Severe Acne Management with Isotretinoin in a 17-Year-Old Female
Introduction
Severe acne in teenagers can be physically painful and emotionally distressing, often resistant to over-the-counter and prescription topical therapies. At our dermatology clinics in Houston and Katy, Texas, we treat many young patients with chronic, inflammatory acne that may require systemic therapy. This case highlights the initiation of isotretinoin (Accutane) for a 17-year-old female with severe acne and early signs of scarring.
Patient Case
A 17-year-old female presented with moderate to severe acne on her face, consisting of comedonal papules, inflammatory pustules, and early scarring. The acne had been persistent for several years despite standard treatments.
On examination, the patient appeared well-developed and well-nourished, alert, and in no acute distress. Dermoscopy revealed numerous inflamed lesions distributed across the forehead, cheeks, and chin.
Diagnosis
Severe Acne Vulgaris (L70.0)
High-Risk Medication Monitoring (Z79.899)
Treatment Plan
After reviewing the patient’s long-term acne history and examining the extent of inflammation and scarring, we discussed treatment options. Given the severity and persistence, isotretinoin (Accutane) was recommended as the most effective therapy to prevent further scarring.
The patient and her guardian were counseled extensively about isotretinoin, including the iPledge program requirements and strict pregnancy prevention guidelines. The patient was informed that two negative pregnancy tests—one month apart—are required before starting therapy, and that Accutane cannot be prescribed until 30 days after enrollment.
Treatment protocol:
Isotretinoin 1 mg/kg/day until a cumulative dose of 220 mg/kg is reached
Monthly office visits and bloodwork for the duration of treatment
Baseline and follow-up labs: hepatic function panel, triglycerides, and quantitative hCG
Avoid pregnancy; use two forms of birth control
Avoid blood donation, elective surgeries, or night driving if vision is affected
Report any mood changes, severe headaches, or abdominal pain
Expect common side effects like dry lips, skin irritation, and joint discomfort
Do not share or double dose the medication
The patient elected to proceed with the Accutane program and completed her first urine pregnancy test, which was negative. She will return in 31 days for re-evaluation and medication initiation pending second test results.
Discussion
Isotretinoin remains the gold standard for severe, recalcitrant acne, with lasting remission in most patients. Early initiation can prevent acne scarring and improve long-term skin health and self-confidence. However, due to its potential side effects and teratogenicity, careful monitoring is essential.
Our practice in Houston and Katy, Texas ensures each isotretinoin patient receives personalized guidance, regular lab testing, and mental health monitoring throughout treatment.
Follow-Up
The patient will follow up in 31 days for her second pregnancy test and isotretinoin prescription initiation. Subsequent labs will be rechecked after two months on therapy.
