CASE INFORMATION

Case ID: ACNE-2025-05
Case Name: Sarah Williams
Age: 17
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: S96 (Acne)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages effectively with an adolescent patient to assess acne concerns 1.3 Explains acne pathophysiology and treatment options clearly 1.5 Uses shared decision-making to develop a management plan
2. Clinical Information Gathering and Interpretation	2.1 Conducts a thorough history to assess acne severity and triggers 2.3 Identifies risk factors for acne, including hormonal, medication-related, and lifestyle factors
3. Diagnosis, Decision-Making and Reasoning	3.1 Differentiates between different types of acne (mild, moderate, severe) 3.4 Recognises indications for escalation of treatment or specialist referral
4. Clinical Management and Therapeutic Reasoning	4.2 Provides evidence-based first-line management for acne 4.5 Discusses the risks and benefits of various acne treatments, including oral and topical options
5. Preventive and Population Health	5.1 Educates on skincare routines and lifestyle modifications 5.3 Discusses the impact of acne on mental health and body image
6. Professionalism	6.1 Provides a sensitive and empathetic approach, considering psychosocial impact
7. General Practice Systems and Regulatory Requirements	7.1 Documents clinical findings and management plan clearly 7.2 Prescribes medications in accordance with PBS guidelines
9. Managing Uncertainty	9.1 Addresses patient concerns about treatment efficacy and side effects
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises when acne may be a symptom of an underlying condition (e.g., PCOS)

CASE FEATURES

Adolescent female presenting with persistent, moderate acne affecting her face and upper back.
Acne is impacting self-esteem and social confidence.
History of irregular periods, raising the possibility of polycystic ovarian syndrome (PCOS).
Has tried over-the-counter treatments with little success.
Seeking effective treatment options, but concerned about side effects of medications.

INSTRUCTIONS

Review the following patient record summary and scenario.
Your examiner will ask you a series of questions based on this information.

You have 15 minutes to complete this case.

The time for each question will be managed by the examiner.
The time allocation for each question is roughly as follows:

Question 1 – 3 minutes
Question 2 – 3 minutes
Question 3 – 3 minutes
Question 4 – 3 minutes
Question 5 – 3 minutes

PATIENT RECORD SUMMARY

Patient Details

Name: Sarah Williams
Age: 17
Gender: Female
Gender Assigned at Birth: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

None currently

Past History

No history of significant medical conditions
Irregular menstrual cycles since menarche

Social History

Year 12 student, feeling self-conscious about her acne
Reports avoiding social events due to acne
Uses social media, comparing herself to peers

Family History

Mother had acne requiring oral antibiotics in adolescence

Smoking

Non-smoker

Alcohol

Occasional drinking on weekends

Vaccination and Preventative Activities

Up to date with HPV vaccination
No recent GP visits

SCENARIO

Sarah Williams, a 17-year-old high school student, presents with moderate acne affecting her face and upper back. She has been using over-the-counter cleansers and topical treatments, but her acne has not improved. She describes feeling self-conscious and withdrawn, often avoiding social situations.

She also mentions irregular periods, which have been present since menarche, raising the possibility of PCOS. She is concerned about scarring and wants to discuss effective treatments, but is worried about side effects of prescription medications.

On examination, Sarah has moderate inflammatory acne, with papules and pustules on her cheeks, chin, and upper back, along with mild post-inflammatory hyperpigmentation. No deep nodules or cystic lesions are present.

She is seeking guidance on treatment options, including whether she should consider oral therapy or hormonal treatments.

EXAMINATION FINDINGS

General Appearance: Well, no signs of systemic illness
Dermatological Exam:

Forehead, cheeks, and chin: Inflammatory papules and pustules, no cystic lesions
Upper back: Mild acne
Post-inflammatory hyperpigmentation but no significant scarring
No hirsutism or acanthosis nigricans (no overt signs of PCOS)

EXAMINER ONLY INFORMATION

QUESTIONS

Q1. What aspects of history and examination are critical in assessing this patient’s acne?

Prompt: What factors contribute to acne severity?
Prompt: How do you assess for underlying causes such as PCOS?

Q2. Based on the findings, what is your differential diagnosis, and what is your working diagnosis?

Prompt: How do you differentiate between acne subtypes?
Prompt: What features would raise concern for PCOS-related acne?

Q3. What treatment options would you consider for Sarah?

Prompt: What is the role of topical vs. oral treatments?
Prompt: When would hormonal therapy or isotretinoin be considered?

Q4. How would you counsel Sarah about acne management and expectations?

Prompt: How do you address concerns about side effects?
Prompt: What lifestyle modifications and skincare advice should be given?

Q5. What follow-up plan would you implement?

Prompt: When should she return for review?
Prompt: What are the next steps if initial treatment fails?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: What aspects of history and examination are critical in assessing this patient’s acne?

A structured approach is essential when evaluating acne to determine severity, potential underlying causes, and appropriate treatment options.

1. History

Onset and duration: When did the acne start? Has it worsened over time?
Lesion type and distribution: Presence of comedones, papules, pustules, nodules, or cysts, and affected areas (face, back, chest).
Previous treatments: Any over-the-counter or prescription treatments, response, and adherence.
Skin and hair care routine: Type of cleansers, moisturisers, makeup, or hair products used.
Hormonal influences: Irregular periods, hirsutism, weight gain (suggestive of PCOS).
Family history: Parental acne history and treatment response.
Lifestyle factors: Diet (high glycaemic foods, dairy), stress, and sleep patterns.
Medications: Use of steroids, oral contraceptives, lithium, or other acne-triggering drugs.
Psychosocial impact: Self-esteem issues, social withdrawal, anxiety, or depression.

2. Examination

Skin assessment: Presence of comedonal, inflammatory, or cystic acne, scarring, or post-inflammatory hyperpigmentation.
Hormonal signs: Look for hirsutism, acanthosis nigricans, or male-pattern hair loss, which may indicate PCOS.
General examination: BMI, signs of insulin resistance, or features of androgen excess.
Acne severity grading:
- Mild: Comedones, few inflammatory lesions.
- Moderate: Widespread papules, pustules, mild scarring.
- Severe: Nodules, cysts, extensive inflammation, scarring.

This assessment guides the choice of treatment, considering whether lifestyle changes, topical agents, systemic therapy, or referral is required.

SUMMARY OF A COMPETENT ANSWER

Elicits acne history thoroughly, including triggers, treatments, and psychosocial impact.
Assesses lesion type, severity, and distribution to guide treatment selection.
Considers hormonal and systemic causes, such as PCOS.
Identifies acne complications, including scarring and post-inflammatory hyperpigmentation.

PITFALLS

Failing to assess hormonal influences, potentially missing PCOS-related acne.
Not exploring previous treatments, leading to ineffective or redundant therapies.
Ignoring psychosocial impact, which can significantly affect mental health and quality of life.
Overlooking dietary and lifestyle factors, which may contribute to acne severity.

REFERENCES

MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

2. Clinical Information Gathering and Interpretation

2.1 Conducts a thorough history to assess acne severity and triggers.
2.3 Identifies risk factors for acne, including hormonal, medication-related, and lifestyle factors.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD