Managing Persistent Acne in a Teen Patient: A Case Report from Katy & Houston, Texas
Acne can be especially frustrating during the teenage years—particularly when breakouts persist despite multiple treatments. At Reena Jogi, MD, we frequently care for adolescents with complex or treatment-resistant acne, offering individualized plans that balance effectiveness, safety, and long-term skin health.
This case highlights the evaluation and management of a 16-year-old female patient with moderate but persistent acne, including involvement of a sensitive area: the left eyelid.
Patient Background
The patient is an established dermatology patient who presented for a follow-up acne visit. Her acne had been present for several months and included a combination of:
Blackheads and whiteheads (comedonal acne)
Inflammatory pimples
Deeper cysts and nodules
Post-inflammatory hyperpigmentation
Early acne scarring
Despite prior therapies, her acne was actively flaring at the time of her visit.
She previously tried multiple treatments, including:
A partial second course (discontinued after 1–2 months)
Topical tretinoin
Amzeeq® (minocycline foam)
The patient reported difficulty swallowing pills, which contributed to stopping isotretinoin early in the past.
Dermatologic Examination
A comprehensive skin examination was performed, including evaluation of the:
Face and eyelids
Neck
Chest and abdomen
Back
Upper extremities
No concerning findings were noted outside of active acne lesions. A full-body skin exam was offered but declined. The patient appeared well, was alert and oriented, and showed no signs of systemic illness.
Treatment Discussion and Decision-Making
Because of ongoing acne flares and early scarring despite prior topical and oral therapies, an extensive discussion of treatment options was conducted. Topics included:
Optimized topical regimens
Short-term oral antibiotics (with discussion of antibiotic resistance risks)
Hormonal therapy options such as oral contraceptives and spironolactone
Light-based and red-light acne therapies
Isotretinoin therapy for long-term acne control
After reviewing the risks, benefits, and alternatives, the patient and family elected to restart isotretinoin therapy, prioritizing its potential for durable clearance and scar prevention.
Isotretinoin Counseling and Safety Monitoring
Given isotretinoin’s potency, thorough counseling was provided. Key points included:
Requirement for two forms of birth control
Monthly pregnancy testing and laboratory monitoring
Common side effects such as dryness, cheilitis, muscle aches, and photosensitivity
Less common but serious risks including liver enzyme changes, triglyceride elevation, mood changes, and benign intracranial hypertension
A urine pregnancy test was performed in clinic and was negative, allowing safe registration to begin therapy. Plans were made for routine laboratory monitoring after two months of treatment.
Ongoing Care Plan
The patient was counseled on:
Gentle, non-comedogenic skincare
Setting realistic expectations (improvement typically begins after 2–3 months)
Recognizing side effects that require prompt medical attention
She will follow up in 31 days to officially initiate isotretinoin dosing and continue close monitoring.
Acne Care for Teens in Katy & Houston, Texas
This case underscores the importance of personalized acne care, especially for teens with scarring or treatment-resistant acne. At Reena Jogi, MD, we provide comprehensive acne management—from topical therapies to isotretinoin—while prioritizing safety, education, and long-term results.
If you or your teen are struggling with acne that isn’t improving, a dermatology consultation can make all the difference.
