Treating Teen Acne When First-Line Topicals Fail
Acne vulgaris is extremely common during adolescence, but when standard topical therapies fail to provide improvement, treatment escalation is often necessary. At Reena Jogi, MD, in Katy and Houston, Texas, we use a stepwise, personalized approach to acne management to help teenage patients achieve clearer skin while minimizing long-term scarring.
This case highlights the management of a teenage patient with persistent acne who did not respond adequately to initial topical therapy.
Patient Presentation
A 14-year-old male presented for follow-up evaluation of acne vulgaris involving the face. At his prior visit, he had been prescribed Epiduo Forte® (adapalene 0.3% / benzoyl peroxide 2.5%) along with a structured morning and evening skincare regimen using gentle cleansers, moisturizers, and sunscreen.
Despite appropriate use, both the patient and his father reported no noticeable improvement, prompting reassessment of treatment options.
Clinical Examination
A focused dermatologic examination of the face, neck, and chest was performed.
Notable findings included:
Comedonal papules
Inflammatory papules and pustules
Distribution primarily across the face
The patient was otherwise healthy, well-nourished, alert, and in no acute distress.
Treatment Discussion and Decision-Making
Given the lack of response to Epiduo Forte, several treatment options were discussed in detail, including:
Adjusting topical therapy
Adding a short course of oral antibiotics
Photodynamic therapy (PDT)
Future consideration of isotretinoin if acne remains refractory
After shared decision-making, the patient and his father elected to proceed with a new topical regimen combined with oral antibiotics, reserving isotretinoin as a future option if needed.
Updated Acne Treatment Plan
Morning (AM) Routine
Gentle facial cleanser
Clindamycin 1% lotion applied to the entire face
Moisturizer with broad-spectrum SPF 30+
Evening (PM) Routine
Gentle facial cleanser
Tretinoin 0.025% cream (pea-sized amount to the entire face, applied gradually)
Moisturizing cream to reduce dryness
Oral Therapy
Doxycycline 100 mg taken twice daily with food and a full glass of water
The patient was counseled extensively on medication use, sun protection, and realistic expectations, with emphasis that acne treatments often require 2–3 months before significant improvement is seen.
Patient Counseling and Education
Counseling included:
Importance of non-comedogenic skincare products
Gradual introduction of retinoids to minimize irritation
Sun protection while on doxycycline due to photosensitivity risk
Monitoring for potential side effects and contacting the office if symptoms worsen
The family was also educated that if acne does not improve with this regimen, isotretinoin therapy may be reconsidered at future visits.
Follow-Up Plan
The patient will return in 8 weeks for reassessment. Treatment response at that time will guide next steps, including possible escalation of care.
Comprehensive Teen Acne Care in Katy and Houston, Texas
This case demonstrates the importance of individualized acne management and early treatment adjustment when initial therapies fail. At Reena Jogi, MD, we provide comprehensive acne care for teens and adults throughout Katy and Houston, Texas, with a focus on preventing scarring and supporting long-term skin health.
