Case Report: Severe Acne in a 20-Year-Old Male Managed with Isotretinoin in Houston & Katy, Texas

Aug 27

Introduction

Severe acne can significantly impact both skin health and emotional well-being, particularly when scarring develops. At our dermatology clinic in Houston and Katy, Texas, we specialize in advanced acne treatments for patients who do not respond to topical medications or oral antibiotics. This case highlights the management of a 20-year-old male with severe, treatment-resistant acne requiring isotretinoin therapy.

Case Presentation

The patient, a 20-year-old male, presented for a focused acne follow-up. At his prior visit, isotretinoin was discussed as a potential option due to his history of refractory acne despite previous treatments, including tretinoin and Plexion.

Clinical Findings

Severe inflammatory papules, pustules, and comedones distributed across the face.
Evidence of progressive scarring, raising concern for permanent skin damage if not aggressively managed.
A dermatoscope was used to evaluate the affected areas.

Management Plan

After reviewing the risks and benefits, the decision was made to initiate isotretinoin therapy at a starting dose of 20 mg daily, pending confirmation of recent baseline laboratory results.

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Key Counseling Points

Common side effects: skin dryness, lip chapping, photosensitivity, joint aches, and mood changes.
Serious risks: rare but possible side effects such as intracranial hypertension, abnormal liver function, and elevated triglycerides.
Precautions: no blood donation, no medication sharing, no elective surgery for 6 months post-treatment, and monthly follow-up visits per iPledge guidelines.
Monitoring: baseline hepatic function and triglycerides, with repeat labs at two months and ongoing monthly evaluations.

The patient and his family were provided with an educational handout on isotretinoin and expressed full understanding of the treatment protocol.

Discussion

Isotretinoin remains the gold standard treatment for severe acne with scarring, especially in patients who do not respond to antibiotics or topical therapies. In this case, the presence of scarring and the lack of improvement with prior treatments warranted initiation of isotretinoin.

By starting at a low daily dose (20 mg) and monitoring labs closely, side effects can be minimized while gradually working toward the cumulative target dose of 220 mg/kg, which is associated with long-term remission.

For young adults in Katy and Houston, Texas, isotretinoin provides an effective, life-changing option when other acne treatments fail.

Conclusion

This case demonstrates the importance of early recognition and aggressive management of severe acne with scarring. With careful monitoring, isotretinoin can provide dramatic and lasting results, helping patients restore both their skin health and confidence.

At our practice in Houston and Katy, Texas, we are committed to offering individualized acne treatment plans, ranging from topical regimens to advanced therapies like isotretinoin and AviClear, ensuring the best possible outcomes for our patients.

Honey Cisneros