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  #1  
Old 11-28-2012
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Default Acne : NBME 2 Concept

14. An otherwise healthy 19-year-old woman comes to
the physician
because of a 3-year history of intermittent facial
blemishes. She drinks
wine occasionally on weekends. She takes no
medications. Examination
shows multiple 1- to 2-mm red and white papules and
larger red nodules
on the forehead and cheeks. Which of the following is
the most
appropriate initial pharmacotherapy?

A) Oral isotretinoin

B) Systemic corticosteroids

C) Topical benzoyl peroxide

D) Topical corticosteroids

E) Topical metronidazole

I believe in nodular acne we give oral isotretinoin. Also was a bit confused with the clinical scenario can this case Rosacea.
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Old 11-29-2012
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Its acne vulgaris,key is teenager with acne and the question is asking about best initial therapy,so its C) Topical benzoyl peroxide
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Old 11-29-2012
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Buts it Nodular Acne and in this category we use Oral Isotretinoin.See UW explanation
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Old 02-08-2013
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If you go by the FDA, the only approved indication for oral isotretinoin is severe, recalcitrant nodular cystic acne unresponsive to other first line therapies.
Other sources* will give oral isotretinoin as first line drug in certain cases, but in any event the vignette in this case did not qualify because it was not so bad.
Keywords that were missing to merit oral isotretinoin are: recalcitrant, severe, conglobate, cystic, and scarring.

* UWorld
* this table from another post
* the American Academy of Dermatology
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Old 02-09-2013
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Unfortunately this is a very old question and the treatment guidelines have changed. But among the chices given (C) Topical benzoyl peroxide can be the only answer.
However, according to the current guidelines the treatment would be Topical tretinoin and oral antibiotics since this patient have inflammatory acne with nodules.
This topic was discussed here.
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