SUBJECTIVE: The patient is a (XX)-year-old who returns accompanied by his mother for followup of acne. He was last seen a year ago. The patient reports that his skin has been doing okay recently, but mother notes he has had significant flares over the past few months and today is a good day. He is having no problems taking the medications. Mother is interested in possible isotretinoin treatment.
The patient’s past medical history is negative for skin disease, other than acne.
The patient’s medications include benzoyl peroxide 4% wash q.a.m., Concerta, erythromycin EES 400 mg p.o. b.i.d., fluticasone nasal spray, tretinoin 0.05% cream at night.
OBJECTIVE: The patient is alert and oriented x3. The patient’s mood is normal, normal body habitus. There are 3 to 6 mm inflammatory papular-nodular lesions coalescing along the jaw line on the left lower cheek, greater than right. There are scattered open and closed comedonal lesions on the face. An occasional inflammatory papule on the chest, 3 to 5 mm scattered inflammatory papules, pustules on the upper to mid back.
ASSESSMENT: Inflammatory acne, worse than on last visit.
PLAN:
1. Discussed with the patient and mother before beginning isotretinoin treatment, we would like to see if he will do well with the change in his antibiotics and increasing the strength of the retinoid. He had problems with headache while on tetracycline in the past. This was after he had been on the medication for months and was not clear if it was associated or not. We discussed with him beginning minocycline. If he develops significant headaches, stop the medication and call. Dosage is 100 mg p.o. b.i.d.
2. Unfortunately, his insurance does not cover for Tazorac, but we did increase the tretinoin to 0.1% cream nightly. They were given patient information booklet on isotretinoin. Followup is scheduled for 6 weeks.
