Acne

A 15-years-old came to you asking for acne pills, previous GP prescribed her Benzoyl peroxide and
topical antibiotic.

Three points
1=Medicolegal:
Confidentiality, breaching confidentiality
2=Acne
3= OCP

Acne case may be the case of OCP

Study well OCP especially side effects and contraindications

Boyfriend age, relation to you like teacher, coach, relative, type of relationship
Premenstrual flare-u should be treated by OCP
A girl with no sexual activity asking for OCP, would you like to do pregnancy test?

1= trust your pt
2= OCP has not much effect but long acting contraception like injectable need to rule out pregnancy
3= need to do pregnancy test for this girl.

Mention at the last to do pregnancy test in OCP case,

I may do pregnancy test if I feel there is a hidden agenda, for a new pt or DR pt relationship not
established well.

Pt’s mother called you about OCP

Your answer = 1st start with, we may appreciate your concerns about your daughter, you know every
age group has their own problems, I would like to tell you that your daughter is in safe hands, I usually
advice my young pts to discuss your problems with your parents as they caring about you, I would like
to advice you don’t argue with her, support your daughter , you should both have a calm chat with each
other and this way you help your daughter and it will also more helpful to your daughter’s problems.
Then see her reaction,
If still insisting, then tell her in a polite way that this is a matter of confidentiality and this is our practice
policy not to breach confidentiality. This is highly recommended to have a conversation with each other.

Gillick competency: think about if she is competent or not, is she understand what is acne really means
or not? Double check with supervisor her competency and breach confidentiality (no need to check with
supervisor in NSW but must be involved in Victoria).

For PESCI:
after asking about Gillick competency and independence as she is doing part-time job. Then double
check with supervisor.
Hidden Agenda of pt
Acne prescription of pt: very important, severity of acne decided by the pt as how much impact acne has
on her social life.
In this case also talk about acne and OCP both together.
History:
Confidentiality
Build trust
Assess acne severity
Gillick competency
ICE,
Hidden agenda
SNAP
SADAMA TOI/ Headsss screening/ HPV & Hep-B vaccination
7Ps

Management:

Acne & OCP

Acne: JM
Educate & advice about general advice
All point about OCP, her perception, contraindications, side effects, missed pill,

Mention related to the case not everything related to the disease

I would like to use UKMEC (contraception medical eligibility criteria) to prescribe OCP.

Missed/delayed/late Pills: if panel ask you then tell otherwise skip it.
Late pill: <24 hours
Missed pill > 24 hours

Effect of enzyme inducing drugs= increase the OCP dose or use extra method
Use condoms to avoid STI as OCP not protecting against STI
Safe sex= have bath one hour before & after sex, avoid sex if have abrasions/discharge from private part
of both
Cost of medication: powerful OCP like anti-androgenic cyproterone against acne not covered by PBS,
choice depends on pt preference. Others are covered by PBS but not effective against ACNE. OCP are
only covered by PBS for contraception not for ACNE.
Don’t expect any positive response before 3-6 months