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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the signs and symptoms of common skin disorders, such as acne, in a presenting patient

  • Identify the goals of therapy for acne

  • Develop an appropriate treatment and monitoring plan for acne, including nonpharmacologic and pharmacologic agents, on the basis of individual patient characteristics

  • Select an appropriate product for acne disorders

  • Properly educate a patient using acne treatment options

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PATIENT PRESENTATION

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Chief Complaint

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"My son's acne medication is not working!"

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History of Present Illness

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Jefferson Roberts is a shy 17-year-old male who is brought into your pharmacy by his mother, Luanne Roberts, complaining that the acne medication prescribed to him is just not working. On further questioning and examination, you find that the patient currently has several papules and pustules on his chin and cheeks, and you also notice a lot of small, depressed pits in the same area along with some excessively dry patches of skin. He has more closed comedones on his cheeks and forehead than open, with the majority of open comedones on his nose. His mother informs you that she watches the patient wash his face three times a day with soap and water, and reminds him constantly that dirty skin leads to "blackheads." The patient's mother admits to buying an "extraction tool" in which she uses to help "clean out the dirt and puss" in the patient's "zits." After looking at the patient's prescription history, you see that he has prescriptions from a local dermatologist. When questioned, you find out from the patient's mother that when he first started "breaking out" he was 13 years old, and tretinoin seemed to help. But in the past year, his acne has only worsened and she was hopeful his skin would further improve once his dermatologist added minocycline. However, she feels that these measures are not enough and wants to know what else they can do to clear up his skin. You hear the patient mumble something about wasting money on the soap that was advertised on television and also sense that he is very uncomfortable talking about his skin disorder.

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Past Medical History

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Hospitalized 5 years ago due to a severe upper respiratory infection

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Family History

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The patient is the youngest of three and his mother reports no one else in the family having so much trouble with acne.

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Social History

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The patient is a varsity swimmer and wants to try out for the US Olympic Water Polo team. He lives at home with his mother and is currently a high school junior. Family recently returned from a skiing vacation in Colorado. He has always been positive and upbeat until a few months ago and has now become more withdrawn and distressed. He works during the summer ...

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