Case Report: 37-Year-Old Male on Low-Dose Isotretinoin for Persistent Acne

At Reena Jogi MD, Village Dermatology in Katy and Houston, Texas, we manage acne for patients of all ages—including adults with long-standing, treatment-resistant acne. This case highlights a 37-year-old male returning for follow-up while undergoing low-dose isotretinoin therapy for chronic acne.

Patient Background

The patient was initially evaluated on October 1, 2025, with a history of years of acne, including comedones, inflammatory papules, pustules, and intermittent cysts.
Given his previous limited response to topical treatments and the chronic nature of his acne, he was started on Isotretinoin 10 mg three times daily (TID).

He now returns for a focused follow-up visit to assess tolerance and progress.

Clinical Examination

A focused facial examination was performed.
The patient appeared well-nourished, alert, and in no distress.

Findings included:

• Inflammatory papules

• Pustules

• Comedonal papules

• A right malar cheek inflammatory cyst

• Areas of post-inflammatory hyperpigmentation (PIH)

No signs of systemic side effects were noted.

Assessment and Treatment Plan

1. Acne Vulgaris (L70.0)

The patient is tolerating low-dose isotretinoin well, with only very mild dryness. Some breakouts occurred this month, which are common during early Accutane therapy.

Plan:

• Continue Isotretinoin 10 mg TID

• Reinforce no sharing medication and no blood donation

• Follow up in 1 month

• Plan routine labs at next visit

• Continue monthly iPLEDGE requirements

Counseling Provided:

• Non-comedogenic skincare is essential
  Recommended cleansers:

  • Cetaphil Oil Control

  • CeraVe Foaming

  • SkinMedica AHA/BHA Cleanser

  • Neutrogena Oil-Free Acne Wash

  Recommended moisturizers:

  • CeraVe PM

  • Cetaphil Oil Control

  • EltaMD UV Clear

• Improvement typically occurs over 2–3 months

• Return sooner for:

  • worsening acne

  • new scarring

  • allergic reactions

  • unusually severe dryness

  • mood changes

  • headaches or vision changes

Accutane Safety Review Included:

• dryness, cheilitis, joint/muscle aches

• liver enzyme/lipid abnormalities

• hair shedding

• pseudotumor cerebri

• depression risks

• pregnancy safety requirements (explained even in male patients)

2. Inflammatory Acne Cyst (L72.8)

The patient presented with a painful inflammatory papule/cyst on the right malar cheek.

Procedure: Intralesional Kenalog

• 2.5 mg/cc, total 0.1 cc

• Discussed risk of skin atrophy

• Procedure was medically necessary and well tolerated

3. Post-Inflammatory Hyperpigmentation (PIH) – (L81.0)

The patient expressed concern about dark marks following acne lesions.

Plan:

• Begin Azelaic Acid 15% gel, apply once daily

• Reviewed alternative treatments:

  • Hydroquinone

  • Chemical peels

  • Additional topical brightening agents

Counseling:

• Sun protection is essential

• PIH can take months to years to fade

• Return if pigmentation worsens or spreads

Follow-Up

The patient will return in 1 month for reassessment, lab review, and dose adjustments as needed.

Discussion

This case demonstrates how low-dose isotretinoin, combined with targeted lesion treatments and pigment management, offers a powerful and safe approach to chronic adult acne.
At Reena Jogi MD, Village Dermatology, we tailor acne treatments to each patient—balancing efficacy, safety, and long-term skin health.

We are proud to help patients throughout Katy and Houston, Texas, achieve clear, healthy, confident skin through evidence-based dermatology.