Restarting Isotretinoin for Persistent Adult Acne: A Case Report from Katy & Houston, Texas
Adult acne is more common than many people realize—and for some patients, it can be persistent, cystic, and resistant to standard topical treatments. At Reena Jogi, MD, we frequently help adults in Katy and Houston, Texas manage stubborn acne using personalized, evidence-based treatment plans. This case highlights the safe and effective re-initiation of isotretinoin (Accutane) in an adult male with ongoing cystic acne.
Patient Case Overview
A 50-year-old male presented for follow-up of acne vulgaris, originally evaluated on September 30, 2025. He had previously been treated with topical tretinoin 0.025% cream, applied several nights per week. Despite adherence, he continued to experience painful cystic breakouts affecting the face, prompting a discussion about restarting isotretinoin therapy.
Clinical Examination
A focused dermatologic exam was performed, including evaluation of the scalp, face, and hair. The patient appeared well-developed, well-nourished, and in no acute distress. Dermatologic findings included:
Comedonal papules
Inflammatory papules and pustules
Distribution primarily on the face
A dermatoscope was used to assist with lesion evaluation. No concerning systemic findings were noted.
Treatment Decision: Restarting Accutane
Given the patient’s persistent cystic acne and lack of improvement with topical and prior combination therapies, isotretinoin was deemed an appropriate next step.
The patient requested to proceed with re-registering for Accutane (isotretinoin). A thorough discussion was held reviewing the risks, benefits, expectations, and safety requirements of therapy.
Isotretinoin Counseling & Safety
The patient received comprehensive counseling, including education on:
Common side effects such as dry skin and lips, joint aches, photosensitivity, and transient hair shedding
Less common but serious risks including mood changes, elevated liver enzymes, lipid abnormalities, and pseudotumor cerebri
The importance of monthly laboratory monitoring
iPLEDGE requirements and monthly check-ins
Avoiding blood donation, medication sharing, waxing, and elective surgery during and for 6 months after treatment
The patient demonstrated understanding and elected to proceed.
Treatment Plan
Isotretinoin 10 mg capsules
Sig: Take 1 capsule by mouth three times daily
Quantity: 90 capsules
High-risk medication monitoring initiated
Emphasis on daily broad-spectrum sunscreen SPF 30+
Regular use of non-comedogenic moisturizers
Supportive Acne Skin Care Recommendations
To support skin barrier health during isotretinoin therapy, the following were recommended:
Cleansers
CeraVe Foaming Cleanser
Cetaphil Oil Control Cleanser
SkinMedica AHA/BHA Cleanser
Neutrogena Oil-Free Acne Wash
Moisturizers & Sunscreen
CeraVe PM
Cetaphil Oil Control Moisturizer
EltaMD UV Clear SPF
Expectations & Follow-Up
The patient was counseled that acne is a chronic condition and that improvement typically occurs over 2–3 months, with up to 60–80% clearance expected. He was instructed to contact the office for worsening symptoms, new scarring, or concerning side effects.
A follow-up visit was scheduled in one month to assess response and review lab results.
Expert Adult Acne Care in Katy & Houston, TX
This case illustrates how adult acne, even later in life, can be effectively managed with the right treatment strategy. At Reena Jogi, MD, we specialize in customized acne care—including isotretinoin therapy, advanced monitoring, and long-term skin health planning—for patients throughout Katy and the greater Houston area.
If you’re struggling with persistent or cystic acne, expert dermatologic care can make a lasting difference.
