Acne vulgaris — RACGP Fellowship MCQ

Correct answer: C — Prescribe combination topical therapy together with an oral tetracycline and schedule a review of response

This 16-year-old has moderate-to-severe acne with multiple inflammatory lesions and early scarring affecting the face and upper back, unresponsive to topical monotherapy. RACGP guidance recommends escalation to combination therapy: non-antibiotic topical agents (such as benzoyl peroxide plus a topical retinoid or azelaic acid) combined with a systemic antibiotic (doxycycline is first-line tetracycline) with scheduled review of response. Option D is wrong because topical corticosteroids are contraindicated for acne and risk worsening the condition. Option B is dangerous: isotretinoin requires baseline and ongoing monitoring (including pregnancy testing in females, liver and lipid function), and is reserved for severe acne failing standard therapy or causing significant scarring—this patient has not yet been tried on combination therapy. Option E is incorrect because amoxicillin is ineffective for acne; tetracyclines are the standard systemic agents. Option A ignores the progressive nature of moderate-to-severe acne and the risk that early scarring may become permanent without timely treatment.

Reference: Royal Australian College of General Practitioners. Acne – best practice management. Australian Family Physician. 2010;39(9):657–665. https://www.racgp.org.au/afp/2010/september/acne-%E2%80%93-best-practice-management/