16-Year-Old Female with Severe Acne Beginning Isotretinoin Therapy
Introduction
Severe acne can deeply affect a teenager’s confidence and quality of life, particularly when resistant to traditional topical and oral therapies. At Reena Jogi MD Dermatology in Katy and Houston, Texas, we specialize in advanced acne treatments, including isotretinoin (Accutane) for patients with scarring, cystic, or treatment-resistant acne.
This case report highlights a 16-year-old female starting isotretinoin therapy following persistent, inflammatory acne despite prior topical management.
Patient Case
A 16-year-old female returned for follow-up evaluation after initial management of acne with tretinoin 0.025% cream nightly and clindamycin 1% lotion daily. The patient followed her prescribed regimen but continued to experience comedonal and inflammatory papules and pustules across her face.
Given the persistence and risk for scarring, isotretinoin (Accutane) was discussed in detail as the next step.
Examination
Findings: Multiple comedonal and inflammatory papules and pustules distributed over the cheeks, forehead, and chin.
Severity: Moderate-to-severe acne with early scarring.
Other systems: Normal physical exam; patient was alert, oriented, and in no distress.
Diagnosis
Severe Acne Vulgaris (L70.0)
High-Risk Medication Monitoring (Z79.899)
Treatment Plan
After extensive counseling regarding risks, benefits, and monitoring, the patient elected to begin isotretinoin (Accutane) therapy.
Isotretinoin Regimen
Medication: Isotretinoin 40 mg capsule, taken orally once daily.
Dosage Plan: 1 mg/kg until a cumulative dose of 120–150 mg/kg is reached.
Duration: Approximately 6–8 months.
Monitoring: Monthly clinic visits, urine pregnancy tests, and bloodwork to assess liver function and lipid levels.
Contraceptive Measures
Because isotretinoin is highly teratogenic, the patient was counseled on the iPledge program requirements and will use two forms of birth control:
Primary: Oral contraceptive pill.
Secondary: Male latex condom.
Counseling and Education
The patient and guardian received detailed instructions regarding isotretinoin safety:
Do not become pregnant, donate blood, or share medication.
Report any signs of depression, severe headaches, vision changes, or abdominal pain immediately.
Avoid waxing, laser treatments, or elective cosmetic procedures during and for 6 months after therapy.
Use gentle cleansers, non-comedogenic moisturizers, and SPF 30+ sunscreen daily.
Common and expected side effects include:
Dry lips and skin
Photosensitivity
Mild joint aches
Temporary hair shedding
Rare but serious risks were also discussed, including elevated liver enzymes, high triglycerides, pseudotumor cerebri, and mood changes.
A urine pregnancy test performed in the clinic was negative. The patient will log into iPledge and complete required monthly documentation.
Follow-Up
The patient will follow up in 1 month for evaluation and to confirm readiness for her next isotretinoin prescription. Improvement is typically noted after 2–3 months, with 60–80% clearance expected by the end of treatment.
Discussion
This case illustrates the importance of timely escalation to isotretinoin in adolescent patients with severe, scarring acne who have not responded to topical therapy. Early intervention helps prevent permanent scarring and restores confidence during formative teenage years.
At Reena Jogi MD Dermatology, our team carefully monitors each isotretinoin patient through the iPledge program to ensure safety, compliance, and optimal results.
