Table of Contents
Common Questions
Chat with CodyMD
Cody's Chat with Patient
Cody's AI Summary
Top 3 AI Diagnosis List
Review by Dr Albert DiPiero
Dr. DiPiero Video Guide to this Case Study
Resource Center
Testimonials
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Case Study
Meet your host
Albert DiPiero, MD MPH FACP
I am a co-founder and the Chief Medical Officer at CodyMD and your host for this edition of Cody Grand Rounds. I have been a practicing physician and faculty member at medical schools for over 26 years.
About The AI Doctor Case Study
CodyMD is a partnership between Human Doctors and AI Doctors. Cody is an AI Doctor who helps thousands of people every day. At each Cody Grand Rounds, I select a real case and review it with Cody, the AI Doctor.
Each case is based on a real patient but has been modified to maintain privacy and to emphasize certain teaching points.
Common Questions
What causes bad skin around the time of the period?
How can I manage hormonal acne effectively?
Is seborrheic dermatitis worsened by menstrual changes?
What are common symptoms of Polycystic Ovary Syndrome (PCOS)?
What skincare routine helps with oily and dry skin?
Are there any specific products recommended for acne around periods?
When should I see a doctor for skin issues around my period?
Chat with CodyMD
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Cody's Chat with Patient
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
So you want to focus on the bad skin you experience around the time of your period, is that correct?
Patient
Yes.
Cody, the AI Doctor
Ok, my goal is to provide you with an accurate assessment and plan. Let's talk about your concerns regarding bad skin around the time of your period. During the last visit, you discussed experiencing moderate mood swings rated 8 out of 10 in severity, along with feelings of depression, anger, and anxiety, particularly before your period, which started about 6 months ago. Can you describe the specific skin issues you experience around your period?
Patient
Yes, I get dry skin, then it becomes oily, and it breaks out with pimples.
Cody, the AI Doctor
When did you first start noticing bad skin around the time of your period?
Patient
It has been happening for about 2 years.
Cody, the AI Doctor
From our previous conversations, I know that you have been diagnosed with anxiety and depression. Apart from those, have you been diagnosed with any other medical conditions?
Patient
None.
Cody, the AI Doctor
It's good to know that you haven't been diagnosed with any other medical conditions. Being 22 means you are in a phase where hormonal fluctuations can significantly impact your skin. Can you specify the exact areas where you notice the bad skin around the time of your period?
Patient
Face, upper back, upper chest.
Cody, the AI Doctor
How would you describe the severity of your skin issues around your period?
Patient
Slowly getting a little worse.
Cody, the AI Doctor
Can you describe how your bad skin around the time of your period started?
Patient
It started gradually.
Cody, the AI Doctor
On a scale of 1 to 10, how severe would you rate your skin issues around the time of your period?
Patient
7.
Cody, the AI Doctor
A severity rating of 7 indicates that your skin issues are quite bothersome. Have you noticed any other symptoms that occur alongside your skin issues?
Patient
I always get mood swings and fatigue around the time of my period.
Cody, the AI Doctor
Have you noticed any specific skincare products or routines that either help or worsen your skin condition around your period?
Patient
I have not tried anything. My doctors do not seem worried about it and basically ignore it.
Cody's AI Summary
- 22 year old woman comes to the AI Doctor regarding bad skin around the time of your period.
- You experience dry skin that becomes oily and leads to breakouts with pimples.
- This issue has been occurring for about 2 years.
- You notice skin issues primarily on your face, upper back, and upper chest.
- Your skin issues seem to be gradually getting worse.
- You rate the severity of your skin issues as a 7 out of 10.
- You experience mood swings and fatigue around the time of your period.
- You have not tried any specific skincare products or routines to address your skin condition.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Hormonal Acne( 60 % probability)
A common skin condition characterized by breakouts related to hormonal fluctuations, often occurring around the menstrual cycle.
2. Seborrheic Dermatitis(20 % probability)
A skin condition that causes scaly patches, red skin, and stubborn dandruff, which can be exacerbated by hormonal changes.
3. Polycystic Ovary Syndrome (PCOS)(10 % probability)
A hormonal disorder causing enlarged ovaries with small cysts, often leading to acne, irregular periods, and other symptoms.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
Considering the history provided and the differential diagnosis list from Cody, the AI Doctor, here is my analysis:
1. Hormonal Acne (PCOS)(80% probability)
Given the temporal correlation with the menstrual cycle and the characteristics of the skin issues described, hormonal acne is highly likely. The gradual onset over two years and worsening severity are consistent with this diagnosis.
