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Acne Vulgaris in a 14-Year-Old Adolescent WITH FACIAL BUMPS | COMPLETE CLINICAL EVALUATION AND MANAGEMENT PLAN ,ADOLESCENT HEALTH/ REASON FOR ENCOUNTER ;BUMPS ON FACE [I human week * walden]soapnote %powerpoint Bumps and Breakouts: A Clinical Approach to Acne Vulgaris in Adolescents
Here’s the continuation with Past Medical History (PMH), Family History (FH), Social History (SH), and Review of Systems (ROS): Past Medical History (PMH)
- No chronic illnesses such as asthma, eczema, or diabetes.
- No previous dermatologic conditions.
- No known drug allergies.
- Up to date on immunizations.
- No prior hospitalizations or surgeries. Family History (FH)
- Mother had adolescent acne that resolved in adulthood.
- No family history of autoimmune diseases or chronic skin conditions.
- No family history of diabetes or other endocrine disorders.
Social History (SH)
- Lives with parents and attends school regularly.
- No tobacco, alcohol, or recreational drug use.
- Uses mild soap for face washing, no makeup or heavy cosmetics.
- Diet is balanced; no specific dietary triggers noted.
- No recent travel or exposure to new environments or allergens. Review of Systems (ROS)
- General: No fever, weight changes, or fatigue.
- Skin: Facial bumps as described, no other rashes or lesions elsewhere.
- HEENT: No headaches, no nasal congestion, no sore throat.
- Respiratory: No cough or shortness of breath.
- Cardiovascular: No chest pain or palpitations.
- Gastrointestinal: No abdominal pain, nausea, or vomiting.
- Neurologic: No dizziness or weakness.
- Face: Multiple open comedones (blackheads) and closed comedones (whiteheads) predominantly on the forehead and cheeks.
- Numerous inflammatory papules and pustules with mild erythema.
- No nodules, cysts, or abscesses.
- No scarring, hyperpigmentation, or excoriations noted.
- No signs of secondary infection. Lymphatic:
- No cervical, submandibular, or preauricular lymphadenopathy. Head, Eyes, Ears, Nose, Throat (HEENT):
- Normocephalic, atraumatic.
- No conjunctival injection or discharge.
- Nasal mucosa normal.
- Oral mucosa moist without lesions. Other systems:
- Cardiovascular, respiratory, abdominal, and neurologic exams unremarkable.
Here’s the Assessment and Plan section for the case: Assessment Primary Diagnosis:
- Mild to moderate acne vulgaris Rationale: The patient’s history of gradually increasing facial bumps, presence of open and closed comedones, inflammatory papules and pustules localized to the face, and absence of systemic symptoms strongly support acne vulgaris as the diagnosis. Differential Diagnoses to Consider:
- Milia
- Folliculitis
- Molluscum contagiosum
- Perioral dermatitis
- Contact dermatitis Plan
4. Follow-up: - Schedule follow-up appointment in 6 weeks to assess treatment response and side effects. - Consider oral antibiotics (e.g., doxycycline) if no improvement or if acne worsens. 5. Referral: - Refer to a dermatologist if the patient develops severe nodulocystic acne, scarring, or fails to respond to initial therapy. Thank you! Here's how "loss" applies to the 14- year-old acne vulgaris case in each of those categories: 1. Loss of Follow-up or Patient Compliance Risk: High, especially in adolescents. Why it happens: - Acne treatment results take 6–8 weeks—many patients expect faster improvement.
- Topical treatments may cause initial irritation (dryness, redness), discouraging continued use.
- Adolescents may lack motivation or parental support for consistent use. Implications:
- Incomplete treatment → persistent or worsening acne.
- Increased risk of scarring or psychological distress. Plan to address:
- Set realistic expectations at the first visit.
- Educate both patient and parents.
- Schedule a specific follow-up date (e.g., 6 weeks).
- Provide a simple, low-burden regimen.
