Jack, 17, has been coming to your pharmacy with prescriptions for a topical retinoid for the last 12 months and, in the last few months, prescriptions for doxycycline. Today he has brought in a prescription for oral isotretinoin, to be taken instead of his doxycycline, as his acne is still severe and has not improved. He has heard that this is a very potent drug with some serious adverse effects including depression and is concerned about having to take it.
How would you counsel Jack?
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Competency standards addressed (2016): 1.1, 1.4, 2.2, 2.3, 3.2
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Acne vulgaris is an inflammatory disease of the pilosebaceous follicles of the skin with clinical features of comedones (blackheads are open comedones, whiteheads are closed comedones), papules, pustules, and in severe cases, nodules and cysts1 (see Figures 1–4). Acne is a common disease affecting about 85% of teenagers with onset at puberty and resolution in most people in their early 20s,3 but it can persist into adulthood, more commonly in women. Acne can have profound effects on self-esteem, self-image and wellbeing, patients with acne have been shown to have an increased risk of depression and suicide attempts.
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