Case Report: 65-Year-Old Female on Isotretinoin (Accutane) for Persistent Acne
At Reena Jogi MD, Village Dermatology in Katy and Houston, Texas, our dermatology team treats acne across all age groups — including adults and seniors. This case features a 65-year-old female undergoing treatment with isotretinoin (Accutane) for persistent acne, a condition that can affect women well beyond their teenage years.
Patient Background
The patient was first evaluated on October 16, 2025, for moderate acne vulgaris affecting the face. After reviewing her history and prior treatments, she began isotretinoin 40 mg daily (1 capsule by mouth daily).
She returned for her second-month follow-up to monitor treatment response and side effects.
Clinical Examination
The patient appeared well-nourished, alert, and in no acute distress. A dermatoscope was used to assess the facial skin. Findings included comedonal and inflammatory papules and pustules, consistent with ongoing but improving acne vulgaris.
Assessment and Plan
1. Acne Vulgaris (L70.0)
The patient has completed two months of isotretinoin therapy and reports no significant side effects such as dryness, joint pain, or mood changes.
Given her stable response, she will continue isotretinoin 40 mg daily and return in one month for reevaluation.
Plan Summary:
Continue isotretinoin 40 mg PO daily (30 capsules)
Continue monthly iPLEDGE confirmation
Monitor labs: hepatic function panel and triglycerides
Follow-up in one month
Patient Counseling:
The patient was counseled extensively on Accutane safety and expectations:
Use non-comedogenic cleansers, moisturizers, and sunscreens (SPF 30+)
Avoid donating blood, elective surgeries, and night driving if vision is affected
Report side effects such as dryness, mood changes, headaches, or abdominal pain
Continue monthly blood work to monitor liver function and lipid levels
Understand the importance of avoiding pregnancy and not sharing medication
Treatment Goals:
Therapy will continue until the patient reaches a cumulative isotretinoin dose of 220 mg/kg, as per standard acne protocols.
2. Angular Cheilitis (K13.0)
The patient presented with fissuring and irritation at the corners of the mouth, a common finding in those on isotretinoin due to dryness.
Plan:
Desonide 0.05% ointment, apply twice daily for 1–2 weeks
Apply barrier creams or ointments to protect fissured areas
Maintain hydration and avoid excessive licking of the lips
Counseling:
Angular cheilitis is often triggered by dryness or yeast overgrowth and typically resolves with topical steroids and emollients. The patient was advised to contact the office if symptoms persist or worsen.
High-Risk Medication Monitoring (Z79.899)
Because isotretinoin is a high-risk medication, the patient was reminded about ongoing monthly monitoring and lab work to ensure safety.
We reviewed the potential side effects again, including dryness, joint pain, muscle aches, depression, and elevated lipids. The patient expressed understanding and consented to continue therapy.
Discussion
This case highlights the effectiveness and safety of isotretinoin in older adults when properly monitored. Acne in patients over 60 can have hormonal and inflammatory components, and isotretinoin remains the gold standard for long-term resolution.
At Reena Jogi MD, Village Dermatology, we emphasize personalized acne care—from teens to adults—using the latest dermatologic advances to achieve clear, healthy skin.
