A 23-year-old woman comes to the physician for treatment of acne vulgaris. She has moderate comedonal acne affecting the face, neck, and shoulders. The patient has attempted treatment with topical azelaic acid without improvement. She has no other medical problems. She is married and has no children. The patient does not smoke but drinks alcohol socially on weekends. What additional information is needed before advising this patient on treatment options?

Question

A 23-year-old woman comes to the physician for treatment of acne vulgaris.  She has moderate comedonal acne affecting the face, neck, and shoulders.  The patient has attempted treatment with topical azelaic acid without improvement.  She has no other medical problems.  She is married and has no children.  The patient does not smoke but drinks alcohol socially on weekends.  What additional information is needed before advising this patient on treatment options?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c123_7708_8f63_4db8fb2b6bf6_MD0005_00 This patient has moderate comedonal acne which has failed initial therapy with topical organic acids. In most cases, the appropriate management would be topical retinoid therapy - adapalene, tretinoin, or tazarotene. However, the potential for pregnancy may influence the choice of treatment for women of childbearing age. For women who are pregnant or may become pregnant, topical erythromycin, clindamycin (inflammatory acne), or azelaic acid (comedonal acne) are designated FDA pregnancy risk category B and are generally considered safe. The risk of teratogenicity with topical retinoids is considered low and most (eg, tretinoin, adapalene) are designated category C. However, tazarotene and the oral retinoid isotretinoin are designated category X and should never be used in pregnancy. Pregnancy risk of medications for acne includes: FDA pregnancy risk category Category B: Azelaic acid, topical clindamycin, topical/oral erythromycin Category C: Adapalene, tretinoin, topical dapsone, benzoyl peroxide, sodium sulfacetamide Category D: Oral tetracyclines Category X: Tazarotene, isotretinoin (Choice A) Even though isotretinoin and tazarotene are teratogenic, retinoid medications are not carcinogenic. Therefore, family history of skin cancer is not a specific concern. (Choice B) Topical and oral antibiotics are used for inflammatory and nodulocystic acne but are not used routinely in comedonal acne. (Choices C and E) Liver function tests and serum lipid levels should be performed regularly in patients treated with oral (but not topical) retinoids. Educational objective: For treatment of acne in women who may become pregnant, the preferred medications include topical erythromycin, clindamycin (inflammatory acne), or azelaic acid (comedonal acne); these are designated FDA pregnancy risk category B. Topical tretinoin and benzoyl peroxide should be avoided in pregnancy (category C). Tazarotene and isotretinoin are potent teratogens that are absolutely contraindicated in pregnancy (category X). References: The management of acne vulgaris in pregnancy. (http://www.ncbi.nlm.nih.gov/pubmed/23996075)

A 23-Year-Old Woman Comes to the Physician for Treatment of Acne