March Week 2: Acne

Zaenglein AL, Thiboutot DM. “Expert committee recommendations for acne management,” Pediatrics 2006; 118:1188–1199

A 14-year-old boy requests treatment for his acne. He is using no medications and has no known drug allergies. Physical examination of the face reveals a few small inflammatory papules and numerous blackheads and whiteheads; there is no scarring. No acne lesions are present on the chest and back.
1. What are the stages of acne and what stage does he have?
2. What is the best initial treatment regimen for him?*
3. How will you counsel him regarding treatment: proper use, side effects, length of treatment?
*This is a PREP question for this scenario! Answer choices are:
A. benzoyl peroxide topically
B. benzoyl peroxide topically and tetracycline orally
C. benzoyl peroxide topically and tretinoin topically
D. clindamycin topically
E. tretinoin topically

A 16-year-old girl requests treatment for acne. She has used a nonprescription medication containing benzoyl peroxide without significant benefit. Physical examination reveals inflammatory lesions and open and closed comedones on the face and inflammatory lesions on the chest and back. There is no scarring. She has no known allergies to medications.

1. What stage acne does she have?
2. What is the most appropriate treatment?**
3. What other screening questions will you discuss with her?
4. What alternative treatments are available?

**This is a PREP question for this scenario! Answer choices are:
A. benzoyl peroxide topically and tretinoin topically
B. clindamycin topically
C. isotretinoin orally
D. tretinoin topically
E. doxycycline orally and tretinoin topically