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A 15-year-old boy comes to the physician for advice about his facial
acne. He is very concerned with his appearance and when questioned, he says
that he washes his face two times a day with a very mild soap. He tries to
eat a healthy well-balanced diet but loves chocolate and spicy foods. He plays on the high school junior varsity basketball team. On examination, the patient
has mild to moderate acne, mostly consisting of open comedones, some closed
comedones, and a few pustules on the forehead and cheeks. The remainder of
the examination is unremarkable. Which of the following is the best advice to give this patient?


A. Avoidance of chocolate and spicy foods


B. Frequent face washing with strong soap


C. Topical application of tretinoin or adapalene


D. Treatment with oral antibiotic


E. Oral treatment with isotretinoin

C
R THESE NBME

ans. D
actually ans. A is also right but i go with d.

C

D.

I like C.

Yes, mild to moderate w/ open and some closed comodones = oral antibitotics

What would the presentation have to be to answers other choices excluding A

ans. is C

A is wrong because their is no relation between food (chocolate...) and acne.

The correct answer is C. Acne
vulgaris affects the majority of adolescents and is more prevalent in males.
Hormonal influences, abnormal keratinization of pilosebaceous units and colonization
by bacteria (Propionibacterium acnes) are
important pathogenetic elements. Treatment of acne depends on the severity
of the condition. Topical application of comedolytic agents such as retinoids (tretinoin, adapalene, and the new yeast-derived agent azaleic acid) is effective
for mild to moderate forms of non-inflammatory acne, characterized by open
comedones. Daily application of these compounds will result in improvement
within several weeks after starting treatment. Mild skin irritation and scaling
may be minimized by starting with low-concentration creams, and then progressively increasing the concentration. Another side effect of retinoids is increased
photosensitivity. The patient must be instructed to avoid prolonged exposure
to the sun and to use a sunscreen.
Avoidance of chocolate and spicy foods (choice
A) would have no beneficial effects on acne. It is well established
that there is no correlation between acne and specific types of foods.
Frequent face washing with strong soap (choice
B) will probably cause exacerbation of acne. This skin condition
is not caused by dirt. Gentle face washing once or twice daily with mild soaps
is recommended.
Treatment with oral antibiotic (choice
D) is aimed at decreasing bacterial colonization It is used for patients who fail to respond to topical treatments or have severe forms of
inflammatory acne. The antibiotics of choice include tetracyclines and erythromycin.
Oral treatment with isotretinoin (choice
E) is used for severe cases of acne not responding to topical comedolytics
and antibiotics. This compound acts by decreasing sebum production. In addition
to various types of side effects, isotretinoin is teratogenic.
Female patients of childbearing age should be required to use effective means
of contraception beginning one month before treatment to one month after treatment