Acne

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍acneskin rash

Location is on ‍faceneckchestback

Onset was ‍gradualsudden, ‍spontaneoustriggered by ‍

Symptoms include:

‍pimples

‍blackheads

‍whiteheads

‍cysts

‍redness

‍inflammation

‍pain

‍scarring

‍menstrual irregularities

‍weight gain, ‍ ‍lbskg over ‍ ‍weeksmonths

‍hirsutism

‍depressed mood

‍anxiety



Impact on daily life or mental health: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍oil-based product use

‍obesity

‍stress

no history of: ‍acne, ‍polycystic ovarian syndrome, ‍other skin conditions

no use of: ‍oral contraceptives

no family history of: ‍acne





EXAM:

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Acne vulgaris ‍likelysuspectedpossible

DDx: acne vulgaris, rosacea, periorificial dermatitis, folliculitis, drug-induced acne, steroid acne, polycystic ovary syndrome, pseudofolliculitis barbae, seborrheic dermatitis, impetigo, contact dermatitis, keratosis pilaris, miliaria, demodicosis





PLAN:

Investigations:

- Blood work: ‍Testosterone, ‍DHEAS, ‍LH, ‍FSH, ‍Prolactin, ‍17-OH Progesterone

- If oral isotretinoin: ‍CBC, ‍LFTs, ‍lipid profile, ‍β-HCG

Treatments:

- ‍Benzoyl peroxide

- ‍Topical antibiotics

- ‍Topical retinoids

- ‍Oral antibiotics

- ‍Oral contraceptives

- ‍Oral isotretinoin

- Avoidance of oil-based cosmetics and sunscreens

- Gentle skin cleansing

- If oral isotretinoin: Advise patient to avoid pregnancy and to use two forms of contraception because of teratogenicity

Further care:

- Repeat blood work in ‍ ‍daysweeks if on oral isotretinoin

- Referral to dermatologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as severe redness, swelling, or pus-filled blisters