Examqo › Examqo library › Family medicine › Skin · IMLE
Acne and rosacea
Acne is treated in steps by lesion type and severity — a topical retinoid and benzoyl peroxide for all, oral antibiotics for moderate, and isotretinoin for severe or scarring acne; rosacea looks similar but has no comedones and is treated differently.
Why it matters in the exam
The exam presents an adolescent with mild acne and asks for the first treatment, a girl who has not improved after a month of benzoyl peroxide (too early to judge), and a patient starting isotretinoin with questions about contraception and tests. For rosacea it asks the topical treatment and what is forbidden.
Remember that a topical or oral antibiotic is always given with benzoyl peroxide to prevent resistance, and that oral antibiotics are limited to 3–4 months.
Acne strongly affects adolescents' self-image, so even "mild" acne deserves full treatment and an explanation of how long it takes to see improvement.
Questions on isotretinoin test pregnancy prevention, blood tests before and during treatment, and asking about the patient's mood. Acne appearing suddenly in an adult woman with hirsutism and irregular periods requires a hormonal work-up. It is also worth asking about drugs that worsen acne, such as steroids, lithium and progestogen products.
Key points
- Comedones — topical retinoid; mild inflammatory — benzoyl peroxide and retinoid.
- Moderate — oral doxycycline for up to 3–4 months with topical treatment.
- Severe or scarring — isotretinoin with strict pregnancy prevention.
- Judge the response after 8–12 weeks.
- Rosacea — no comedones; topical metronidazole or ivermectin, no steroids.
Summary table
| Condition | Finding | Treatment | Exam note |
|---|---|---|---|
| Mild comedonal acne | Blackheads and whiteheads | Topical retinoid (adapalene, tretinoin) | Improvement is seen after 8–12 weeks |
| Mild inflammatory acne | Few papules and pustules | Benzoyl peroxide and a topical retinoid, with topical clindamycin if needed | A topical antibiotic never alone |
| Moderate acne | Many papules, back lesions | Oral doxycycline with topical treatment | Limit to 3–4 months |
| Severe, nodular or scarring acne | Nodules, scars, treatment failure | Isotretinoin 0.5–1 mg/kg a day | Teratogenic: two contraceptive methods and monthly pregnancy tests; liver tests and lipids |
| Hormonal acne in a woman | Jaw and chin, premenstrual flare | Combined pill or spironolactone | Look for signs of androgen excess (PCOS) |
| Rosacea | Central facial redness, flushing, papules without comedones | Topical metronidazole, azelaic acid or ivermectin; low-dose doxycycline | Avoid topical steroids and flushing triggers |
A free exam question
( מהו סיבוך אפשרי של טיפול לאקנה Acne ? ) בתכשיר פומי מקבוצת הרטינואידים (the question as examined, in Hebrew)
- א. היפרגליקמיה בצום
- ב. פיברוזיס של הכבד
- ג. מחלה ציסטית של הכליה
- ד. פסאודו-טומור צרברי
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Family medicine, Medical licensing exam (IMLE), Dermatology and venereology, Pediatrics.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- American Academy of Dermatology, 2024 — Guidelines of care for the management of acne vulgaris
- National Rosacea Society Expert Committee, 2019 — Update on the management of rosacea
- Goroll AH, Mulley AG. Primary Care Medicine, 8th edition (2020) — Management of acne and rosacea
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.