[doctor] kayla ward , date of birth , 4/28/07 . mrn 3-8-4-9-2-0 . she's here for a new visit with her mother for acne located on the face , which started about two years ago and is present most every day . she has been using persa-gel and washing regularly , which is somewhat helpful . there are no associated symptoms including itching , bleeding , or pain . no additional past medical history . she lives with her parents and sister . they have a dog , bird , and bunnies . she is in 7th grade . she plays basketball and volleyball and tap . she wears sunscreen in the summer , spf 30 . no additional family history . hi kayla , i'm dr. juan price . i hear you are starting to get some acne on the face . how about the chest and back ?
[patient] it's not too bad .
[doctor] so , it's not bad on the chest or back . you've used some over the counter items like washes and persa-gel ?
[patient] yeah .
[doctor] do those seem to be helping ?
[patient] yes , i think so , a little bit .
[doctor] good . what's your skin care routine like now ?
[patient] do you wan na know , like , the things i currently use ?
[doctor] yes . what do you do for your acne in the morning ? and then what do you do at nighttime ?
[patient] i wash my face , more like i wipe it down in the morning . then at night i use an elf facial cleanser called the super clarity cleanser . i finish with a toner and then the persa-gel .
[doctor] when you say , " wipe your face in the morning , " do you use a product or just water ?
[patient] mm , just water and a washcloth , really . if i feel really greasy , sometimes i'll use the elf cleanser in the morning , too .
[doctor] okay . and is today a good day , bad day , or an average day for you ?
[patient] mm , i would say it's probably a good day for me , of course , since i'm here , right ?
[doctor] acne is always good when you come to see the doctor . do you find that your acne flares with your periods ?
[patient] no , not really .
[doctor] and do you get a regular period ?
[patient] yup .
[doctor] how long have you been getting a regular period ?
[patient] mm , i think about two years .
[doctor] okay .
[patient_guest] the biggest flare , probably , was when she started school sports in the fall , just with all the sweating .
[doctor] yup , that will do it . is there anything else that you've noticed , mrs. ward ?
[patient_guest] no . kayla really has been doing a good job with the facial care regimen . it just does n't seem to help as much as we wanted .
[doctor] got it . okay . well , let's take a look then . full exam is performed today , except for under the underwear and under the bra . multiple benign nevi on the trunk and extremities . scattered skin colored papules . open and closed comedones . and erythmateous papules on the face , primarily on the forehead and with also some on the central cheeks and chin . the chest and back are relatively spared . and the remainder of the examination is normal . so , what i'm seeing from your exam today is mild to moderate acne , mostly comodonal with small inflammatory component .
[patient] okay , so is there anything we can do to help it ?
[doctor] yes . i would like to start with a topical therapy first . every morning , you will wash your face with a mild cleanser then use a moisturizer labeled , " noncomedogenic , " with sunscreen spf 30 or higher . this means it wo n't clog your pores . now , in the evening , wash your face with the same cleanser and allow it to dry . apply adapalene , 0.1 % cream , in a thin layer to the areas you generally get acne . i want you to start off using this a few nights a week and slowly work up to using it every night . if it is ... excuse me , if it is very expensive or not covered by insurance , you can try different gel over the counter . you can follow that with clean and clear persa-gel in a thin layer , or where you generally get acne . and then a noncomedogenic moisturizer . you're atopic retinoid will cause some sensitivity , so you will need to wear sunscreen when you are outside . it may also cause some dryness or irritation .
[patient] okay , i can do that .
[doctor] you also have multiple benign moles on your arms , legs , back and abdomen . this means they all look normal with no worrisome features . we will see if you have any progress over the next six months and follow up at that time .
[patient] okay , that sounds good . thank you .
[doctor] do you have any questions for me ?
[patient] no , i do n't think so .
[doctor] okay . if you have questions or concerns before your next visit , please call the office .
[patient] thank you , doctor , we will .

Medical orders:
description: topical adapalene 0.1 % cream start off using this a few nights a week and slowly work up to using it every night
order_type: medication
reason: acne located on the face