Pediatric case study: A 13-year-old girl complains about “zits’ on her face and shoulders. She has tried over-the-counter benzoyl peroxide for 2 months to no avail, and has stopped eating chocolate and French fries on her mother’s advice. She states that she tries to wash her face three times a day with soap.

Pediatric case study: A 13-year-old girl complains about “zits’ on her face and shoulders. She has tried over-the-counter benzoyl peroxide for 2 months to no avail, and has stopped eating chocolate and French fries on her mother’s advice. She states that she tries to wash her face three times a day with soap.

Pediatric case study: A 13-year-old girl complains about “zits’ on her face and shoulders. She has tried over-the-counter benzoyl peroxide for 2 months to no avail, and has stopped eating chocolate and French fries on her mother’s advice. She states that she tries to wash her face three times a day with soap.

Pediatric Case Study
Acne is one of the skin conditions that largely affect adolescents. Patients with acne have skin inflammation, scarring, and irritation, which can affect the patient’s psychological health. The risk of mental health problems such as depression and suicide among adolescents affected by acne vulgaris is high due to its impact on their self-esteem and identity. Nurses and other healthcare providers should provide treatments and psychological support to the affected populations for optimum care outcomes. Therefore, this paper examines a case study of a 13-year-old diagnosed with acne vulgaris. The paper focuses on the differential diagnoses that can be considered for the patient, primary diagnosis and its pathophysiology, health maintenance issues, management, health education, follow-up, and reflection.


