15-Year-Old Male with Persistent Acne Undergoing Combination Therapy
At Reena Jogi MD, Village Dermatology in Katy and Houston, Texas, we frequently manage acne in teenagers who experience ongoing breakouts despite standard topical regimens. This case highlights a 15-year-old male returning for follow-up evaluation after beginning a structured acne regimen earlier this year.
Patient Background
The patient was initially evaluated on July 25, 2024, and started on a comprehensive acne regimen:
Morning Routine
Cleanse with preferred cleanser
Apply Benzaclin (clindamycin + benzoyl peroxide)
Apply moisturizer with SPF 30+
Evening Routine
Cleanse
Apply adapalene (per gradual onset instructions)
Apply moisturizing cream
He was also prescribed:
Adapalene 0.3% gel nightly
Clindamycin/Benzoyl Peroxide 5% gel for morning use
Doxycycline 100 mg twice daily, avoiding lying down for 1 hour after ingestion
The patient now presents for follow-up due to ongoing breakouts on the face and chest.
Clinical Examination
A thorough examination was performed, including:
Face
Neck
Chest
Back
Abdomen
Upper extremities
The patient declined a full-body skin exam.
Findings included:
Inflammatory papules and pustules
Comedonal papules
Breakouts on the face and chest
He appeared well-nourished, alert, and in no distress.
Assessment and Plan
1. Acne Vulgaris (L70.0)
The patient continues to experience active acne on the face and chest despite consistent use of adapalene and spot benzoyl peroxide. He previously declined restarting isotretinoin due to side effects experienced during past treatment.
Treatment Options Discussed
We reviewed:
Restarting isotretinoin — declined by patient
Continuing topical retinoids and benzoyl peroxide
Oral antibiotics
AviClear laser therapy
Accure radiofrequency device
Photodynamic therapy with or without Ameluz
Red-light LED therapy
We provided counseling on:
Expected outcomes
Cost considerations
Likelihood of partial or temporary improvement with device-based care
Final Treatment Plan
After discussion, the patient elected to proceed with red-light therapy and chemical peels, in addition to topical and oral medications.
Medication Plan
Oral Antibiotics
Restart doxycycline 100 mg twice daily for 2 months
Then decrease to doxycycline 20 mg twice daily for maintenance
Topical Treatments
Cabtreo gel (clindamycin 1%, adapalene 0.15%, benzoyl peroxide 3.1%) nightly to the face
Tretinoin 0.025% cream to chest and back nightly
Moisturizer on top as needed
The patient and his mother both expressed full understanding of the treatment plan.
Counseling Provided
Skin Care Guidance:
Use non-comedogenic cleansers, moisturizers, and sunscreen
Expect 2–3 months for noticeable improvement
Contact the office if acne worsens, new cysts or scars appear, or allergies develop
Doxycycline Counseling:
Risk of photosensitivity → must wear SPF
Take with full glass of water
Avoid lying down for 30 minutes
Avoid dairy at the time of ingestion
Severe side effects (hearing changes, easy bruising, severe headaches) should prompt an urgent call
Isotretinoin Counseling (for future consideration):
Reviewed risks including dryness, joint aches, liver enzyme elevation, triglycerides, depression, and pseudotumor cerebri
Patient declines isotretinoin at this time
Follow-Up
The patient will follow up in one year, unless breakouts worsen or side effects occur sooner.
Discussion
Teen acne is influenced by hormones, genetics, lifestyle, and environmental triggers. This case illustrates the need for a multifaceted approach—including oral therapy, topical retinoids, and adjunctive cosmetic treatments such as red-light therapy and chemical peels.
At Reena Jogi MD, Village Dermatology in Katy and Houston, Texas, we provide personalized acne plans that blend medical and cosmetic dermatology to achieve clearer and healthier skin for teens and young adults.
