Write proper exam style discription of a patient with grade 3-4 acne for my dermatology practical exam
Reading File
Finding Sources
Searching PubMed
acne AND severity
Searching the Web
acne vulgaris severity grading grade 3 grade 4 clinical description
Reading File
Examination description: Grade III-IV acne vulgaris
On cutaneous examination, the patient has multiple polymorphic acne lesions involving the face, predominantly over the forehead, cheeks, chin, and jawline, with possible extension to the upper chest and upper back.
There are numerous open comedones (blackheads) and closed comedones (whiteheads), along with multiple erythematous inflammatory papules and pustules. In addition, there are several deep-seated, tender nodules/cysts, some of which may be fluctuant. The lesions are associated with post-inflammatory erythema and hyperpigmented macules. There may be pitted/atrophic scars, including ice-pick, boxcar, or rolling scars, indicating chronic inflammatory disease.
There is no evidence of sinus formation or systemic illness.
Provisional diagnosis:
Severe inflammatory acne vulgaris, Grade III-IV (papulopustular to nodulocystic acne), with post-acne scarring.
Severe inflammatory acne vulgaris, Grade III-IV (papulopustular to nodulocystic acne), with post-acne scarring.
Short viva-style grading
- Grade III acne: Predominantly inflammatory acne with numerous papules and pustules, with comedones; nodules may be occasional.
- Grade IV acne: Severe nodulocystic acne with numerous inflammatory lesions, deep nodules/cysts, and a high risk of scarring.
Use the grading system followed by your department, as acne grading is not fully uniform across all institutions. Clinically, lesions are described as non-inflammatory comedones and inflammatory papules, pustules, nodules, and cysts, with severity based on lesion number, extent, type, and scarring. Swanson's Family Medicine Review, acne section, pp. corresponding to lines 2441-2472.
Since it is going to be a spotter so i am not supposed to touch the patient can i still say nodules are present
Reading File
Finding Sources
Searching PubMed
acne AND clinical examination
Searching the Web
dermatology examination lesion terminology nodule palpation clinical definition acne
Yes, but phrase it as an inspection finding, not as a palpation-confirmed finding.
A nodule is technically a deep, solid, palpable lesion, so in a spotter you should avoid claiming features that require touch, such as tenderness, induration, fluctuation, consistency, or depth. However, if the lesion is visibly a large, deep-looking inflammatory raised lesion consistent with nodulocystic acne, you may say:
“Multiple inflammatory papules and pustules are present, along with a few clinically apparent nodular lesions over the cheeks/jawline. There is associated post-inflammatory hyperpigmentation and pitted scarring.”
Or, safest wording:
“There are large inflammatory lesions suggestive of nodules, with comedones, papules, pustules, and scarring.”
Do not say:
- “The nodules are tender.”
- “The nodules are firm/indurated.”
- “The cysts are fluctuant.”
- “Deep nodules are palpated.”
For the diagnosis, say:
“Severe inflammatory acne vulgaris, likely Grade III-IV, with clinically apparent nodular lesions and post-acne scarring.”
This is defensible because severe acne may visibly include nodules/pseudocysts, but the formal lesion definition of a nodule includes palpability. DermNet’s lesion terminology defines a nodule as a deep, solid palpable lesion, while its acne overview lists nodules and pseudocysts among severe-acne features.
This is a shared conversation. Sign in to Orris to start your own chat.