32-Year-Old Female With Acne and Seborrheic Dermatitis Follow-Up
At Reena Jogi MD, Village Dermatology in Katy and Houston, Texas, we frequently evaluate patients experiencing both acne and scalp conditions such as seborrheic dermatitis. This case highlights a 32-year-old female, an established patient, who presented for acne management and a refill of her seborrheic dermatitis treatment.
Patient Background
The patient has experienced moderate facial acne for the past seven months, consisting of:
Pimples
Inflammatory papules and pustules
Comedonal papules
Pigmentation from previous breakouts
She also has a history of seborrheic dermatitis, diagnosed at her visit on November 22, 2023, for which she was prescribed ketoconazole 2% shampoo and instructed to alternate it with over-the-counter anti-inflammatory shampoos.
The patient reports:
A previous course of isotretinoin
Acne flare beginning after initiation of a GLP-1 medication earlier this year
No current acne medications prior to this visit
She presents today for acne treatment options and refill of her ketoconazole shampoo.
Clinical Examination
A focused examination of the face and scalp was performed, revealing:
Acne Findings
Inflammatory papules
Pustules
Comedonal papules
Lesions primarily on the right side of the face
Seborrheic Dermatitis Findings
Pink-orange scaly plaques on the scalp
Condition stable with ketoconazole use
The patient was well-appearing, alert, and in no acute distress.
Assessment and Treatment Plan
1. Acne Vulgaris (L70.0)
The patient’s acne likely worsened after beginning a GLP-1 agonist, a response occasionally seen due to hormonal modulation and metabolic changes. She is not currently on acne treatment, and requested renewed therapy.
Treatment Options Discussed:
Topical clindamycin
Topical tretinoin
Spot treatment using clindamycin/benzoyl peroxide gel
Additional future options if needed (oral antibiotics, hormonal therapies, etc.)
Tretinoin 0.025% cream
Apply pea-sized amount 2–3 nights/week, increase to nightly as tolerated
Clindamycin 1% lotion
Apply to affected areas every morning
Clindamycin/Benzoyl Peroxide 5% gel
Use as morning spot treatment
Counseling Provided:
Expect improvement in 2–3 months
Use gentle, non-comedogenic skincare products
Use broad-spectrum SPF 30+ every morning
Apply moisturizer after tretinoin if dryness occurs
Recommended Cleansers:
Cetaphil Oil Control
CeraVe Foaming Cleanser
Neutrogena Oil-Free Acne Wash
SkinMedica AHA/BHA Cleanser
2. Seborrheic Dermatitis (L21.8)
Her seborrheic dermatitis remains stable on ketoconazole shampoo.
Plan:
Refill ketoconazole 2% shampoo
Use at least 3 times weekly, alternating with OTC anti-inflammatory shampoos
Discussed shampoos containing tar, selenium sulfide, or zinc pyrithione
Counseling Provided:
Condition is chronic with periods of flares
Stress may worsen symptoms
Contact the office if irritation increases or symptoms fail to improve
Follow-Up
The patient was advised to:
Continue her new acne regimen
Continue ketoconazole for scalp maintenance
Return in 1 year for routine dermatologic follow-up, or earlier if acne does not improve
Discussion
This case illustrates the importance of addressing acne in the context of medication-induced changes, such as those related to GLP-1 therapy. It also highlights the long-term management approach required for seborrheic dermatitis.
At Reena Jogi MD, Village Dermatology, we personalize care for acne and scalp disorders, helping patients throughout Katy and Houston, Texas achieve healthy, radiant, and confident skin.
