Acne vulgarisBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.a2738 (Published 05 June 2009) Cite this as: BMJ 2009;338:a2738
- Fiona Hamilton, GP and honorary clinical research fellow1,
- Josip Car, GP and director of e-health unit1,
- Alison Layton, consultant dermatologist23
- 1Department of Primary Care and Social Medicine, Imperial College London, Charing Cross Campus, London W6 8RP
- 2Harrogate and District NHS Foundation Trust, Harrogate, North Yorkshire
- 3North Yorkshire and York Primary Care Trust, Harrogate
- Correspondence to: J Car
- Accepted 7 January 2008
A 17 year old woman comes to see you with a 12 month history of pimples and pustules on her face, with a few blackheads and no scarring. She says they are making her feel very self conscious and are affecting her A level studies and social life.
What issues you should cover
What other symptoms or signs does she have? Seborrhoea, irregular menses, weight gain, or hirsutism should alert you to polycystic ovarian syndrome.
Is she worried that her diet is causing her acne? Currently no conclusive evidence exists to confirm that foods such as chocolate contribute to acne, so it is a good opportunity to dispel myths and to discuss healthy eating in general.
Does she have any particular skin care regime? Often people with acne use aggressive cleaning products, which can aggravate the problem or cause irritation.
Is she taking any prescribed or over the counter treatments? Some treatments, particularly antiepilepsy drugs, steroid creams, anabolic steroids, and some hormonal treatments, can cause or worsen acne.
Would she consider hormonal treatment for acne? This would also give you the opportunity to discuss her sexual health, if appropriate.
How does the acne affect her mood and social life? Acne can lead to low self-esteem and depression, so you could ask her how it affects her mood and whether it stops her doing anything she would normally enjoy doing.
American Academy of Dermatology. AcneNet: a comprehensive acne information resource. www.skincarephysicians.com/acnenet
British Association of Dermatologists. …