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Additional Testing
The patient has acne vulgaris. Acne vulgaris diagnosis is largely done through physical examination instead of laboratory tests. Laboratory investigations or radiological tests are indicated if the healthcare provider suspects underlying pathologies such as hyperandrogenism. Patients with suspected acne vulgaris do not require a skin biopsy to confirm the diagnosis. However, it might be essential to perform laboratory tests for luteinizing hormone, testosterone, dehydroepiandrosterone, and follicle-stimulating hormone in patients with a history of hirsutism or dysmenorrhea. Patients might also require imaging and laboratory tests if they report a sudden onset of recalcitrant acne. The tests will help rule out hyperandrogenism caused by either an adrenal or ovarian tumor. A complete blood count, erythrocyte sedimentation rate, liver function tests, and C-reactive protein tests must be performed in patients diagnosed with acne fulminans. Pregnancy tests, serum triglycerides, and cholesterol levels should be checked for any female considering radiographs (Sutaria et al., 2024). This is important when patients present to the hospital with symptoms suggestive of bone or joint involvement.
Primary Diagnosis
Acne vulgaris is the patient’s primary diagnosis. Acne vulgaris is a common skin disorder among young adults and adolescents. Its prevalence rate among adolescents ranges between 35% and 90%. Acne is more common in adolescent males than females. Acne typically affects the neck, face, chest, upper arm, or upper back areas. These body areas have abundant sebaceous glands. The presenting symptoms include polymorphic lesions classified from grade 1 to 4. In grade 1, patients have either open or closed comedones. The comedones are smooth and dome-shaped with varying appearances. In grade 2, patients have erythematous inflammatory lesions. Pustules are seen in grade 3 polymorphic lesions while pustules coalesce to form nodulocystic acne in grade 4 (Sutaria et al., 2024; Vasam et al., 2023). The patient in the case study presented with complaints of zits on her face and shoulders. She also reports blackheads and deep, painful lesions. The assessment revealed keratotic papules and open and closed comedones with mild redness across her forehead, lower cheeks, shoulders, chin, and back. The findings confirm a diagnosis of acne vulgaris.
Pathophysiology of primary diagnosis
Several factors have been proposed to contribute to the development of acne vulgaris. One of them is an increase in sebum production. Androgen hormones such as insulin growth hormone stimulate increased sebum production in the body. Increased sebum production worsens the acne vulgaris symptoms. The other mechanism attributed to acne vulgaris is hyperkeratinization abnormalities affecting the pilosebaceous follicles. Patients with acne have hyper-proliferated keratinocytes. The keratinocytes do not shed into the lumen as seen in normal skin, which causes the accumulation of pilosebaceous follicles and lipids (Vasam et al., 2023). The accumulation forms the basis of acne vulgaris development.
Hyperproliferation of propionibacterium acnes has also been associated with acne vulgaris. Propionibacterium acnes is a bacteria that is involved in inflammatory acne. Sebaceous follicle colonization with propionibacterium acnes stimulates inflammatory processes associated with acne vulgaris. The bacteria also facilitates lipase enzyme secretion, which metabolizes sebum triglycerides into glycerol, hence, skin inflammation and comedones formation. Acne vulgaris also develops from the immune system’s response to Propionibacterium acnes. The immune system stimulates the production of neutrophils, lymphocytes, and macrophages, which worsen acne vulgaris symptoms and cause follicular rupture, damage, and lipids release to the dermis (Vasam et al., 2023). Consequently, inflammatory lesions, ulcerations, and acne inflammation will develop.
Genetics also play a role in acne vulgaris development. Evidence shows that individuals with a family history of acne are highly likely to develop the condition. The risk of acne vulgaris is as high as three times greater among individuals with first-degree family individuals compared to those without genetic predisposition. Genetic processes such as the upregulation of inflammatory cytokines, antimicrobial peptides, and matrix metalloproteinases 1 and 3 also stimulate acne vulgaris. In addition, individuals with elevated bata-defensin 2 immunoreactivity are highly predisposed to acne vulgaris. Exposure to environmental stressors and epigenetic modification also cause acne vulgaris through DNA methylation. The exposure causes gene expression and epigenetic modification of the autoimmune and inflammatory processes. DNA methylation worsens the progression of skin diseases such as acne vulgaris and atopic dermatitis (Sutaria et al., 2024; Vasam et al., 2023). Cumulatively, these processes contribute to acne vulgaris development and progression among the affected populations.
Therapeutic Plan
Pharmacological Treatment
Pharmacological treatment of acne vulgaris aims at controlling abnormal hyperkeratinization, sebum secretion, and propionibacterium infection. The main treatments include the use of antibacterial and anti-inflammatory medications. The medications are administered orally, topically, systemically, or physically through cryotherapy, optical therapy, cyroslush therapy, or comedone extraction therapy. Topical treatments are largely used for acne vulgaris because of their minimal systemic absorption and increased pilosebaceous follicular unit exposure rate. Topical medicines include retinoids such as tretinoin tazarotene, and adapalene. These medications reduce sebum production, comedone growth, and epithelial damage, and treat scarring and hyperpigmentation. They also reduced acne lesion creation and the proliferation of the existing comedones (Shi et al., 2020). Topical antibiotics, including clindamycin and erythromycin, are also recommended to diminish inflammatory lesions and act against P. acnes.
Combined topical treatments can also be prescribed for acne vulgaris. Combined therapy is highly effective compared to monotherapy. Some of the combined therapy drugs for acne include benzoyl peroxide, salicylic acid, niacinamide, dapsone, and azelaic acid. Patients who do not respond to topical treatments of revealed skin lesions with scars should be started on systemic treatment. Systemic therapies that can be considered include hormonal medicines, isotretinoin, and oral antibiotics (Habeshian & Cohen, 2020; Leung et al., 2021). Systemic treatments prevent psychological embarrassment and social humiliation due to skin changes.
Non-Pharmacological Management
Non-pharmacological interventions are also used in acne vulgaries. One of the interventions is dietary control. Dietary factors such as milk and dairy products, the glycemic value of the diet, chocolate, and the amount of dietary fiber affect acne vulgaris. Dietary products such as milk chocolate consumption are associated with increased acne lesions compared to dark chocolate. Diets with high glycemic indexes elevate acne proliferation (Shi et al., 2020). Therefore, patients should be educated on the importance of limiting the intake of these diets.
The other non-pharmacological intervention is counseling. Counseling is important for increased knowledge about acne vulgaris and the minimization of the mental health effects of the condition. Dermocosmetics can also be considered as part of non-pharmacological interventions for acne. Some of the dermo-cosmetic preparations that can be used for acne include moisturizers, cleansers, sunblock agents, camouflaging preparations, antioxidants, and sebum-controlling agents. Comedone extraction can be considered for treatment-resistant comedones (Bungau et al., 2022). Additional interventions that might prescribed for patients with acne vulgaris include cryotherapy, platelet-rich plasma therapy, lasers, and light therapy.
Health Maintenance Issues
Acne vulgaris treatment does not produce immediate results. As a result, healthcare providers should offer patients comprehensive counseling to increase their knowledge about the management process and expectations. The education should equip patients with competencies in proper skincare practices and develop realistic expectations related to their treatment. Patients should be aware that long-term therapy might be needed to achieve the desired treatment outcomes. This includes the use of a topical retinoid to suppress sebum production. As a result, the importance of treatment adherence should be emphasized (Huang et al., 2023). Patients should be advised against changing skin care products frequently since it will increase the risk of adverse outcomes in acne management.
Acne patients should also embrace routines that will prevent the recurrence of acne vulgaris. This includes the need for a consistent skincare routine such as using a mild cleanser on the affected skin areas. Moisturization of the affected skin areas might be needed to prevent skin dryness, which would exacerbate acne. The initial analysis revealed that some dietary practices predispose patients to acne vulgaris. Effective acne management would require patients to change their dietary practices. This includes reducing the intake of milk and dairy products, staying hydrated, and eating a balanced diet. The importance of regular follow-up should be emphasized (Vasam et al., 2023). This will enable timely diagnosis of other skin problems and the need for treatment plan change.
Patient Education
Patient education on acne vulgaris should be offered. I will educate the patient about treatment expectations. I will inform her that acne vulgaris treatment might take a long time for effective symptom control. I will educate her that lesion improvement might be delayed since the treatment aim is to prevent new lesion formation and resolve the existing ones. As a result, she will wait at least 2-3 months for treatment effectiveness to be determined. I will also educate her about the potential of long-term treatment. Acne treatment suppresses sebum production, and infections, and does not cure the problem (Sutaria et al., 2024). The patient might be required to be placed on long-term maintenance treatment. Educating her on these areas will help the patient develop realistic expectations about her treatment.
I will also educate her on the importance of treatment adherence. Acne vulgaris treatment is a long-term process. I will educate her on the importance of treatment adherence for recurrence prevention. I will emphasize the use of gentle skin cleansers. I will discourage her from using harsh scrubs or soaps that can cause skin irritation, dryness, and exacerbation of acne. I will also discourage skin picking. This is because it leads to acne lesions and scarring. Health education will also focus on the importance of using non-comedogenic products. This includes fluids and gels that will not block skin pores. I will emphasize the need for avoiding overconsumption of milk and high glycemic diets to prevent and minimize acne vulgaris. Some medications, including isotretinoin, are teratogenic (Shi et al., 2020). I will stress the importance of not getting pregnant when using isotretinoin to prevent adverse outcomes. I will also advise her not donate blood when taking the drug.
Follow Up
The patient’s follow-up should be scheduled after two weeks to assess her treatment response. This duration will also help rule out any side or adverse effects the patient has developed following her treatment initiation.
Use of Test Results
Elevated white blood cell levels in the complete blood count test will mean that the patient has an infection. As a result, it would be appropriate to prescribe topic antibiotics for her. Imaging tests such as a CT scan would be indicated for the patient should she report a sudden onset of severe, recalcitrant acne. The imaging would reveal if the patient has either an adrenal or ovarian tumor. Elevated liver function tests, erythrocyte sedimentation rate, and C-reactive protein results would indicate the patient has systemic involvement in acne vulgaris (Sutaria et al., 2024; Vasam et al., 2023). A positive pregnancy test will rule out treatments such as the use of isotretinoin in treating acne vulgaris.
Reflection on Personal Learning
The patient’s encounter has increased my understanding of acne vulgaris. The experience exposed me to the different pathophysiologic processes that lead to the development of acne vulgaris. It also broadened my understanding of the different treatments that can be used to treat the condition. The assignment also developed my scholarly skills. I was able to research and analyze data from different sources and use it to develop a better understanding of the case. I believe that the knowledge gained from the case study will inform my practice. I will use it to assess, plan, implement, monitor, and evaluate treatment outcomes for patients with acne vulgaris. I will also use the knowledge to provide patient-centered health education to patients and empower them to be involved in managing their conditions.

