Oral Erythromycin Case Summary

A 15-year-old female comes with her mother to her pediatrician complaining of “pimples that just won’t go away.”. She has tried numerous soaps and scrubs over the last six months, but has not really seen any dramatic improvement. She states that her breakouts have made her feel very self-conscious and although she is a very active teenager, she has started staying at home more due to her acne. Physical examination shows numerous comedones, pustules, and inflamed nodules distributed diffusely on her face. The rest of her skin seems clear of abnormality and review of systems is unremarkable. She is of normal height and weight for her age, with a BMI of 22.2. She states that some of her friends have tried something called isotretinoin and wonders if she could get a prescription for the drug.

Which of the following is the best next step in management?

A. Oral contraceptive pill
B. Oral erythromycin
C. Oral isotretinoin
D. Topical clindamycin
E. Topical retinoids and benzoyl peroxide

Answer

Choice "E" is the best answer. Acne vulgaris is a skin disease resulting from blockage and subsequent inflammation of the pilosebaceous unit. It is important to also consider
Current literature favors combination treatment plans over monotherapy. The first first-line therapy for acne vulgaris is topical retinoids and a topical antimicrobial agent, such as benzoyl peroxide. Topical retinoids are comedolytic and anti-inflammatory. It is important to note that since topical retinoids thin the stratum corneum, skin irritation, peeling, redness and sun sensitivity are common side effects. Benzoyl peroxide is effective against Propionibacterium acnes, decreasing colonization, and subsequent inflammation. Other topical antimicrobial medications can be given, such as clindamycin, but bacterial resistance may