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1. A 16-year-old male presents with comedonal acne on his forehead and cheeks.
He has been using over-the-counter benzoyl peroxide gel for two months
without improvement. What is the most appropriate next step in his
management?
a) Prescribe oral isotretinoin
b) Prescribe topical clindamycin
c) Prescribe oral doxycycline
d) Prescribe topical retinoid*
Rationale: Topical retinoids are the first-line treatment for comedonal acne, as
they unclog the pores and prevent new comedones from forming. Benzoyl
peroxide is effective for mild inflammatory acne, but not for comedonal acne.
Oral isotretinoin is reserved for severe or resistant cases of acne, and has
significant side effects. Topical clindamycin and oral doxycycline are
antibiotics that are used for moderate to severe inflammatory acne, but not for
comedonal acne.
2. A 22-year-old female presents with papulopustular acne on her chin and
jawline. She reports having irregular menstrual cycles and hirsutism. She has
tried several topical agents without success. What is the most likely
underlying cause of her acne?
a) Polycystic ovary syndrome (PCOS)*
b) Cushing's syndrome
c) Hypothyroidism
d) Acromegaly
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