Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓
Doctor Instruction:
You are a Junior Doctor working in General Practice. Your next patient is an 18-year-old female called Cornflakes Doodles, presenting with rashes on her face and body. Please take a history and perform an appropriate examination.
Patient History:
Cornflakes Doodles, an 18-year-old female student.
Over the past few years, you have been getting spots on your face, and they are only getting worse! You have tried multiple products for these spots from the shops, including Vitamin C serum and have yet to see much difference. Sometimes these products can irritate the skin. These spots are starting to spread to your body - both and back. These spots are filled with pus and look red. When you touch them, they are slightly tender. When you pop them, the pus comes out. You tried popping the spots to make them disappear, but you have been told not to do so.
Because of the scarring left from these spots on your face, you are beginning to have low confidence and self-esteem issues - affecting your ability to socialise with your friends when going out. You always wear heavy makeup to cover your face. You are scared your friends might laugh at you because of the spots. No fever. No joint pain. You feel well generally otherwise.
Ideas, Concerns, Expectations:
You think this is acne, as your father had this when he was young. He currently has quite a few permanent scars on his face. You are concerned because you also start to notice a few scars on your face due to your acne. Your friend told you that she recently used a cream called ?Accutane, and this has massively improved her acne. You haven’t yet had any prescribed medication for your acne. You want to see whether you can have the same thing like your friend.
Past Medical History:
Anxiety, epilepsy
Drug History:
Sodium valproate
NKDA
Family History:
Dad had acne when he was around 18 years old.
Social History:
Student studying English Literature at the University of Awesomeness.
Don't smoke.
Occasionally drink a couple of glasses of wine with the mates over the weekend.
Live in university accommodation with your peers.
Examination Findings:
Greasy, tender macules, papules, and pustules with various open/closed comedones surrounding the face, front torso and back. Ice pick/ hypertrophic/ rolling scarring on the face.
Differentials:
Acne Vulgaris
Acne Rosacea
Folliculitis
Milia
Investigations: