Return to Scenario ListShow Learning Points most relevant to Phase 1:

Pimples and rash on the face

Clinical Discipline(s)/Organ System(s)
Dermatology, General Practice
Progress Test Topic(s)
A Samoan woman of 17 years presents to her GP with a red rash on the face with spots. She has become very self-conscious and uses makeup to cover the blemishes.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Structure and function of the pilosebaceous gland
   - Pathophysiology of the pilosebaceous gland in acne vulgaris
   - Pharmacology of benzoyl peroxide, topical and systemic antibiotics, topical and systemic retinoids, antiandrogens, tetracycline antibiotics
   - Knowledge of bacterium Propionibacterium acnes
Clinical and Communication Skills 
   - Use history and examination to assess the extent and severity of a rash, including the level of psychological disturbance in a patient; note the presence or absence of comedones and scarring; recognise that acne can, rarely, be a manifestation of endocrine conditions
   - Differential diagnosis of a red facial rash
   - Conduct a HEADSS assessment
   - Establish the type and duration of topical and systemic treatments that have been used previously, and evaluate any associated adverse effects
   - Appropriate communication with a patient who feels embarrassed; appropriate communication with a teenager
   - Appropriate examination including asking for removal of makeup; conduct an appropriately sensitive examination including the face, scalp, neck and trunk; consider use of a chaperone
   - Describe the cutaneous features using dermatological terminology
   - Describe the range of treatments for acne vulgaris and rosacea including topical, systemic e.g. antibiotics, combined oral contraceptive pill (OCP), antiandrogens and retinoids; combined use of topical and systemic treatments
Personal and Professional Skills 
   - Acknowledge that even though a dermatological condition may have few clinical signs, it may be significant and distressing to the patient
   - Awareness of how preconceived ideas of 'significant' skin disease may prejudice an assessment of a patient; a clinically 'mild' skin condition may seem severe to the patient
   - Awareness of mind-body link in some dermatological conditions
   - Awareness of cross-cultural differences affecting communication, diagnosis and management
Hauora Māori 
   - Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management
Population Health 
   - Epidemiology of acne vulgaris (prevalent in adolescence but also occurs in adults)
   - Epidemiology of rosacea (usually affects those over 30 years but can affect younger individuals)
Conditions to be considered relating to this scenario
acne vulgaris, rosacea, polycystic ovarian syndrome
Less common but 'important not to miss'
systemic lupus erythematosus (SLE)
cutaneous lupus (subacute cutaneous lupus, discoid lupus)