A 19-year-old woman presents to a family medicine clinic with persistent facial, chest, and back lesions that have caused scarring and significant distress. Despite 4 months of adapalene-benzoyl peroxide topical gel and a 12-week course of doxycycline PO, which she completed 1 month ago, she continues to develop new lesions. On examination, there are multiple inflammatory papules, pustules, and deep nodules on the face, chest, and upper back, with several pitted and pigmented scars. She has no past medical history, takes no other medications, and has no allergies. She is sexually active with a male partner, uses condoms inconsistently, and does not use other contraception. A urine pregnancy test today is negative.
| Heart rate | 72/min |
| Respiratory rate | 14/min |
| Temperature | 36.8 °C |
| Blood pressure | 112/70 mm Hg |
Question 1 of 15
Which one of the following is the most appropriate therapy at this time?
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