Medical Student Impresses Residents With Acne Treatment Plan

Brandon T., a medical student at the University of North Carolina, shares how VisualDx helped him find the appropriate therapy for his patient’s acne.

“While in dermatology clinic for the first time as a medical student, I saw run-of-the-mill acne, but couldn’t remember how to treat it! Fortunately, I had VisualDx and was able to impress my residents with a thorough approach. In the end, we treated with oral doxycycline after running through all the topical options.”

Acne vulgaris pictured here is not the patient in this case study. See more pictures of acne vulgaris in VisualDx.

What is acne vulgaris?

Acne, or acne vulgaris (typical teenage acne), is an extremely common, usually self-limited chronic inflammatory condition of the pilosebaceous unit. The pathogenesis involves multiple factors, including (1) increased sebum production, (2) follicular hyperkeratinization, (3) proliferation of the bacterium Cutibacterium acnes (formerly known as Propionibacterium acnes), and (4) inflammation. It typically begins at puberty as a result of androgen stimulation of the pilosebaceous unit and changes in the keratinization at the follicular orifice. There is a wide spectrum of clinical disease, ranging from a few comedones to many inflamed papules, pustules, and nodules.

What should we be aware of when making a diagnosis?

Characteristic lesions include open comedones (blackheads), closed comedones (whiteheads, noninflammatory bases), erythematous inflammatory papules, and pustules. Nodules and cysts can result in scarring, including pitted or hypertrophic scars. Acne most frequently targets the face, neck, upper trunk, and upper arms. In adult women, deeper-seated, tender, red papules are common along the jaw line.

How can we treat this?

Approaches to treatment vary and are based on the severity of the acne. Topical treatments include antibacterial agents and antibiotics such as benzoyl peroxide, clindamycin, erythromycin, sulfur, sodium sulfacetamide, and azelaic acid, as well as retinoids such as tretinoin, tazarotene, and adapalene. Oral treatments may include oral contraceptives or isotretinoin.

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