Question 1#

A 20-year-old woman complains of skin problems and is noted to have erythematous papules on her face with blackheads (open comedones) and whiteheads (closed comedones). She has cystic lesions on her chest and back. She is prescribed topical tretinoin and topical clindamycin, but without a totally acceptable result. You are considering oral antibiotics, but the patient requests oral isotretinoin.

Which of the following statements is correct? 

A. Oral minocycline and isotretinoin are a good combination for severe acne
B. Systemically administered isotretinoin therapy can be tried if the couple agrees to use barrier contraception and if they sign a consent form
C. Oral antimicrobial therapy is less effective than a topical antibiotic gel
D. The teratogenic effects of isotretinoin are its only clinically important side effects
E. Oral combination contraception has been approved as a treatment for moderate acne vulgaris

Correct Answer is E


Comedonal acne is first managed with topical retinoids. Mild to moderate disease usually requires the use of topical antibiotics and topical retinoids. The combination of topical retinoids and topical antibiotics has been shown to be better than topical retinoids alone. Oral combination contraception decreases sebum production and is useful in moderate acne. Moderate to severe acne is managed with oral antibiotics, usually tetracycline derivatives, added to topical therapy. The more severe papulonodular forms require oral isotretinoin to inhibit sebaceous gland sebum production. Intralesional steroids for cystic lesions may be considered, but may cause thinning of the subcutaneous fat. Oral tetracycline and isotretinoin may cause pseudotumor cerebri and should never be used together. Isotretinoin has a high potential for teratogenicity and should not be used in women in their childbearing years unless two effective forms of contraception are being practiced. Isotretinoin can cause hypertriglyceridemia, hepatotoxicity, musculoskeletal pains and drying of mucous membranes. It should be reserved for severe or refractory acne.