Acne and Rosacea

1.

A 14-year-old girl (see photo) presents to your office with her mother. How would you describe her skin lesions?

a. Nodulocystic acne

b. Primarily comedonal acne*

c. Primarily inflammatory acne

d. Rosacea

e. She does not have acne

2.

A 15-year-old female presents to clinic with acne with 30-40 comedones on the forehead, cheeks, and chin, with very few erythematous papules, and no scarring. She reports that topical benzoyl peroxide is not working for her despite using it according to instructions for 6 months. She has no involvement of chest or back and has normal menstrual periods. Which of the following is the BEST addition to her acne treatment at this time?

a. Oral Isotretinoin

b. Oral Minocycline

c. Oral Spironolactone

d. Topical antibiotic

e. Topical retinoid*

3.

A 16-year-old male presents to your office for his health maintenance visit. He has not used any treatment for his acne (see photo). The MOST appropriate initial treatment plan is:

a. Start oral doxycycline, topical tretinoin and benzoyl peroxide wash and see him in follow-up in 3 months*

b. Start oral doxycycline, topical tretinoin and benzoyl peroxide wash and see him in follow-up in 6 months

c. Start topical tretinoin and benzoyl peroxide wash and see him in follow-up in 3 months

d. Start topical tretinoin and benzoyl peroxide wash and see him in follow-up in 6 months

4.

Which of the following diagnoses BEST describes the patient in the photo?

a. Erythematotelangietatic Rosacea*

b. Papulopustular Rosacea

c. Phymatous Rosacea

d. Ocular Rosacea

5.

A 52-year-old male presents with erythematous papules and pustules on his cheeks and nose for several years (see photo). He also is embarrassed by the erythema on his nose and worries that his friends think he’s an alcoholic. The most appropriate next step is:

a. Clobetasol cream twice daily

b. Ketoconazole cream twice daily

c. Metronidazole cream twice daily*

d. Moisturizers 2-3 times daily

6.Oral tetracyclines are not used in children younger than 8 years of age because:

a. A. Risk of bleaching of the hair

b. B. Risk of damage to tooth enamel and developing bones*

c. C. Risk of hyperkalemia

d. D. Risk of hyperpigmentation of the skin

7.When prescribing medications for acne vulgaris, an important step is to establish reasonable expectations with the patient. How long might the patient have to wait before seeing improvements in his/her acne?

a. A. 1-2 weeks

b. B. 3-4 weeks

c. C. 2-3 months*

d. D. 4-6 months

8.Acne rosacea can be differentiated from acne vulgaris by which of the following features?

a. A. Absence of comedones*

b. B. Distribution limited to the face (Individuals can have acne vulgaris limited to the face)

c. C. Inflammatory papules and pustules (Seen in both acne rosacea and acne vulgaris)

d. D. Irritation from topical products (True in both acne rosacea and acne vulgaris)

9.Which of the following medications is indicated to treat acne in a pregnant woman?

a. A. Oral doxycycline

b. B. Oral isotretinoin

c. C. Oral minocycline

d. D. Topical clindamycin*

10.

Which of the following patients would be most appropriate to refer to a dermatologist?

a. A. Patient has both comedonal acne and few inflammatory lesions on the face, chest, and back.

b. B. Patient has no improvement in moderate acne after 1 month of treatment with topical retinoid.

c. C. Patient is a post-adolescent female with new onset acne.

d. D. Patient has extensive nodular lesions with cysts and diffuse scarring.*