Severe Teen Acne Treated With Isotretinoin (Accutane): A Case Report from Katy & Houston, Texas
Acne can be physically uncomfortable and emotionally distressing—especially for adolescents experiencing worsening breakouts despite consistent treatment. At Reena Jogi, MD, we specialize in managing moderate to severe acne in both teens and adults using personalized, evidence-based care. This case highlights the thoughtful initiation of isotretinoin (Accutane) in a teenage patient with worsening, treatment-resistant acne.
Patient Case Overview
A 13-year-old male presented for evaluation of worsening acne, accompanied by his father. The patient reported pimples and cysts affecting the face, chest, and back. He had been consistently using Amzeeq® (topical minocycline) and adapalene, but noted minimal improvement and overall worsening since his last visit.
Given the impact of acne at this critical developmental stage, a comprehensive discussion of next-step treatment options was initiated.
Clinical Examination
A focused dermatologic exam was performed, including the scalp, face, and hair, with dermoscopic evaluation. The patient appeared well-developed, well-nourished, and in no acute distress.
Clinical findings included:
Comedonal papules
Inflammatory papules and pustules
Distribution across the face, with reported involvement of the chest and back
Treatment Discussion & Decision-Making
Treatment options were reviewed in detail with both the patient and his father, including:
Alternative topical therapies
Oral antibiotics
Isotretinoin (Accutane)
Given the patient’s severe acne with early scarring and lack of response to combination topical therapy, isotretinoin was determined to be an appropriate and evidence-based option.
After a thorough discussion of risks, benefits, expectations, and monitoring requirements, the patient and his father expressed understanding and elected to proceed with isotretinoin therapy.
Isotretinoin Treatment Plan
Isotretinoin 40 mg capsule
Sig: Take 1 capsule by mouth daily
Quantity: 30 capsules
Prednisone taper prescribed to help reduce the risk of an initial acne flare (“purging”)
Treatment goal: 1–2 mg/kg cumulative dosing, targeting 200–220 mg/kg
Baseline laboratory testing was ordered, including:
Triglycerides
Hepatic Function Panel
Safety Counseling & Monitoring
Extensive isotretinoin counseling was provided, including education on:
Common side effects such as dry skin and lips, muscle and joint aches
Possible lab abnormalities involving liver enzymes and lipids
Rare but serious risks including mood changes and pseudotumor cerebri
The importance of monthly lab monitoring and follow-up visits
Avoiding blood donation, medication sharing, and elective surgery during and after treatment
Both patient and parent verbalized understanding and were instructed to contact the office immediately for concerning symptoms.
Supportive Skin Care Recommendations
To protect the skin barrier during treatment, the following were recommended:
Cleansers
CeraVe Foaming Cleanser
Cetaphil Oil Control Cleanser
SkinMedica AHA/BHA Cleanser
Neutrogena Oil-Free Acne Wash
Moisturizers & Sun Protection
CeraVe PM
Cetaphil Oil Control Moisturizer
Broad-spectrum sunscreen SPF 30+ daily
Expectations & Follow-Up
The patient and family were counseled that acne is a chronic condition and that improvement typically occurs over 2–3 months, with 60–80% improvement expected. A follow-up visit in one month was scheduled to review labs, assess response, and adjust treatment as needed.
Compassionate Acne Care for Teens in Katy & Houston, TX
This case demonstrates how severe adolescent acne can be safely and effectively managed with isotretinoin under close dermatologic supervision. At Reena Jogi, MD, we partner with families to provide thoughtful, monitored acne care for teens throughout Katy and the Houston area, helping prevent scarring and restore confidence.
