J.S., age 16, comes to your office for a routine physical examination. You notice that she has facial acne that she is hiding with heavy makeup. She has tried Clearasil inconsistently without relief. She works at a fast food restaurant as a cook after school and on the weekends. Her mother has made her stop eating chocolates and greasy foods, but that has not seemed to help her. She is concerned because her prom is in 6 weeks and she wants her face clear. On physical examination, there are open and closed comedones as well as papules on her face and back. No scarring is evident. J.S. confides that she has recently become sexually active.
Diagnosis: Acne Vulgaris
Answer the following questions. Include two references, cited in APA style.
List specific treatment goals for J.S.
What drug therapy would you prescribe? Why?
What are the parameters for monitoring the success of the therapy?
Describe specific patient education based on the prescribed therapy.
List one or two adverse reactions for the selected agent that would cause you to change therapy.
What would be the choice for second-line therapy?
What over-the-counter or dietary supplement would you recommend to J.S.?
What dietary and lifestyle changes should be recommended for J.S.?
Describe one or two drug–drug or drug–food interactions for the selected agent.
Sample Answer
Specific Treatment Goals
The specific treatment goals for J.S, who has acne vulgaris include reduction of inflammatory lesions, reduction of comedonal, avoidance of scarring, and improvement of psychosocial symptoms (Roman et al., 2016).
Drug therapy
The drug therapy that I would prescribe for J.S, who has a mild case of acne vulgaris, would be the use of benzoyl peroxide, a combination of topical antibiotics, and other medication or administration of topical retinoid. This will therefore be the first treatment for the case of mild acne vulgaris. On the other hand, the addition of a hormonal agent such as spironolactone would be effective in treating J.S (Zaenglein et al., 2016). This is because a hormone or treatment would be effective in treating the patient’s acne vulgaris because the patient is 16 years old and has recently reported being sexually active. It is most likely that hormonal imbalance would be responsible for J.S’s acne vulgaris.
Parameters to monitor the success of the therapy
The parameters to monitor the success of the first line of treatment for acne vulgaris, which includes administering a topical retinoid, benzoyl peroxide, or a combination of topical medications, retinoid, and antibiotics, would be to evaluate the effectiveness of the medications after the first eight weeks of treatment. The treatment would only be suspended if the patient developed intolerable adverse effects or an allergy before the end of eight weeks of treatment (Zaenglein et al., 2016).
Specific Patient Education Based On Prescribed Therapy
Based on the prescribed treatment therapy for JS to treat acne vulgaris, the ideal patient education would include instructing the patient on how to conduct effective skincare, including skin hygiene, the use of moisturizers, and sun protection. The patient would ever be required to wash their face at least twice daily using a non-soap facial skin cleanser. On the other hand, the patient would be required to utilize moisturizers as they minimize skin peeling and dryness of the skin, which are common side effects of acne treatment. Finally, the patient will be required to utilize sun protection cream as some acne treatments will increase the sensitivity of the skin to sunlight, such as retinoid (Roman et al., 2016).
Adverse Reactions That Would Warrant a Change in Treatment Therapy
The main adverse reactions that would warrant a change related to the administration of benzoyl peroxide to treat acne vulgaris would include the patient developing severe skin irritation or allergic reaction. This will cause the patient to develop symptoms such as swelling on their face, feeling light-headed, itching, hives, experiencing difficulty breathing, and also swelling on the throat, lips, or tongue (Zaenglein et al., 2016).
Second-line therapy
The use of systemic antibiotics would be the most effective second-line therapy for acne vulgaris. This would include drugs such as doxycycline and minocycline. Systemic antibiotic treatment would be supplemented with a retinoid (Roman et al., 2016).
Dietary or over-the-counter supplements
I want to recommend vitamin C supplements for J.S.
Dietary and Lifestyle Changes
The dietary supplement that I would recommend to JS, who is suffering from hormonal acne, is eating nutrient-dense and whole foods. According to Zaenglein et al. (2016), eating an anti-inflammatory diet that is nutrient-dense will be the most effective way of preventing and treating others naturally. Scholarly research has therefore indicated that inflammation will be the main cause of acne. Patients without acne should consume foods that reduce inflammation, such as Omega-3 fatty acids. Eating the correct quantities of vegetables and fruits can also help reduce inflammation and reduce acne symptoms as they have supportive skin nutrients such as Vitamin C. Being physically active would also help the patient to deal effectively with her acne.
Drug–Food Interactions for the Selected Agent
The patient should not use benzoyl peroxide when eating food as drug interactions could occur.
References
- Roman, C. J., Cifu, A. S., & Stein, S. L. (2016). Management of Acne Vulgaris. JAMA, 316(13), 1402. https://doi.org/10.1001/jama.2016.11842
- Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., Bowe, W. P., Graber, E. M., Harper, J. C., Kang, S., Keri, J. E., Leyden, J. J., Reynolds, R. V., Silverberg, N. B., Stein Gold, L. F., Tollefson, M. M., Weiss, J. S., Dolan, N. C., Sagan, A. A., . . . Bhushan, R. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945–973.e33. https://doi.org/10.1016/j.jaad.2015.12.037