Bungau, S. G., Tit, D. M., Vesa, C. M., Abid, A., Szilagyi, D.-V., Radu, A.-F., Bungau, A. F., Tarce, A. G., Behl, T., Stoicescu, M., Brisc, C. M., Gitea, D., Nechifor, A. C., & Endres, L. (2022). Non-conventional therapeutical approaches to acne vulgaris related to its association with metabolic disorders. European Journal of Pharmacology, 923, 174936.
Habeshian, K. A., & Cohen, B. A. (2020). Current Issues in the Treatment of Acne Vulgaris. Pediatrics, 145(Supplement_2), S225–S230.
Huang, C.-Y., Chang, I.-J., Bolick, N., Hsu, W.-T., Su, C.-H., Hsieh, T.-S., Huang, I.-H., & Lee, C.-C. (2023). Comparative Efficacy of Pharmacological Treatments for Acne Vulgaris: A Network Meta-Analysis of 221 Randomized Controlled Trials. The Annals of Family Medicine, 21(4), 358–369.
Leung, A. K., Barankin, B., Lam, J. M., Leong, K. F., & Hon, K. L. (2021). Dermatology: How to manage acne vulgaris. Drugs in Context, 10, 2021-8–6.
Shi, Q., Tan, L., Chen, Z., Ge, L., Zhang, X., Yang, F., Liu, C., & Zhang, J. (2020). Comparative Efficacy of Pharmacological and Nonpharmacological Interventions for Acne Vulgaris: A Network Meta-Analysis. Frontiers in Pharmacology, 11.
Sutaria, A. H., Masood, S., Saleh, H. M., & Schlessinger, J. (2024). Acne Vulgaris. In StatPearls. StatPearls Publishing.
Vasam, M., Korutla, S., & Bohara, R. A. (2023). Acne vulgaris: A review of the pathophysiology, treatment, and recent nanotechnology based advances. Biochemistry and Biophysics Reports, 36, 101578.



