Chapter 39: Adnexal Disease Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient has acne and the provider notes lesions on half of the face, some nodules, and two scarred areas. Which treatment will be prescribed?

a. Oral clindamycin for 6 to 8 weeks b. Oral isotretinoin c. Topical benzoyl peroxide and clindamycin d. Topical erythromycin

ANS: C a. A progesterone-only contraceptive is most beneficial for treating acne. b. Combined oral contraceptives are effective for non-inflammatory acne only. c. Oral contraceptives are effective because of their androgen enhancing effects. d. Yaz, Ortho Tri-Cyclen, and Estrostep, are approved for acne treatment.

This patient has moderate acne, based on symptoms of lesions on half of the face with nodules and a few scars. A combination of topical benzoyl peroxide and clindamycin is recommended. Oral antibiotics are reserved for severe cases. Oral isotretinoin is used only for recalcitrant cases which are severe and have not responded to other treatments. Topical antibiotics should be used as monotherapy.

2. A provider is considering an oral contraceptive medication to treat acne in an adolescent female. Which is an important consideration when prescribing this drug?

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ANS: D a. Antibiotic therapy is effective in clearing up the lesions. b. It is often progressive with relapses and permanent scarring. c. The condition is precipitated by depilatories and deodorants. d. The lesions are infective, and the disease may be transmitted to others.

Three oral contraceptives have a labeled use for acne treatment: Yaz, Ortho Tri-Cyclen, and Estrostep. Progesterone-only contraceptives may worsen acne. Combined oral contraceptives are effective in reducing inflammatory and non-inflammatory acne. Oral contraceptives are effective because of their antiandrogen effects, since androgen induces sebum production.

3. A female patient is diagnosed with hidradenitis suppurativa and has multiple areas of swelling, pain, and erythema, along with several abscesses in the right femoral area. When counseling the patient about this disorder, the practitioner will include which information?

ANS: B

Although lesions may be treated with antibiotics, other medications, and drainage, the disease is often progressive, with relapses and permanent scarring. Deodorants and depilatories are not implicated as a cause. The disease is not transmitted to others, although the organisms may cause other infections in other people.

Multiple Response

1. When counseling a patient with rosacea about management of this condition, the provider may recommend (Select all that apply.)

a. applying a topical steroid.

b. avoiding makeup.

c. avoiding oil-based products.

d. eliminating spicy foods.

e. exposing the skin to sun.

f. using topical antibiotics.

ANS: C, D, F a. Chemotherapy b. Erythromycin c. Infliximab d. Isotretinoin e. Prednisone

Patients with rosacea should avoid oil-based products and eliminate spicy foods, alcohol, and hot fluids. Topical antibiotics may be used if pustules are present. Topical steroids are not recommended. Patients do not need to avoid makeup and should avoid the sun.

2. Which medications may be used as part of the treatment for a patient with hidradenitis suppurativa? (Select all that apply.)

ANS: B, C, D, E

Hidradenitis suppurativa is not malignant and chemotherapy is not used. Erythromycin, infliximab, isotretinoin, and prednisone are all used.