Managing Moderate to Severe Teen Acne with Isotretinoin: A Case Report from Katy, Texas
Acne vulgaris is one of the most common skin conditions affecting adolescents and teens, often causing both physical discomfort and emotional distress. For patients with persistent or treatment-resistant acne, isotretinoin (commonly known as Accutane®) remains one of the most effective options. At Reena Jogi, MD, in Katy and Houston, Texas, we specialize in evidence-based acne management tailored to each patient’s needs.
This case highlights the careful monitoring and dose adjustment involved in treating moderate to severe acne in a teenage patient using isotretinoin therapy.
Patient Presentation
A teenage male patient presented for a follow-up visit for acne vulgaris after initiating isotretinoin therapy one month earlier. Prior treatments had not provided adequate improvement, prompting escalation to oral isotretinoin for inflammatory and comedonal acne.
At the initial visit, the patient was started on isotretinoin 30 mg daily and counseled extensively on expectations, side effects, and the importance of monthly monitoring.
Clinical Examination
A focused dermatologic examination was performed, including evaluation of the face, neck, chest, back, abdomen, and upper extremities. The patient declined a full-body skin exam.
Key findings included:
Inflammatory papules and pustules
No concerning lesions or systemic abnormalities noted
The patient appeared well-nourished, alert, and in no acute distress.
Treatment Response and Monitoring
At follow-up, the patient reported:
Mild dryness and cheilitis
Transient mild joint aches at treatment initiation
Ongoing acne breakouts, which can be expected early in isotretinoin therapy
Importantly, the patient was tolerating isotretinoin well, with no serious side effects such as mood changes, vision issues, or systemic symptoms.
Given the persistent acne activity, the isotretinoin dose was increased to 40 mg three times daily, following standard weight-based dosing guidelines. The goal is to reach a cumulative dose of approximately 220 mg/kg to optimize long-term clearance and reduce relapse risk.
Patient Counseling and Safety
Extensive counseling was provided, including:
Use of non-comedogenic cleansers and moisturizers
Expectations for improvement (often 2–3 months for significant results)
Avoiding blood donation and medication sharing
Recognizing and reporting side effects promptly
The patient was enrolled and confirmed in the iPLEDGE program and instructed on monthly laboratory monitoring, including liver function tests and triglyceride levels.
Follow-Up Plan
The patient will return in one month for continued isotretinoin monitoring, either in person or via telemedicine. Ongoing lab surveillance and symptom review will guide further dose adjustments.
Expert Acne Care in Katy and Houston, Texas
This case underscores the importance of individualized acne treatment and close monitoring when using high-risk medications like isotretinoin. At Reena Jogi, MD, we provide comprehensive acne care for teens and adults in Katy and Houston, Texas, combining medical expertise with patient-centered counseling.
If you or your child are struggling with persistent acne, a board-certified dermatologist can help determine whether isotretinoin or other advanced therapies are appropriate.