2. Seborrheic Dermatitis(10% probability)
While not impossible, seborrheic dermatitis typically presents with scaly, flaky skin rather than pimples. The patient's primary complaint of pimples makes this less likely.
3. Polycystic Ovary Syndrome (PCOS)(10% probability)
PCOS can cause acne; however, the absence of other key symptoms like irregular menstruation and hirsutism makes this less probable. Nonetheless, it cannot be entirely ruled out without further evaluation.
Next Steps for Evaluation
Skin Evaluation: Have a thorough skin exam by a doctor trained to recognize conditions such as acne. Hormonal acne is a clinical diagnosis based on an inspection of the skin.
Hormonal Evaluation: Consider a referral to an endocrinologist to rule out underlying hormonal imbalances that might be exacerbating the skin condition.
Psychological Support: Given the concurrent mood swings and fatigue, integrating psychological support or therapy could improve overall well-being and potentially positively impact the skin condition.
Potential Treatment Modalities
Topical Treatments: Initiating a proper skincare regimen with products containing salicylic acid or benzoyl peroxide or retinoids can help manage acne.
Oral Medications: Hormonal treatments such as combined oral contraceptives or anti-androgens if hormonal acne is diagnosed.
Therapeutic Sessions: Psychological counseling or cognitive-behavioral therapy.
Natural Treatments: Hormonal acne can be challenging, but several natural treatments may help manage and reduce symptoms. Although these are less well studied than the medication options, here are some options you might consider:
- Tea Tree Oil: Known for its anti-inflammatory and antimicrobial properties. Apply diluted tea tree oil to the affected areas with a cotton swab.
- Green Tea: Both drinking green tea and applying it topically can help due to its antioxidant and anti-inflammatory properties.
- Zinc Supplements: Oral zinc supplements can help reduce inflammation and bacterial growth associated with acne.
- Apple Cider Vinegar: This can help balance pH levels of the skin and has antibacterial properties. Apply diluted apple cider vinegar to your skin using a cotton ball.
- Aloe Vera: Has soothing, anti-inflammatory, and antibacterial properties. Apply pure aloe vera gel directly to the skin.
- Omega-3 Fatty Acids: Found in fish oil supplements, flaxseeds, and walnuts, omega-3s can help reduce inflammation in the skin.
- Spearmint Tea: Drinking two cups a day has been shown to reduce androgen levels, which can contribute to hormonal acne.
- Probiotics: These can help balance gut health, which is linked to overall skin health. Foods like yogurt, kefir, and fermented vegetables are good sources.
- Dietary Changes: Reduce intake of sugar, dairy, and high-glycemic foods, which can exacerbate hormonal acne.
- Manage Stress: High stress levels can increase cortisol, a hormone that can worsen acne. Practices like yoga, meditation, and deep-breathing exercises may help.
- Evening Primrose Oil: Provides gamma-linolenic acid (GLA), which can help balance hormones. Taken as a supplement, it may improve hormonal balance and reduce acne.
- Saw Palmetto: This herb can help lower levels of androgen hormones and may be particularly useful for women with excess androgens.
- Turmeric: Known for its anti-inflammatory properties, turmeric can be consumed as a supplement or applied as a mask when mixed with honey.
- Exercise: Regular physical activity can help regulate hormones and reduce stress levels.
- Proper Skin Hygiene: Use gentle, natural skin care products and avoid over-washing your face, which can strip it of natural oils and exacerbate acne.
Conclusion
The leading diagnosis is hormonal acne, for which a structured treatment plan involving both skincare and possibly hormonal therapies should be initiated. Further diagnostic evaluations are warranted for comprehensive care.
Dr. DiPiero Video Guide to this Case Study
Resource Center
Testimonials
CodyMD is a very precise and accessible app. My consultation with CodyMD is commendable and I highly recommend it for others to try CodyMD especially for assessment and consultation purposes.
TrustPilot Review
Dr Cody spot on, better than most Human Drs. Also far more pleasant. Try him, he could better help you understand your issues. He will give you good info for your Drs visit as well.
TrustPilot Review
It gave me the best response possible and suggested simple self care treatment options which I'm in favor with. It has a to the point interface and brief answer for better understanding.
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