Acne Psychology and Approach to Patient
Acne affects patients at a most vulnerable time of their life. They are unhappy or depressed about their appearance. Enduring comments and ridicule is miserable. Young patients may be seen alone or with their parents. They are embarrassed and even have trouble explaining why they are at the doctors. The response to the doctors initial inquiry of what can I do for you is often simply my skin.
Ask about present and past medications. Determine the degree of irritation from previous topical treatment. Inquiring about many details tells the patient that this is an important and complicated problem. It also conveys the message that you are willing to spend the time to ensure that it will be managed properly.
Design a treatment plan. Explain that compliance is very important but sometimes difficult because the response may not be as rapid as desired. Medications give gratifying results in most cases if treatment is uninterrupted. Remove large comedones with a comedone extractor. This immediately improves the appearance.
Scarring is a major concern. Patient who demonstrate the ability to scar must be treated aggressively. Those who fail a program of oral antibiotics and topical medication should be considered for treatment with isotretinoin. Delaying reliably effect treatment can be tragic.
Many patients do not seek help until significant scarring has occurred. Patients are very concerned about the appearance and may inquire about procedures to correct scars. Explain that scars undergo a long process of healing. Redness will fade or disappear but this may take at least a year to occur. All scars atrophy and improve with time. Patients who are unhappy with their appearance after a healing period of over a year may be referred to plastic or dermatologic surgeons.
Schedule follow up visits. Young people are very concerned and desperate to look better. They are reassured when you demonstrate that you are committed to follow them. Acne cysts can improve or resolve in 24 to 48 hours after an intralesional injection of triamcinolone 2.5-5 mg/cc. Allow patients to call on an emergency basis for injections. The procedure just takes a moment and is very effective. Patients are gratified to know that a very unsightly lesion can disappear quickly. They are grateful that you care enough to allow immediate access to your care.