Teenage Male with Acne

2024.1 – case 7A

History Taking

• Biopsychosocial History
  • Home: Living situation, family dynamics, and support system.
  • Education: School performance, attendance, and relationships with peers.
  • Activities: Hobbies, interests, and involvement in extracurricular activities.
  • Drugs/Alcohol: Usage history and frequency.
  • Sexual Activity: Sexual history, protection methods, and sexual health concerns.
  • Suicide Risk: Any thoughts of self-harm or suicidal ideation.
  • Safety: Bullying, abuse, or any other safety concerns.

Diagnosis and Management Plan

• Diagnosis: Acne vulgaris.
• Management Plan:
  • Medical Management:
    • Topical Treatments: Benzoyl peroxide, retinoids, antibiotics.
    • Oral Medications: Antibiotics, hormonal treatments (for females), isotretinoin for severe cases.
    • Over-the-counter Options: Acne washes, non-comedogenic moisturizers.
  • Psychosocial Management:
    • Counseling: Addressing low mood, bullying, and other stressors.
    • Support Systems: Engaging family, school counselors, or peer support groups.
  • Preventative Care:
    • Screening: Regular follow-ups for mental health, substance use, and sexual health.
    • Education: Importance of skincare routines, avoiding picking or squeezing pimples, and awareness of triggers.

Demonstrating Competency

• Empathy and Communication Skills:
  • Active listening, open questions, summarizing, reflecting, and checking understanding.
  • Age-appropriate communication to engage the patient.
• Biopsychosocial History:
  • Comprehensive history using the HEADSSS screening tool.
• Medical Management:
  • Providing a range of management options for acne.
  • Specific pharmacological and over-the-counter treatments.
• Mental Health:
  • Identifying contributing factors and addressing mental health concerns.
• Patient Engagement:
  • Prioritizing both the patient’s and doctor’s agendas.
  • Ensuring the patient understands the management plan.

Common Pitfalls

• Incomplete History:
  • Failing to take a comprehensive biopsychosocial history.
• Poor Listening Skills:
  • Asking for information already provided, not picking up on patient cues of distress.
• Lack of Patient Understanding:
  • Failing to check the patient’s understanding of the management plan.
• Treatment Choices:
  • Not offering treatment choices, following only the doctor’s agenda.
• Preventative Care:
  • Missing the opportunity for age and context-specific screening and preventive care.
• Education and Explanation:
  • Not providing clear explanations and education about the condition and treatment choices.