- Use adherence aids (e.g., apps, reminders). 2. Loss of Skin Integrity (Scarring or Tissue Damage) Caused by:
- Picking, squeezing, or popping acne lesions
4. Other Relevant “Losses” - Loss of self-esteem / psychological distress: o Very common in adolescents with facial acne o May lead to social withdrawal, anxiety, or depression o Important to ask about mood, bullying, or social impact o Consider referral to counseling if needed Here’s a list of Differential Diagnoses for a 14- year-old presenting with facial bumps , along with brief distinguishing features to help differentiate them from acne vulgaris : **Differential Diagnoses
- Acne Vulgaris** (Primary Diagnosis)
- Open and closed comedones (blackheads and whiteheads)
- Inflammatory papules and pustules
- Common on face, chest, back
- Peak incidence during adolescence
- No systemic symptoms 2. Milia
- Small, white or yellow keratin-filled cysts
- Often on cheeks, eyelids, or nose
- No inflammation or comedones
- Common in infants but also in adolescents 3. Folliculitis
- Infected hair follicles → pustules with erythema
- May be itchy or tender
- Often caused by bacteria (e.g., Staph aureus )
- Usually lacks comedones 4. Molluscum Contagiosum
- Caused by a poxvirus
- Dome-shaped, flesh-colored, umbilicated papules
- Common in children and adolescents
- Triggered by heat, sun, spicy food
- More common in adults, but can occur in adolescents 8. Contact Dermatitis
- Itchy, red rash with papules or vesicles
- History of exposure to allergens or irritants
- No comedones
- May involve swelling or weeping Here is a list of recommended and optional diagnostic orders for a 14 - year-old with facial bumps (suspected acne vulgaris), including rationale: ✅ **Diagnostic Orders for Acne Vulgaris (Usually Clinical Diagnosis)
- No routine tests are needed**
- Acne vulgaris is primarily diagnosed based on history and physical exam.
Optional/Supportive Diagnostic Orders (Ordered only if atypical features are present or diagnosis is unclear)
1. Skin Swab for Culture & Sensitivity - When to order : If lesions appear infected, are draining pus, or not responding to treatment - Rationale : Rule out Staphylococcus aureus , MRSA , or gram-negative folliculitis 2. Hormonal Panel (Females Only) - Tests : o Total and free testosterone o DHEA-S (Dehydroepiandrosterone sulfate) o LH/FSH ratio - When to order : If signs of androgen excess (e.g., hirsutism, irregular menses, sudden severe acne) - Rationale : Evaluate for polycystic ovary syndrome (PCOS) or other endocrine disorders 3. Wood’s Lamp Examination
✅ Final Diagnosis: Acne Vulgaris – Mild to Moderate Severity Clinical Justification:
- Patient: 14 - year-old adolescent
- Presentation: Multiple open and closed comedones, papules, and pustules localized on the forehead and cheeks
- Duration: ~3 months, gradually worsening
- No systemic symptoms , no nodules, cysts, or scarring
- Physical Exam: Classic signs of inflammatory and non-inflammatory acne
- No evidence of secondary infection, allergic reaction, or hormonal imbalance at this time
- Diagnosis made clinically – no additional labs or imaging required Here is a comprehensive treatment plan for a 14 - year-old adolescent diagnosed with mild to moderate acne vulgaris :
1. Topical Treatment (First-Line for Mild to Moderate Acne) ✅ Topical Retinoid – Adapalene 0.1% gel
- Apply a thin layer once daily at bedtime to the entire face (not just visible lesions)
- Mechanism: Prevents comedone formation, reduces inflammation
- Side Effects: Dryness, mild irritation (usually resolves in 2–4 weeks) ✅ Topical Antimicrobial – Benzoyl Peroxide 2.5–5% gel or wash
- Apply once daily in the morning (or use as a cleanser for 1–2 minutes before rinsing)
- Mechanism: Bactericidal against Cutibacterium acnes (P. acnes), reduces inflammation
- Note: Helps reduce risk of antibiotic resistance if combined with topical or oral antibiotics Combo Product Option: Adapalene 0.1% + Benzoyl Peroxide 2.5% (e.g., Epiduo ) – once daily at bedtime
