Simple cases
Case 1
19 year old male with skin lesions on face and upper trunk.
History
How long have you had this skin disease?
It started at the age of 13, six years ago.
Reasonable question, since this dermatosis typically starts in puberty.
Do you have pain or itch?
Yes, sometimes pain.
Good question, since especially inflammatory forms may be painful.
Does any food worsen the symptoms?
No, it is always the same.
This question is not necessary, since diet does not have any impact. Individual differences however are possible.
Are other family members affected?
Yes, my father had the same problem in his youth. Today there is nothing to be seen anymore.
Useful question, since especially severe forms are often familial.
Do you take medicaments for other diseases?
No, no medicines.
Good question, since some drugs like steroids, INH, lithium, hydantoin or halogens may induce skin lesions. Important question also because of possible drug interactions.
What is your profession?
I still go to school.
Good question, since contact with tar or oil may induce acne.
Lesion
Choose the right efflorescences:
False, the efflorescences are elevated.
Correct. Multiple papules.
Correct. Some papules have transformed into pustules.
Correct. Many blue-red coloured nodules.
Diagnosis
Choose the right diagnosis:
Correct. Open and closed comedones, papules, pustules and sometimes nodules and scars are typical for acne.
False. Allergic contact dermatitis shows a typical eczematous morphology with confluent papules, sometimes vesicles and scaling.
False. Rosacea is a chronic dermatosis with erythema, teleangiectasia, papules and pustules. There are no comedones. The etiology is unknown.
False. Perioral dermatitis is another facial disorder, showing erythema, papules, pustules. However, it is present most frequently in women and often associated with abuse of skin moisturizers.
False. The seborrheic dermatitis is an inflammatory disorder with yellow greasy scales, oily skin and underlying erythema. Localization: naso-labial, glabella, eyebrows, hair line, retro auricular, capillitium and presternal.
Therapy
Choose the right therapy(ies):
False. These are contraindicated in acne.
Correct. This is a possibility. More inflammatory forms need antibiotics in addition to keratolytic treatment. This may be topicall (benzoyl peroxide, clindamycin (cave resistances)) or systemicall (tetracycline, minocycline).
Correct. Isotretinoin is sebostatic, antiproliferative and anti-inflammatory. It is the strongest drug against acne. Systemic use only in scarring acne; the treatment of choice in our patient.
False. No diet influences the course of acne.
In this case wrong. Antiandrogens may be used in women with acne.
