Starting Isotretinoin for a Teen Male With Persistent Acne — Plus Follow-Up on Tinea Corporis and Eczema
Village Dermatology | Reena Jogi, MD | Katy & Houston, Texas
Acne is one of the most common conditions treated at our dermatology clinics in Katy, Texas and Houston, Texas, and for some patients, stubborn breakouts require more advanced therapy. This case report highlights a 15-year-old male presenting for follow-up care for acne vulgaris, tinea corporis, and eczema, ultimately initiating isotretinoin (Accutane) after limited improvement on oral antibiotics and topical retinoids.
Patient Background
A 15-year-old male previously evaluated on October 21, 2025 returned for follow-up regarding three active dermatologic conditions:
Moderate inflammatory and comedonal acne
Tinea corporis, previously treated with oral terbinafine
This visit included a comprehensive physical examination of the face, neck, trunk, arms, and nails. The patient appeared well-developed, well-nourished, and in no distress. A full skin check was offered but declined.
1. Persistent Acne: Transitioning to Isotretinoin (Accutane)
At his prior visit, he began doxycycline 100 mg twice daily and tretinoin 0.025% cream for his acne. Despite adherence, he continued experiencing inflammatory papules, pustules, and comedonal lesions. Due to the lack of adequate improvement and potential for acne scarring, isotretinoin became an appropriate next step.
Isotretinoin Counseling and Safety Measures
As is standard in our Katy and Houston dermatology offices, extensive counseling took place:
Side effects reviewed: dryness, cheilitis, sun sensitivity, joint/muscle aches, mood changes, temporary hair shedding, LFT/triglyceride abnormalities, rare benign intracranial hypertension.
Safety protocols:
Monthly blood tests
No blood donation
Avoid driving at night if vision changes
Do not share medication
Avoid waxing or elective procedures for 6 months post-treatment
Must take with a fatty meal
Expected treatment plan:
Start isotretinoin 30 mg daily
Continue therapy until reaching a cumulative dose of ~220 mg/kg
The patient and his parent expressed complete understanding and agreed to start therapy.
Sun protection emphasized
Daily SPF 30+ sunscreen use and reapplication every two hours were advised due to heightened photosensitivity during isotretinoin therapy.
2. Follow-Up: Tinea Corporis Showing Significant Improvement
The patient had been treated with oral terbinafine 250 mg daily for one month for tinea corporis. At this visit, the fungal infection showed substantial improvement, with only residual itching.
Management Recommendations:
Continue gentle skin care
Begin daily Claritin for itch relief
Review risk factors such as pets and humid environments
Discuss recurrence prevention strategies
We also reviewed counseling for antifungal medications such as fluconazole in case future therapy is needed.
3. Eczema Management for Ongoing Flare-Ups
The patient also presented with eczema on the arms, a chronic condition requiring consistent skin barrier support.
Counseling Provided:
Daily lukewarm bathing
Immediate moisturization after bathing
Use fragrance-free detergents
Avoid excessive hand washing
Keep nails short to reduce damage from scratching
He was prescribed triamcinolone 0.1% cream, applied twice daily for up to two weeks during flares. Proper steroid use and potential side effects—skin thinning, telangiectasias, hypopigmentation—were thoroughly reviewed.
Plan and Follow-Up
The patient will return in one month for isotretinoin monitoring and reassessment of eczema and residual tinea corporis symptoms.
This case highlights the importance of personalized dermatologic care, especially for adolescents navigating multiple, overlapping skin conditions. For families in Katy, Texas and Houston, Texas, early evaluation and a clear, tailored treatment approach can significantly improve outcomes for acne, infections, and chronic skin sensitivities.
