A shy 14-year-old girl accompanied by her mother presents for treatment of acne of 1 year's duration.
1. What historical information will assist in staging her disease and in the choice of appropriate treatment?
2. What should you look for on physical exam?
3. What general treatment measures other than medication should you institute?
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?
5. What would you change in your management if her acne also involved her chest, shoulders, and lower back?
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