What are the Treatment Recommendations for Acne?

CASE

Patient Presentation

A 19-year-old female comes to clinic for her health maintenance examination. She has had mild acne in the past, mainly comedones and some papules, that has responded to oral antibiotics and benzoyl peroxide/clindamycin. Over the past 2 months her acne has gotten worse on these medications with more pustules and some nodules.

She is concerned about her appearance. She denies new soaps, lotions, haircare products or cosmetics. She wears a sunscreen recommended by her mother’s dermatologist.
The family history reveals ‘bad’ acne in her mother who continues to have occasionally acne problems that are related to her menstrual cycle.

The pertinent physical exam shows a healthy adolescent with normal growth parameters. She has about 75 total lesions mainly around her forehead, cheeks and around the nose. Most are comedomal, but there are ~10 lesions that are pustular and ~5 that are nodular.

She also has ~10 lesions on her upper back/neck area that are pustular.

The diagnosis of moderate acne was made that is failing past treatment. The patient, mother and physician agreed that a consultation with a dermatologist may be helpful considering the progression of symptoms, moderate psychological stress to the patient and the mother’s history. The patient was prescribed Retin-A® to use in the evening along with the benzoyl peroxide/clindamycin in the morning in the meantime.

The patient’s clinical course showed some improvement with the Retin A® and benzoyl peroxide treatment by the time of her dermatology appointment. The dermatologist also suggested possible oral contraceptive treatment now and possible Accutane® treatment if there was failure. The patient decided to try the oral contraceptives which also markedly improved her acne.




Inflammatory papules and pustules in a patient with acne vulgaris.
How pimples form



Pimples form when dead skin cells mix with excess oil (sebum). This mixture plugs the pore, causing swelling. Bacteria can grow in the mix and lead to infection and pus.
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