Acne vulgaris

QUESTION 15

A 20-year-old man presents to the dermatology office for evaluation of worsening acne. He has struggled with acne since adolescence and has tried numerous topical over-the-counter products containing salicylic acid and benzoyl peroxide and prescription medications including topical clindamycin 1% gel, dapsone gel, topical azelaic acid and a topical retinoid, with only moderate improvement of his acne. He is concerned about the worsening of acne on other parts of his body, including the chest and the back. On examination, there are a few scattered erythematous papules and pustules on the forehead, cheeks and the chin (15a). On the back, there are erythematous papules, pustules, and hyperpigmented papules and scars from prior acne lesions (15b).