<prompt> A 19-year old male presents with several comedones, papules, and pustules on face and trunk. The appropriate drug of choice for the patient would be:Topical retinoic acidTopical retinoic acid Oral doxycyctineTopical clindamycinTopical azithromycin  <response>: Ans. b. Topical retinoic acid Oral doxycycline Ref. Fitzpatrick. 6e p672-686; Rooks 8e p42.17-42.70; Roxburgh 18e p159-172; Harrison 19e p351-352, 18e p403-409A 19-year-old male presents with several comedones, papules, and pustules on face and trunk. This is a case of inflammatory acne with comedones and appropriate drug of choice for this patient is a topical retinoic acid with oral doxycycline.In the given picture a patient is suffering from severe nodulocystic acne with pus filled lesions. Oral therapy with Isotretinoin is indicated is such a patient.IsotretinoinDoc for nodulocystic acne severe acne.Side effects:Rash MCQTeratogenic contraindicated in pregnancyQHypertriglyceridemia on prolonged usetreatment options for AcneDrugAcneMildModerateSevere ComedonalPapularPustularPapularPustularNodularNodularConglobate1st ChoiceTopicalretinoidTopical retinoid Topical antimicrobialTopical retinoid Oral antibiotic - BPOTopical retinoid Oral antibiotic - BPOOral isotretinoinAlternatives for FemalesTopicalretinoidTopical retinoid Topical antimicrobialOral antiandrogen topical retinoid - topical antimicrobialOral antiandrogen topical retinoid - oral antibioticHigh dose oral antiandrogen topical retinoid - topical antimicrobialAcne VulgarisChronic inflammatory disease of pilosebaceous unitsCharacterized by seborrhoea, open closed comedones, erythematous papules pustulesIn more severe cases nodules, deep pustules, pseudocysts even scarring.Aggravating Factors:androgensSteroids topical systemic in high dosesCosmetics, hair preparations, industrial compounds, lubricating cutting oil.Friction traumaDrugs: lithium, isoniazid, halogens, phenytoin phenobarbitoneChlorinated naphthalenic compounds dioxin chloracne, pomades pomade acne, topical steroid other drugs drug-induced acneClinical Feature:The self-limiting disorder primarily of teenagers young adults.Earliest feature in the greasy skin seborrhoea.Lesions consist of papules, nodules, pustules and comedonesQ.The clinical hallmark of acne vulgaris: comedones, closed white head or open black headSandpaper comedones multiple, very small whiteheads, frequently on fore head, macrocomedones 1mm mostly whiteheads, submarine comedones 0.5 cm in diameter deeply situated and secondary comedones like chloracne and pomade acne are other subtypes.Earliest lesions are generally mildly inflamed or non-inflammatory comedones on the forehead.MC location is the face cheeks, chin, forehead sides of nose but shoulder, upper chest back involvement is not uncommon.Most cases do not develop scarring.Treatment DrugsAntimicrobial agents reduce bacterial population;Comedolytic agents encourage the shedding of follicular homy plugs and remove the obstructionSebum production is decreased by biotrophic agents directly and antiandrogens indirectlyAnti-inflammatory agents reduce the damaging effects of acne inflammation on skin. 