Teen Acne Follow-Up Case: Adjusting Treatment After Retinoid Irritation
Reena Jogi, MD | Dermatology Care in Katy & Houston, Texas
Acne is a chronic skin condition that frequently affects teenagers and young adults, often requiring adjustments in treatment to balance effectiveness with skin tolerability. This case report highlights a 16-year-old male seen at our dermatology clinic in Katy, Texas, with continued management of acne vulgaris after experiencing irritation from combination topical therapy.
Patient Background
The patient was initially evaluated on October 24, 2024 for acne vulgaris and returned for follow-up accompanied by his mother. At the initial visit, he was instructed on a structured skincare routine and prescribed combination topical therapy, including Epiduo and Cabtreo.
Despite adherence, he discontinued Epiduo due to significant dryness and peeling, a common side effect of topical retinoids in adolescent patients with sensitive skin.
Clinical Examination
A focused dermatologic examination was performed, including:
Scalp and hair
Face, lips, nose, and ears
Chest, abdomen, back
Upper extremities
The patient appeared well-developed, well-nourished, and in no acute distress. Examination revealed:
Comedonal papules
Inflammatory papules and pustules
These findings were consistent with moderate acne vulgaris.
Treatment Discussion and Adjusted Acne Plan
During the visit, treatment options were reviewed in detail with the patient and his mother, including:
Topical therapies
In-office treatments such as Hydrafacials
Oral antibiotics
Traditional and low-dose isotretinoin (Accutane)
After reviewing the risks, benefits, and expectations, the decision was made to transition to a gentler regimen designed to improve tolerability while maintaining acne control.
Updated Acne Treatment Regimen
Morning Routine (AM):
Wash face with sodium sulfacetamide–sulfur cleanser
Apply a non-comedogenic moisturizer with SPF 30+
Evening Routine (PM):
Wash face with a gentle cleanser
Apply a pea-sized amount of tretinoin 0.025% cream to the entire face (gradual onset emphasized)
Apply a moisturizing cream over tretinoin
Prescriptions Provided:
Tretinoin 0.025% topical cream
Sulfacetamide sodium–sulfur 10%–5% cleanser
This approach allows continued treatment of comedonal and inflammatory acne while minimizing excessive dryness and irritation.
Patient Counseling and Education
Extensive counseling was provided, including:
Importance of non-comedogenic cleansers and moisturizers
Expected timeline for improvement (2–3 months for 60–80% improvement)
Proper retinoid application techniques to reduce irritation
Awareness that acne is a chronic condition that can affect self-esteem and may cause scarring if not managed appropriately
The patient was advised to contact the office if acne worsens, new scars develop, or irritation persists.
Follow-Up Plan
The patient will return in 4–6 months for reassessment and further management if needed.
This case highlights the importance of personalized acne treatment, particularly in teenagers who may experience sensitivity to combination topical regimens. Our dermatology team in Katy and Houston, Texas emphasizes education, flexibility, and long-term skin health when treating adolescent acne.
