Acne (Facial)

Diagnosis: Acne (Facial)

Example of moderate case of acne affecting forehead:

Clinical Presentation

Example of moderate case of acne affecting forehead:

Clinical History

Onset typically at puberty. Assess distribution (face, chest, back), lesion types (comedones, papules, pustules, nodules, cysts), scarring, and psychosocial impact. Medication history including hormonal contraceptives, corticosteroids, and lithium.

Treatment

Mild: topical retinoid ± benzoyl peroxide. Moderate: add topical/oral antibiotics (doxycycline, minocycline). Severe/nodular: isotretinoin 0.5-1 mg/kg/day. Hormonal: spironolactone or combined oral contraceptives in females. Maintenance: topical retinoid.

Differential Diagnosis

• Rosacea • Perioral dermatitis • Folliculitis (bacterial, fungal/pityrosporum) • Demodex folliculorum infestation • Drug-induced acneiform eruption • Keratosis pilaris • Hidradenitis suppurativa

Key Learnings

• Multifactorial pathogenesis: follicular hyperkeratinization, excess sebum, C. acnes, inflammation • Isotretinoin is the only therapy that targets all four pathogenic factors • Hormonal evaluation warranted in females with treatment-resistant acne, late-onset acne, or signs of hyperandrogenism • Post-inflammatory hyperpigmentation more common and persistent in skin of color • Avoid unnecessary antibiotics — limit courses to 3-4 months and combine with benzoyl peroxide to reduce resistance

Tags: acne, boards, case, dermatologist, dermatology, vulgaris