OSCE — topical retinoids for acne: technique, irritation management, photosensitivity, pregnancy

Brief (to candidate)

A 22-year-old woman with comedonal and mild inflammatory acne is started on a topical retinoid. She is sexually active, uses sunscreen inconsistently, and previously stopped a retinoid after 5 days of peeling. You have 8 minutes to counsel correct use, manage irritation, and cover pregnancy and photosensitivity safety.

Candidate instructions

1. Name common agents (adapalene, tretinoin, tazarotene) and their comedolytic role.
2. Teach night use, pea-sized amount, moisturiser buffering, gradual titration.
3. Manage retinoid dermatitis without permanent abandonment.
4. Combine sensibly with benzoyl peroxide/acne ladder.
5. Counsel photosensitivity and pregnancy contraindication.

Examiner checklist (mark each domain / 10)

Model key actions

• Start adapalene or equivalent retinoid with a tolerability titration plan.^[1][2]
• Combine with BPO for inflammatory acne when indicated.^[3][4]
• Explicit pregnancy avoidance and sunscreen counselling.^[5]

Common errors

• No pregnancy warning.
• Applying excessive amounts multiple times daily.
• Abandoning therapy after mild peel without titration.
• Skipping photoprotection.
• Using retinoid alone when nodular/scarring acne needs systemic therapy.