Acne vulgaris in adolescents — formative SAQs

SAQ 1 — A 15-year-old boy with moderate inflammatory acne

Stem. A 15-year-old boy presents with a one-year history of open and closed comedones across his forehead and cheeks, now with increasing red papules and pustules and a few tender nodules on his jawline and upper back. He has become withdrawn and has stopped swimming. He has tried over-the-counter washes without success. Outline your assessment and your stepwise management. (10 marks, 15 minutes) ^{[1] [2]}

Assessment (3 marks). Take the onset, distribution, flare factors, prior treatments and adherence, the menstrual question is not applicable, the family history of severe or scarring acne, the diet and the cosmetics, and — above all — the psychosocial impact, because his withdrawal from swimming signals the distress that the lesion count hides. Examine and grade the severity on a reproducible scale, record the proportion of the comedonal versus the inflammatory lesions, look for the early atrophic scarring and the post-inflammatory hyperpigmentation, and note the truncal involvement. Screen the mood and self-harm risk. The diagnosis is clinical and no routine test is needed. ^{[1] [9]}

Mild-to-moderate rung (2 marks). Begin the topical retinoid — the adapalene 0.1 per cent gel as a thin film to the whole affected area at night — and the benzoyl peroxide 2.5 per cent by day. Counsel the dryness, the photosensitivity, and the sunscreen, and warn that the adapalene, not the tretinoin, is the photostable retinoid that combines safely with the benzoyl peroxide. The improvement is judged at six to eight weeks. ^{[1] [11]}