A 19-year-old woman presents to the dermatology clinic for a follow-up of worsening acne. She has previously tried topical tretinoin as well as topical and oral antibiotics with no improvement. She recently moved to the area for college and says the acne has caused significant emotional distress when it comes to making new friends. She has no significant past medical or surgical history. Family and social history are also noncontributory. The patient’s blood pressure is 118/77 mm Hg, the pulse is 76/min, the respiratory rate is 17/min, and the temperature is 36.6°C (97.9°F). Physical examination reveals erythematous skin lesions including both open and closed comedones with inflammatory lesions overlying her face, neck, and upper back. The patient asks about oral isotretinoin. Which of the following is the most important step in counseling this patient prior to prescribing oral isotretinoin?
AWear a wide-brimmed hat outdoors
BApply topical retinoids in the evening before bed
CDocument 2 negative urine or blood pregnancy tests before beginning oral isotretinoin
DUse non-comedogenic sunscreen daily with SPF of at least 45
EAvoid direct sunlight, from 10am to 2pm
Body dysmorphic disorder can be associated with all except
ABulimia nervosa
BOCD
CAnxiety
DMania
Recalcitrant acne is treated by:
ASteroids
BRetinoids
COral erythromycin
DOral tetracycline
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