A 25 year old lady comes to your office for a Urinary tract infection. She is sexually active and had her last period start 2 weeks ago. She uses oral contraceptives and has had no breakthrough bleeding. Her periods occur once a month and last for about 3 days each time. You notice that she has acne and bring up the topic with her. She expresses an interest in getting them treated.. Which of the following choices is the correct way to treat her?

1. If she wants them to disappear quickly, use Isotretinoin (Accutane).

2. Ask her to sunbathe whenever possible and use over the counter facial cleansers before starting prescription medications.

3. Evaluate her for an androgen producing tumor before starting on treatment so that treatment can be accurate and safe.

4. Start a special diet with less chocolate and fat.

5. Start her on Tretinoin cream/gel (Retin A) and ask her to use sunscreen in the daytime. Besides this discuss stopping  the contraceptive pills.

Answer is choice 5.

Acne: Please remember that it is not caused or worsened by any type of food or chocolate or sugar. Worse in fall or  winter. It has mild lesions or nodular lesions. Nodular lesions can hurt and scar badly.

Lithium, steroids, phenytoin (Dilantin) and contraceptive pills worsen it.

Diagnosis: Lesions are round. May merge to give different shapes. Hormones and Propionibacterium acne are responsible for the disease. Propionibacterium breaks fat to fatty acids and this causes a sterile inflammation. When the comedone bursts, it leads to inflammation and scarring.

Treatment with face wash soaps etc is not helpful. Treatment options include Tretinoin cream/gel (Retin A cream/gel), Adapalene (Differin gel), Tetracyclines and lately Tazarotene (Tazorac cream).

Resistant acne should be treated using Isotretinoin (Accutane).   Accutane cannot be used in pregnancy. A signed informed consent is necessary when treating girls of reproductive age with Accutane because it is highly teratogenic.

Rosaceae:

Worsened by sun exposure, emotional stress and alcohol

Tetracycline, minocycline, erythromycin/clindamycin, help rosacea.

People who develop infections of the eyelids must practice frequent lid hygiene.

Sunscreens, particularly those that protect against ultraviolet A and B light waves and have a sun-protecting factor (SPF) of 30 or higher.