 |  nbme 2 derm, please explain your answer
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| Author | 9 Posts |
nadiabarati
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An otherwise healthy 19-year-old woman comes to
the physician
because of a 3-year history of intermittent facial
blemishes. She drinks
wine occasionally on weekends. She takes no
medications. Examination
shows multiple 1- to 2-mm red and white papules and
larger red nodules
on the forehead and cheeks. Which of the following is
the most
appropriate initial pharmacotherapy?
A
) Oral isotretinoin
B
) Systemic corticosteroids
C
) Topical benzoyl peroxide
D
) Topical corticosteroids
E
) Topical metronidazole
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| fongch
Forum Elite
Topics: 71
Posts: 316
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I think this has been discussed before, it's C.
Topical benzoyl peroxide is among the first line drugs for acne.
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| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,274
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This is Acne Vulgaris
I am between A or C
The initial treatment of Acne Vulgaris is Topical Retinoids since there is no such choice here , I would go for Topical benzoyl peroxide because they are also effective against P acnes, and bacterial resistance to benzoyl peroxide has not been reported.
Topical Isotretinoin is a systemic retinoid that is highly effective in the treatment of severe, resistant acne vulgaris . It is not the first line treatment because it has too many SE like Teratogenicity ( she is in child bearing age ) , hypertrigliceridemia , hepatotoxicity , mood chage and depresion . So for all that reason , I would go for
C ---Topical benzoyl peroxide
That 's only my opinion . Any more input is WELCOME
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The elevator to succes is broke ,you must take the stairs
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| nadiabarati
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I also think like you. But someone told me this is roseace and topical metronidazole is answer!!! he blieved so because of blemishes and drinking wine!!!
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| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,274
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FEATURES OF ROSEOLA
flushing, papules, pustules, and telangiectasias on the convex surfaces. Secondary characteristics are burning and stinging, edema, plaques, a dry appearance, ocular manifestations, and phymatous changes.
FEATURES OF ACNE VULGARIS
comedones, papules, pustules, and nodules in a sebaceous distribution. A comedone is a whitehead (closed comedone) or a blackhead (open comedone) without any clinical signs of inflammation. Papules and pustules are raised bumps with obvious inflammation. The face may be the only involved skin surface,
THIS IS DEFINITLY NOT ROSEOLA 
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The elevator to succes is broke ,you must take the stairs
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| nadiabarati
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thanks a lot. Nice explanation
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| vanshita
Forum Guru
Topics: 30
Posts: 915
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A
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| ram3
Forum Guru
Topics: 48
Posts: 525
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This is rosacea its in the first aid it says there are papules
pustules erythema on cheeks chin forehead like the question says
facial flushing is worsed by hot liquids spicy foods alcohol heat caffeine and sun exposure
treatment is topical metronidazole
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| fox
Forum Guru
Topics: 70
Posts: 727
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rosacea is more likely on the nose & not forehead & cheeks. My Ans: C) BP topical
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