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DR1.1-2 | Acne — Assignment

Instructions

Read the case vignette below carefully. Then complete each section of the management plan using the scaffold provided. Your responses must be evidence-based and clearly reasoned — simply listing treatment names without justification will not achieve a pass. Imagine you are writing a patient record that a supervising consultant will review.

Case vignette:
Meenakshi, a 21-year-old female BSc Nursing student, presents to your clinic with a 2-year history of acne that has worsened over the last 4 months. She reports inflammatory papules and pustules predominantly on the lower face and jawline, with a few comedones on the nose. Lesions worsen in the week before her period. She has mild hirsutism (chin and upper lip). Her menstrual cycles are regular (28-day). She has tried over-the-counter clindamycin gel for 3 months with minimal improvement. There are no nodules, cysts, or scarring. She is not pregnant and is not on any medication. Her BMI is 23. She is concerned about scars.

Your task is to complete a structured management plan for Meenakshi.

Length: Total: 700–900 words (excluding references). Allocate approximately: Sections 1–2: 200 words; Section 3: 300 words; Section 4: 150 words; Section 5: 150 words. You may use bullet points in Sections 1–3.

What to Submit

Grading Rubric — Acne Management Plan Marking Rubric

Criterion	Points	Full-marks descriptor
Clinical Assessment and Grading (IGA grade justified with lesion types; hormonal features identified; appropriate investigation decision; two relevant differentials with distinguishing features)	30 pts	IGA grade correct and fully justified with specific lesion types and zones. All three hormonal features identified. Investigation decision is precise (correct tests, correct reasoning). Both differentials are clinically appropriate with accurate distinguishing features.
Pathogenesis Mapping (All four pillars named and correctly mapped to specific case features)	15 pts	All four pillars correctly named and each mapped to a specific, accurate feature from Meenakshi's case with mechanistic explanation.
Management Plan Quality (Correct step-therapy rung; regimen correctly specified; each agent justified by pathogenetic pillar; adjunctive hormonal therapy correctly described; contraindication identified)	30 pts	Correct step for grade 3 (oral antibiotic + topical retinoid ± BPO). Each agent linked to its pillar. Hormonal adjunct (spironolactone or COC) correctly described with mechanism and monitoring requirement. Contraindication identified correctly (e.g., isotretinoin without adequate pregnancy protection, or avoiding tetracyclines if pregnancy planned).
Patient Counselling (Accurate explanation of hormonal flare; realistic timeline stated; correct application advice given in patient-appropriate language)	15 pts	All three points addressed accurately. Language is genuinely patient-friendly (no unexplained jargon). Timeline is realistic (8–12 weeks). Application tip is specific and clinically correct (e.g., apply to dry skin at night).
Critical Reflection (Antibiotic resistance mechanism identified; modification to address resistance correctly described including addition of BPO)	10 pts	Correctly identifies C. acnes antibiotic resistance as likely reason for failure. Recommends adding BPO to any continuing antibiotic regimen and explains the mechanism (oxidative bactericidal, resistance-free). Reflects on time-limiting antibiotics.