a. The extent and distribution of the lesions.
b. The degree of oiliness or seborrhea.
c. The relative mixture of noninflammatory papules, inflammatory papules, pustules, nodules, cysts, and sinus tracts in each area.
d. The degree of scarring in each involved area.
3. What general treatment measures other than medication should you institute?
a. Explain the general nature and course of the disease, and the need for a certain level of maintenance treatment once control is achieved.
b. Review use of cosmetics.
c. Review appropriate cleansing practices.
d. Discourage picking and manipulation of lesions. The first visit is not always the best time for this discussion.
e. Discuss diet and rest.
f. Explain to the patient why you have chosen the program she is going to follow. This improves compliance.
4. The patient has fairly dense acne of the face and mid-upper back. Her chest, shoulders, neck, and lower back are spared. Her lesions are predominantly noninflammatory papules, open comedones, and a few inflammatory papules and pustules. Her mother has read about isotretinoin therapy. How would you grade her acne, and what would be an appropriate treatment regimen?
b. Medication consisting of a topical antibiotic each morning and a topical retinoid every other night alternating with a benzoyl peroxide product tailored to her degree of oiliness.
c. Regularly scheduled follow-up visits for acne surgery, medication adjustment, and to assess progress.
5. What would you change in your management if her acne also involved her chest, shoulders, and lower back?
Answer: A systemic antibiotic would be more cost-effective.
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