Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android


Chief Complaint

Moderate acne

History of Present Illness

DM is a 22-year-old female presenting to your counter seeking advice for treating her acne. She has multiple small comedos (both open and closed) concentrated on her chin, nose, and central forehead, also approximately 5 pustules around her nose. She is concerned about changes to her skin pigmentation that occurs after larger acne lesions have healed. She is currently 5 months postpartum and breastfeeding her infant and therefore not interested in a hormonal agent or contraception at this time.

Student Work-Up

|Download (.pdf)|Print

Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. Why is DM’s acne classified as moderate?

    Hint: See Treatment in PPP

  2. Considering the potential hormonal component to DM’s acne, what treatment options could address this if DM was interested in that type of therapy?

    Hint: See Treatment in PPP

  3. Is DM a good candidate for oral isotretinoin therapy?

    Hint: See Treatment in PPP

  4. What is the risk of using clindamycin topical solution as monotherapy? What can be done to ameliorate this risk?

    Hint: See Treatment in PPP

  5. Considering that DM reports a history of pigmentation changes, what medication recommendations would you make regarding this? Or would you consider an alternate medication?

    Hint: See Treatment in PPP and also in the literature it is recommended that retinoids can be used to treat and/or prevent hyperpigmentation.


One year later DM comes to the pharmacy with a prescription for isotretinoin 20 mg by mouth twice daily. Her current medication list includes ethinyl estradiol/norethindrone acetate/ferrous fumarate, adapalene 0.1% gel, clindamycin 1% topical solution. She is no longer breastfeeding. Her acne has not improved on her current therapy. She is hopeful that adding isotretinoin will improve her acne and would like any information you can provide on this medication.

What counseling tips would you provide to DM?

Hint: See Treatment in PPP


Global Perspective

Acne is prevalent worldwide, with the Global Burden of Disease project ranking it the eighth most prevalent disease worldwide.1 Acne affects races and skin types differently and may present with different clinical manifestations depending on the affected patient. Patients with skin of color may experience more post inflammatory hyperpigmentation and scarring.2 Although the primary cause of acne depends on pathogenic factors, additional factors, such as the use of occluding cosmetic and hair products, certain medications, disease states, dietary consideration, and items worn directly against skin that obstruct skin pores can worsen acne and should be identified, discussed, and avoided if possible....

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.