A 16-year-old boy has severe nodulocystic acne on the trunk and face with multiple hypertrophic scars. He has been on oral doxycycline and topical tretinoin for 4 months with minimal improvement. What is the most appropriate next step in management?

• A Add topical clindamycin to the existing regimen
• B Intralesional triamcinolone injection alone
• C Switch to oral azithromycin
• D Initiate oral isotretinoin (0.5–1 mg/kg/day) ✓

Explanation

Oral isotretinoin is the only drug that targets all four pathogenic factors in acne (sebum production, follicular hyperkeratinisation, Cutibacterium acnes, and inflammation) and is the treatment of choice for severe nodulocystic acne unresponsive to antibiotics. The standard dose is 0.5–1 mg/kg/day with a cumulative target dose of 120–150 mg/kg. Adding topical antibiotics provides marginal benefit in severe disease and risks resistance; azithromycin is not first-line.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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