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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Erin. A clinical photograph of Erin’s face will be available to you on request (refer to Figure 1).1

Please then outline the most likely diagnosis and negotiate a management plan with her.

Scenario

Erin Campbell is a 14-year-old girl who presents to you with moderate facial acne. Her mum has come with her to the surgery but lets Erin see you on her own.

The following information is on her summary sheet:

  • Past medical history

  • Nil significant

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Social history

  • Lives with parents.

INSTRUCTIONS FOR THE PATIENT, ERIN CAMPBELL

You are 14 years old and attend the local high school. Your pimples dominate your life. Each morning your mum shouts at you to get dressed and ready for school, while you stare at your pimples in the mirror. You are convinced that you will never have a boyfriend like all your other friends. You used to take comfort in eating chocolate and cheese but have stopped since a friend said that was causing your pimples.

You are embarrassed to be going to see the GP and hope the doctor will be kind.

The following information is on your summary sheet:

  • Past medical history

  • Nil significant

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Social history

  • Lives with parents.

SUGGESTED APPROACH TO THE CASE

Establish rapport with Erin

Open-ended questions to explore Erin’s concerns and expectations about her acne.

Specific questions

Duration of acne

Location of acne

Impact of acne on social life and relationships

What has she tried so far as treatment?

What does she think causes the acne?

General health, e.g. are her periods regular?

Request permission to examine.

Examination

Examine the face

  • — Confirm acne

  • — Describe signs: comedones, pustules, erythema or scarring.

Management

Explain medical understanding of cause of acne without using jargon

Reassure that acne can be controlled, should not stop her socialising

Advise against picking or squeezing

Offer treatment depending on what Erin has already tried

Advise regular washing with soap

Avoid oily or greasy skin preparations

Recommend healthy diet

Treatment takes four to eight weeks to be effective, can combine topical and oral treatments

Reduce excess cells (hyperkeratinisation)2

Topical retinoids, azelaic acid

Reduce bacteria ...

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