CC/HOPI: A 13-year-old girl complains about “zits’ on her face and shoulders. She has tried over-the-counter benzoyl peroxide for 2 months to no avail, and has stopped eating chocolate and French fries on her mother’s advice. She states that she tries to wash her face three times a day with soap. She has been invited to an upcoming school dance and wants to look her best. She complains about blackheads, but also lesions that are deep and painful.

PMH: non-contributory. No surgical history.

Allergies: None known.

Medications: OTC Benzoyl Peroxide

Immunization status: Up-to-date; has not received Gardasil.

SH: Lives with both parents; denies smoking, drinking or recreational drugs; denies being sexually active.

FH: No known contributory history.


General – No complaints other than skin today.

HEENT – Denies hearing or vision problems; denies nasal drainage or congestion; denies sore throat.

Lungs – Denies shortness of breath; no cough reported

Skin – States that acne seems to worsening over the past 6 months, in spite of OTC management,


VS Wt. 98lbs Ht. 5’1” T 98.6 P 108 R 14

General – 13-year-old female who appears pleasant, in no apparent distress, well developed, well-nourished and with good attention to hygiene and body habitus. Looks older than stated age


• Head: normocephalic

• Eyes: PERRLA.

• Ears: left and right canals without redness or swelling.

• Nose: no drainage noted

• Throat: tonsils +1 bilaterally with no erythema or exudate.

Neck – negative anterior and posterior cervical and occipital lymph nodes.

Cardiac – RRR, normal S1/S2; no murmurs appreciated.

Respiratory – CTAB

Skin – Examination of scalp shows no abnormalities. Hair growth and distribution is normal. Inspection of skin outside of affected area reveals no abnormalities. Palpation of skin shows no abnormalities. Keratotic papules, open and closed comedonesnoted across forehead, lower cheeks, chin, shoulders and back, with mild redness over all.

DIAGNOSIS: Acne vulgaris

The differential diagnosis for acne includes:

?Adenoma sebaceum


?Eosinophilic folliculitis

?Erythema toxicum neonatorum

?Keratosis pilaris



?Pityrosporum folliculitis


?Sebaceous hyperplasia

No chart necessary. I will add differential rule out chart

sources can include, epocrates, lexicomp, the textbook, etc.

The textbook information:

Primary care pediatrics for the nurse practitioner : a practical approach / [edited by] Theresa Kyle.

Description: New York, NY : Springer Publishing Company, LLC, 2021. | Includes bibliographical references and index.

Identifiers: LCCN 2021012452 | ISBN 9780826140944 (paperback) | ISBN 9780826140951 (ebook)

Case study grading rubric, template, and example paper attack

Pediatric Case Study

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