A 14-year-old girl is brought to the office by her father for a well-patient visit. She has intermittent asthma and allergies to peanuts, tree nuts, and shellfish. She uses an albuterol inhaler as needed and has an epinephrine auto-injector at home. The patient lives at home with her parents and 12-year-old brother. She is in ninth grade and is a straight-A student. She participates in student council, theater club, soccer, and field hockey. During the physical examination, the patient says that the acne on her forehead and nose is "so embarrassing! My friend told me to use water-based makeup to help cover my blemishes, which makes me feel better. I shower every night and use an unscented acne facial scrub at least twice a day. I read on the Internet about certain foods to avoid, but the list was really long." BMI is 21 kg/m². Physical examination shows an oily complexion and closed comedones with minimal inflammation on the forehead. Examination shows no hirsutism or acanthosis nigricans. The patient and her father say that they prefer to avoid medication. Which of the following is the best next step in management of this patient?

Question

Quizplus · Accepted Answer

Explanation: 11ec2b69_be6c_6d14_8f63_833650ccf793_MD0005_00 This patient has comedonal acne vulgaris. Contributing factors include increased sebum production, follicular hyperkeratinization, and bacterial colonization (Cutibacterium acnes). Pharmacologic management for comedonal acne without inflammation includes topical retinoids and organic acid preparations (eg, salicylic acid, azelaic acid). Lifestyle interventions should be offered to all patients with acne, including this patient who prefers to avoid pharmacologic therapy. Patients should be advised to use pH-neutral detergent cleansers, as opposed to more alkaline soaps, with warm water twice daily. Cleansers should be applied gently without vigorous scrubbing, which can both aggravate existing and create new acne. Patients should also be encouraged to use water-based rather than oil-based skin products (eg, moisturizers, cosmetics, sunscreens) (Choice D). (Choice A) Vitamin E, a topical agent in many over-the-counter moisturizers and cosmetics, has not been shown to prevent or reduce scarring. This patient with comedonal acne would not improve with this therapy, and gentle cleansing should be advised. (Choice B) Although there is a correlation between foods with a high glycemic index and acne, there is no definitive data linking diet to acne. A restricted diet should not be advised solely for the purpose of acne control. (Choice E) Picking or expressing acne lesions can lead to scarring and should be discouraged. Educational objective: Lifestyle interventions to manage acne include avoidance of vigorous scrubbing and use of water-based skin products and pH-neutral detergent cleansers. References: Cleansing and moisturizing in acne patients. (http://www.ncbi.nlm.nih.gov/pubmed/19209947)

A 14-Year-Old Girl Is Brought to the Office by Her