Question

A female patient presented with acne that is not resolving on oral isotretinoin and antibioticstherapy. Which of the following is the next best investigation?

• A. Look for dietary triggers
• B. Evaluate for hyperandrogenism
• C. Check for antibiotic resistance
• D. Look for drug triggers

Answer 1

The Correct Option is B

In the case presented, a female patient is experiencing acne that has not resolved with oral isotretinoin and antibiotic therapy. When standard treatments fail to manage acne, it is important to consider underlying causes that may contribute to its persistence, particularly in females. One potential cause is hyperandrogenism, a condition characterized by excessive levels of androgens (male hormones) in females, which can lead to acne, among other symptoms.

Given the failure of conventional treatments, the next best investigation is to evaluate for hyperandrogenism. This condition can manifest as persistent acne, especially when it resists standard treatment regimens. Evaluating for hyperandrogenism typically involves assessing clinical signs of androgen excess and laboratory testing for elevated androgen levels.

Here's a concise rationale:

1. Resistance to Standard Treatments: Since both oral isotretinoin and antibiotics have been ineffective, it suggests an underlying issue not addressed by these medications.
2. Potential Underlying Cause: Hyperandrogenism is a common cause of treatment-resistant acne in women.
3. Evaluation Process: This involves clinical assessment and laboratory tests to measure androgen levels such as testosterone, as well as other related hormones.

Therefore, the correct next step is Evaluate for hyperandrogenism.