A 22-Year-Old Woman Is Evaluated in the Office Due to Progressive

A 22-year-old woman is evaluated in the office due to progressive acne on her face, chest and back. Her acne has worsened over last month. The patient was recently diagnosed with iron deficiency anemia due to abnormal uterine bleeding and began taking a combined oral contraceptive and an iron supplement. She has been training for a half-marathon for the past 4 months and has lost 6.8 kg (15 lb) during this period.  She does not use tobacco, alcohol, or illicit drugs. Vital signs are within normal limits.  Physical examination shows acneiform eruptions on the shoulders and mid-back.  Which of the following is most likely contributing to worsening of this patient's acne?

A) Exposure to colder temperatures
B) Exposure to contaminated water
C) Rapid loss of body weight
D) Use of hormonal contraceptive
E) Use of tight-fitting sports clothing

Correct Answer:

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