QuestionSBA
QuestionChoice
For this patient with severe acne vulgaris, once-daily oral lymecycline 408 mg or oral doxycycline 100 mg is the recommended first-line management. Topical therapy such as azelaic acid should also be co-prescribed.
10003491
a
Lymecycline with topical azelaic acid
QuestionChoice
This would be appropriate for patients with mild-moderate acne. This patient however has presented with severe nodular acne.
10003492
b
Combination of topical benzoyl peroxide with topical clindamycin
QuestionChoice
Adequate courses of standard therapy with systemic antibiotics and topical therapy should be attempted before trialling oral isotretinoin. Additionally, this patient has presented in GP and isotretinoin can only be prescribed by a dermatologist.

It is standard practice to co-prescribe two forms of contraception prior to starting isotretinoin as it is a teratogen.

There is also a reported increased risk of depression and suicide associated with systemic retinoids; any changes in mood should be closely monitored. Given that this patient has self-reported depression, we would need to be cautious when prescribing isotretinoin.
10003494
d
Oral isotretinoin
QuestionChoice
Adequate courses of standard therapy with systemic antibiotics and topical therapy should be attempted before trialling the COCP.
10003495
e
Combined Oral Contraceptive Pill (COCP)
QuestionChoice
This regime is more likely to be used in patients with moderate acne. This patient however has presented with severe nodular acne. Furthermore, macrolides such as clindamycin are typically used for acne when patients cannot tolerate tetracyclines e.g. lymecycline or doxycycline. There is no indication of tetracycline intolerance in this case.
10003493
c
Clindamycin with topical benzyl peroxide
QuestionComment
If there is extensive scarring isn't oral isotretinoin first line?
29540
User
subscriber
Callum
QuestionComment
it should really be refer to dermatologist 
51265
User
subscriber
SEXY GALLBLADDER
Concept
Chapter
2693
3918
acne vulgaris
Topic
144
Dermatology
13245
A 22-year-old woman presents to the GP. She mentions that she is feeling depressed due to her extensive scarring acne and painful nodules.

What is the most appropriate management for her?
a