Case Report: 30-Year-Old Female with Persistent Hormonal Acne and Hirsutism
At Reena Jogi MD, Village Dermatology in Katy and Houston, Texas, we treat a wide range of skin conditions, including adult acne and hormonal skin concerns. This case highlights a 30-year-old female presenting as a new patient with chronic acne and unwanted facial hair (hirsutism)—a common combination seen in women with hormonal influences on the skin.
Patient Background
The patient presented with moderate acne characterized by cysts, nodules, and inflammatory papules on the face, which have persisted for several years.
She has previously tried tretinoin and Curology products with limited improvement.
The acne lesions were described as painful and recurrent, leading to emotional distress and concern about scarring.
Clinical Examination
A focused skin examination was performed including the scalp, head, and face.
The patient was well-developed, well-nourished, and alert and oriented, with no signs of acute distress.
A dermatoscope was used to evaluate the skin in detail.
Findings included:
Comedonal and inflammatory papules on the cheeks and jawline
A single inflamed cyst on the left central cheek
Fine to coarse pigmented terminal hairs on the chin and upper lip (consistent with hirsutism)
Assessment and Treatment Plan
1. Acne Vulgaris (L70.0)
The patient’s history and examination were consistent with hormonal acne, often linked to increased androgen activity or sensitivity of oil glands.
Treatment Plan:
Start spironolactone 25 mg orally twice daily to target hormonal oil production.
Continue gentle, non-comedogenic skincare, including:
Cleansers: CeraVe Foaming Cleanser, Cetaphil Oil Control, Neutrogena Oil-Free Acne Wash
Moisturizers: CeraVe PM, EltaMD UV Clear
Sunscreen: Broad-spectrum SPF 30+ daily
Patient Counseling:
Spironolactone side effects were discussed, including mild diuretic effects, menstrual irregularities, and the importance of avoiding use during pregnancy.
The patient was advised to monitor for dizziness, low blood pressure, or muscle cramps and to follow up for possible lab work to monitor potassium and kidney function.
2. Inflammatory Acne Cyst (L72.8)
A painful inflammatory papule on the left cheek was treated with a Kenalog intralesional injection to reduce inflammation and speed healing.
Treatment Details:
Kenalog 2.5 mg/cc, total of 0.2 cc injected
Risks of localized skin thinning (atrophy) were discussed
Patient tolerated the procedure well
Counseling:
Localized acne cysts are easily treatable but may recur. The patient was instructed to contact the office if swelling, tenderness, or new lesions develop.
3. Hirsutism (L68.0)
The patient reported unwanted facial hair growth in areas typical of hormonal imbalance.
She was prescribed Eflornithine HCl (Vaniqa) topical cream, to be applied twice daily to affected facial areas.
Discussion:
Hirsutism in women can be related to polycystic ovary syndrome (PCOS), familial traits, or androgen-producing conditions.
The patient was advised to continue follow-up with her OB-GYN for hormonal evaluation and management, including the use of oral contraceptives for additional acne and hormonal control.
Long-Term Management and Follow-Up
The patient was counseled that acne is a chronic condition that may take 2–3 months to show significant improvement with hormonal treatment.
She was advised to return for follow-up in 3 months to assess progress, monitor tolerance to spironolactone, and adjust the regimen as needed.
Discussion
This case illustrates the complexity of adult female acne—often driven by hormonal factors rather than surface bacteria alone.
At Reena Jogi MD, Village Dermatology, we take a comprehensive, personalized approach to adult acne management, combining topical treatments, hormonal therapy, and targeted procedures for long-term results.
Our dermatology practice in Katy and Houston, Texas helps patients regain confidence with clear, healthy skin through science-backed care and ongoing support.
