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Discussion Starter · #1 ·
A 23 year old female presents with complains of facials pustules and papules. On examination you notice that the patient's face is greasy and contains multiple reddish macules, papules and pustules. You make the Dx of acne. You discuss the management plan with this patient and she disapproves of taking antibiotics or teratogens.

1)What is the teratogen that can be used in treating this patient's acne:
A-Tetanus Toxoid
B-Isotretinoin
C-Methotrexate
D-Lithium
E-Methimazole

2)The patient chooses to use OCPs as her line of treatment of acne. What is the mechanism of OCPs in treating acne:
A-Decreases facial FA breakdown
B-Decreased Sebum secretion
C-Increased Free testosterone
D-Decreased Free testosterone
E-Decreasing propinebacterium Acnes in the pilosebaceous unit
 

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B and D, the estrogen component of OCPs causes increased sex hormone binding globulin which binds testosterone and causes less free testosterone
 

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nice

B and D .
OCPs inc SHBG , decresing free testosterone
what teratogenicity does isotretinoin cause ? please refresh my mind, i cant seem to rmbr
 

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Discussion Starter · #10 · (Edited)
Yes correct, it's:
1)B-Isotretinoin
2)D-Decreased Free testosterone. If you recall from pathology acne is more common in males than females, why? Because of the Extra androgen which leads to more sebaceous secretions. So, as answered the OCP (Estrogen effect) causes an increased in sex hormone binding globulin "SHBG" which decreases the FREE testosterone, thus decreasing the sebaceous secretion on which propinebacterium Acnes metabolizes into FA that cause the inflammation. Clear? :D


Now, Isotretinoin can cause a cleft palate but most lethal is the cardiac defect.


*The same patient revisits your clinic 9 months later saying that she's still taking the same treatment, and that the acne was improving, but a couple of weeks ago she started noticing hyperpigmintation of the of the forehead and cheeks. The patient did not lose weight during the time of treatment. What is the most likely pathology in this patient?

A-Recurrence of acne
B-SLE
C-Melasma
D-Lupus Pernio
E-Lentigo Maligna Melanoma
F-Acanthosis Nigricans
 

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Well i'm gonna answer this one based on exclusion, pregnancy is most times associated with SLE. None of the others seem to have any connection. Maybe it was a flare caused by the OCPs?
 

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Discussion Starter · #12 ·
Well i'm gonna answer this one based on exclusion, pregnancy is most times associated with SLE. None of the others seem to have any connection. Maybe it was a flare caused by the OCPs?
LOL, I forgot to write down the answer!!!
 
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