورة‬ ‫من‬ ‫الخامس‬ ‫واليوم‬
.
‫و‬
‫شهريا‬ ‫العالج‬ ‫اثناء‬ ‫الفحص‬
6
.
‫بشهر‬ ‫استعماله‬ ‫قبل‬ ‫الحمل‬ ‫موانع‬ ‫من‬ ‫نوعين‬ ‫يأخذ‬ ‫تناوله‬ ‫اثناء‬ ‫حمل‬ ‫حدوث‬ ‫لتجنب‬
physical + pill
‫وتستمر‬
‫لمده‬ ‫بأخذها‬
3
-
6
‫الدواء‬ ‫ايقاف‬ ‫بعد‬ ‫من‬ ‫اشهر‬
.
7
.
‫بشهر‬ ‫ايقافه‬ ‫وبعد‬ ‫أثناء‬ ‫بالدم‬ ‫يتبرع‬ ‫ال‬ ‫ان‬
.

32. 8
.
‫لحد‬ ‫و‬ ‫استخدامه‬ ‫أثناء‬ ‫للعيون‬ ‫بعمليات‬ ‫القيام‬ ‫يمنع‬
6
‫ايقافه‬ ‫من‬ ‫اسابيع‬
.
9
.
‫ساعة‬ ‫نصف‬ ‫كل‬ ‫للعين‬ ‫قطرة‬ ‫استخدام‬ ‫يجب‬ ‫استخدامها‬ ‫حال‬ ‫وفي‬ ‫للضرورة‬ ‫اال‬ ‫العدسات‬ ‫استخدام‬ ‫يمنع‬
,
‫ان‬ ‫حيث‬
‫العين‬ ‫جفاف‬ ‫للدواء‬ ‫الجانبية‬ ‫االعراض‬ ‫من‬
.
10
.
‫كامال‬ ‫الجسم‬ ‫في‬ ‫جفاف‬ ‫يسبب‬ ‫انه‬ ‫كما‬
,
‫والشفت‬ ‫والجسم‬ ‫للوجه‬ ‫الدائم‬ ‫بالترطيب‬ ‫القيام‬ ‫يجب‬ ‫لذا‬
‫ين‬
,
‫واستخدام‬
‫للعين‬ ‫قطرة‬
iso-tears
‫السوائل‬ ‫شرب‬ ‫كمية‬ ‫من‬ ‫يزيد‬ ‫وأن‬
.
11
.
‫الشمس‬ ‫لدى‬ ‫الحساسية‬ ‫زيادة‬ ‫الدواء‬ ‫يسبب‬
,
‫واقي‬ ‫يضع‬ ‫وان‬ ‫االمكان‬ ‫قدر‬ ‫الشمس‬ ‫اشعة‬ ‫تجنب‬ ‫يجب‬ ‫لذا‬
‫شمس‬
‫ساعتين‬ ‫كل‬ ‫بتجديده‬ ‫ويقوم‬
.
12
.
‫فيتامين‬ ‫على‬ ‫المحتوية‬ ‫األطعمة‬ ‫من‬ ‫التقليل‬
A
‫والجزر‬ ‫الكبدة‬ ‫مثل‬
.
13
.
‫ال‬ ‫مثل‬ ‫األدوية‬ ‫بعض‬ ‫مع‬ ‫الدواء‬ ‫هذا‬ ‫يتداخل‬
doxycycline
‫من‬ ‫يزيد‬ ‫حيث‬
intracranial
pressure .
14
.
‫السمع‬ ‫على‬ ‫يؤثر‬
,
‫اكتئاب‬ ‫ويسبب‬ ‫ليال‬ ‫الرؤية‬
.

33. Oral contraceptives and Antiandrogens
(spironolactone and cyproterone acetate) are valuable second-line treatment
options for moderate to severe acne in female patients.
MOA: primarily work by decreasing androgen production resulting in reduced
sebum formation Because sebum production occurs early in the pathogenesis of
acne, it may take up to 3 to 6 months to see the full effect of hormonal agents.
Many contraceptives are effective, agents containing norgestimate with ethinyl
estradiol, norethindrone acetate with ethinyl estradiol, and drospirenone with
ethinyl estradiol , have been FDA approved for the treatment of acne.
Hormonal Agents :

34. Norgestimate/ethinylestradiol
Norethindrone acetate/ethinyl estradiol
Dose: One tablet daily
S.E: Nausea, headache, weight gain, breast tenderness,
break through bleeding, venous thromboembolism
Not for treatment of acne in men.
Use only in females ≥ 15 years of age.
Increased risk of venous thromboembolism in women who use tobacco products.

35. Spironolactone
Dosage form: 25, 50, 100 tablet
Dose: 50–200 mg daily
S.E : Menstrual irregularities, breast tenderness,nausea, dizziness, headache, transient
diuretic effect,
hyperkalemia
Not recommended for treatment of acne in men.
Brand :Aldactone

37. Other Agents Although use is infrequent, several other
agents are available as second- or third-line treatment
options for acne when first-line therapies fail
• Corticosteroids
• Chemical peels
• Surgical extraction
• Phototherapy/photodynamic therapy
• Laser treatments

38. • REF:
Pharmacotherapy principle&
practice 4th edition.
lexi.comp
Jodrug