April Week 4: Acne
1. You are in clinic seeing a 17 year old girl for an acne visit. She tells you that her main concern is “red spots” on her face and back. She scrubs her face at least three times a day with various OTC exfoliators and acne cleansers to try to keep her face clean. She tries OTC topical treatments, but gives up on them after about a week since she doesn’t see improvement by then. She notices that the acne is worse just before she starts her period. On exam, you note open comedones across her nose and chin. She has several erythematous pustules on her forehead and upper back.
-How does the appearance of acne change from early to late puberty?
-What causes acne?
-Describe the difference between open and closed comedones
-What is the difference between obstructive and inflammatory acne?
-She wants something that will work fast. What kinds of first line conventional treatments (topical and systemic) are available for acne, and how long before they start to work? Which ones treat inflammatory acne, and which ones treat comedones?
-What are common side effects of topical treatments?
You see the patient for several more visits, and although she is compliant with the regimen you initially prescribed, the acne is persisting and has gotten quite severe. The patient wants to know if there is something more that can be done. You consider a dermatology referral for isotretinoin. But- the patient is now sexually active, and she inconsistently uses condoms.
-Does this information have an effect on your options or the counseling you give her?
-Would prescribing an OCP help with the acne?
2. You are in adolescent clinic speaking with a 16 year old female and her mother. The patient has suffered from acne since starting middle school, and has tried prescription topical medications, and “some antibiotics” to try to get rid of the acne. These help, but the acne keeps recurring. The patient also doesn’t like the side effects of the medications she has tried. She is embarrassed by the acne, and is in clinic to find out if there is anything else she can try. Mom is hesitant to have her use any stronger medications, like isotretinoin, because of the side effects. She has been recommending diet changes and witch hazel at home, and is interested in your opinion on alternative treatments.
-How do you respond to the diet changes and use of witch hazel? -What types of complementary and alternative treatments for acne exist?
-Are any of them proven to be efficacious?
-Are any of them dangerous for patients to use? Mom is worried about side effects.
Cases/Questions by Dr. Piper Sandel