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Patient Case: Acne

Patient Case: Acne

Discussion

A 19-year-old male presents to the dermatology clinic with a persistent outbreak of facial acne. He reports having pimples for the past three years, which have worsened over the last six months. The lesions are predominantly on his forehead, cheeks, and jawline. He describes frequent flare-ups, especially after consuming oily foods or experiencing stress. He denies using any specific skincare products or treatments.

On examination, multiple comedones (both open and closed), inflammatory papules, and pustules are noted on the forehead, cheeks, and chin. A few nodules are present along the jawline, but there are no signs of cystic lesions or scarring. His chest and back show scattered mild acne lesions.

A diagnosis of moderate inflammatory acne vulgaris is made. The patient is counseled on proper skincare, including gentle cleansing and avoiding excessive face washing. Treatment with a combination of topical retinoids and benzoyl peroxide is initiated, along with an oral antibiotic (doxycycline) to reduce inflammation. He is advised that acne management takes time and that consistent treatment will help improve his skin.

Questions
  1. What is the primary cause of acne vulgaris?
    a) Bacterial infection alone
    b) Excess sebum production, follicular hyperkeratinization, bacterial colonization, and inflammation
    c) Poor hygiene and dietary habits
    d) Fungal overgrowth on the skin
  2. Which type of acne lesion is considered a non-inflammatory comedone?
    a) Papule
    b) Pustule
    c) Open or closed comedone
    d) Nodule
  3. What is the most appropriate first-line treatment for moderate inflammatory acne in this patient?
    a) Topical retinoids and benzoyl peroxide with an oral antibiotic
    b) High-dose systemic corticosteroids
    c) Antifungal cream and frequent washing with soap
    d) Surgical drainage of comedones
  4. Why is patient counseling important in acne treatment?
    a) To ensure the patient understands that acne treatment requires time and consistency
    b) Because acne is primarily caused by poor hygiene, and patients need education on proper face washing
    c) To encourage frequent squeezing of pimples to speed up healing
    d) To suggest immediate discontinuation of treatment if no improvement is seen in one week
Reveal answers

Answers

  1. (b) Excess sebum production, follicular hyperkeratinization, bacterial colonization, and inflammation
    • Acne vulgaris results from multiple factors, including increased sebum production, clogged pores (hyperkeratinization), bacterial growth (Cutibacterium acnes), and inflammation.
  2. (c) Open or closed comedone
    • Comedones are non-inflammatory acne lesions. Open comedones (blackheads) occur when a clogged pore is exposed to air, while closed comedones (whiteheads) are beneath the skin’s surface.
  3. (a) Topical retinoids and benzoyl peroxide with an oral antibiotic
    • Moderate acne is best treated with a combination approach: topical retinoids (to unclog pores), benzoyl peroxide (to reduce bacteria and inflammation), and an oral antibiotic (such as doxycycline) to control moderate inflammatory lesions.
  4. (a) To ensure the patient understands that acne treatment requires time and consistency
    • Acne treatments often take 6-8 weeks to show improvement. Patients need education on adherence, as premature discontinuation is a common reason for treatment failure.