Case Report: Managing Persistent Adult Male Acne with Isotretinoin in Houston and Katy, Texas
Introduction
Adult acne is a common dermatologic concern that often persists despite traditional treatments. While many patients respond well to topical therapy and short courses of oral antibiotics, some continue to experience breakouts that affect both their skin health and confidence. At our dermatology practice in Houston and Katy, Texas, we often see patients who require more advanced therapies such as isotretinoin (Accutane).
This case highlights the treatment journey of a 37-year-old male who presented with refractory acne vulgaris despite multiple prior treatments.
Case Presentation
The patient, a 37-year-old male, presented for follow-up of acne. At his prior visit, he was prescribed doxycycline 100 mg twice daily, alongside a comprehensive skincare regimen that included:
Morning: Gentle cleanser, Medrock Compound, sunscreen (EltaMD UV Clear recommended).
Evening: Cleanser, Arazlo (tazarotene lotion), followed by CeraVe PM moisturizer.
Despite completing a 1-month course of oral doxycycline and undergoing three AviClear laser treatments, the patient continued to experience inflammatory papules, pustules, and comedonal breakouts.
He reported that stress from a new job also seemed to worsen his acne, despite adherence to his skincare routine.
Management Plan
Given his persistent acne and lack of improvement with antibiotics, topical medications, and energy-based treatments, the patient expressed interest in low-dose isotretinoin therapy.
After a detailed discussion of the risks, benefits, and necessary precautions, the decision was made to initiate isotretinoin at 10 mg three times daily (low-dose protocol). Counseling included:
Side effects: dryness, cheilitis, joint aches, hair shedding, mood changes, liver enzyme or triglyceride elevation, photosensitivity.
Precautions: no blood donation, no waxing, no medication sharing, and avoidance of elective surgery for 6 months after treatment.
Monitoring: monthly blood work, ongoing dermatology visits, and vigilance for concerning symptoms such as severe headaches, abdominal pain, or mood changes.
The patient had recent baseline bloodwork, which was within normal limits, and elected to proceed with isotretinoin initiation.
Discussion
This case demonstrates the importance of a stepwise, patient-centered approach in managing persistent acne. While antibiotics and topical retinoids remain first-line options, isotretinoin is the most effective therapy for moderate-to-severe or treatment-resistant acne in adults.
Low-dose isotretinoin protocols, as in this case, are increasingly used to minimize side effects while still achieving long-term remission.
For patients in Houston and Katy, Texas, access to dermatologists experienced in isotretinoin therapy provides reassurance and safe monitoring throughout treatment.
Conclusion
Persistent adult acne can be both frustrating and emotionally distressing. For patients who fail traditional therapies, isotretinoin offers a highly effective solution with proper monitoring and expert care.
At our dermatology practice in Katy and Houston, Texas, we specialize in customized acne treatment plans—including isotretinoin, advanced laser therapies, and medical-grade skincare—to help patients achieve clear, healthy skin.
