A 17-Year-Old Girl Is Brought to an Urgent Care Center

A 17-year-old girl is brought to an urgent care center for sunburn.  She was jogging outside for an hour today and subsequently developed redness and pain on the exposed portion of her arms and face.  The patient says, "It wasn't even that sunny today.  I've been outside for a lot longer than this and have never had a sunburn this bad."  Her medical history includes acne vulgaris for which she was prescribed a topical and an oral medication, neither of which she can remember by name.  She does not take any other medications and has no allergies.  The patient is a long-distance runner for her high school track team.  She lives with her father, who has dyslipidemia.  Physical examination shows numerous comedones, papules, and pustules on her face and chest.  Confluent areas of erythema, warmth, and edema are present on the patient's face and upper extremities.  Her left arm is shown in the image below. Over the next several months, the patient consistently uses a topical retinoid, a topical antibiotic, and an oral antibiotic.  She is also prescribed a daily oral contraceptive as adjunctive therapy for acne.  Six months later, the patient returns to the office for a follow-up appointment.  She says she is not sexually active, and review of systems is positive for occasional feelings of anxiety with school workload.  Current BMI is 19 kg/m².  Blood pressure is 90/60 mm Hg, and pulse is 68/min.  Examination shows oily skin on the forehead, nose, and cheeks.  Inflammatory and nodular acne is present on the face, back, and upper arms.  There is also scarring on the forehead.  The patient has no hirsutism or acanthosis nigricans.  Urine β-hCG is negative.  The patient desires the most effective treatment, and appropriate pharmacotherapy is discussed.  Which of the following should also be discussed prior to prescribing the new medication?

A) A family history of hypertriglyceridemia is a contraindication to starting this new medication
B) All previously prescribed medications should be continued to achieve the best response
C) An increase in urinary frequency can occur with this therapy
D) Pregnancy testing should be repeated prior to starting the new medication
E) Treatment should be discontinued if acne worsens within 2 weeks of initiation