Case Report: Isotretinoin (Accutane) Initiation for Severe Acne in a 24-Year-Old Female | Village Dermatology Katy & Houston, TX
by: Caroline Vaughn
Introduction
Acne vulgaris is one of the most common dermatologic conditions affecting young adults. At Village Dermatology in Katy and Houston, Texas, we see many patients with acne that is persistent, hormonally influenced, and resistant to standard therapies. This case highlights a 24-year-old female whose acne worsened around her menstrual cycle and was inadequately controlled with prior treatments, leading to the initiation of isotretinoin (Accutane).
Patient Presentation
The patient is a 24-year-old female who presented for evaluation of acne on her face and back. She reported both comedonal papules and inflammatory papules/pustules, with flares around her menstrual cycle.
Examination
A focused skin examination of the face revealed:
Comedonal papules
Inflammatory papules and pustules
Acne of moderate-to-severe nature with potential for scarring
The patient was otherwise well developed, oriented, and in no acute distress.
Diagnosis
Acne vulgaris (L70.0), inadequately controlled
Pattern consistent with hormonally influenced acne
Risk of scarring identified
Management Plan
Counseling
The patient received detailed education about:
Skin care: Use of gentle cleansers, non-comedogenic moisturizers, and cosmetics
Treatment expectations: Improvement may take 2–3 months with a 60–80% reduction in acne lesions
Warning signs: Return to clinic if acne worsens, new scars form, or cysts appear
Treatment Initiation: Isotretinoin (Accutane)
Planned dose: 40 mg daily
Indication: Severe acne with scarring, resistant to prior treatments
iPledge program: Patient registered and counseled regarding strict pregnancy prevention requirements
Contraception: Patient started Aviane oral contraceptive pill (OCP) in addition to condoms
High-Risk Medication Monitoring
Patient counseled on potential side effects: dryness, headaches, blurry vision, muscle aches, mood changes, liver effects, lipid changes
Monitoring: Monthly visits with blood work (hepatic function panel, triglycerides)
Urine pregnancy test: Negative in clinic prior to starting therapy
Follow-Up
The patient will return in 31 days for repeat testing, counseling, and isotretinoin monitoring.
Conclusion
This case demonstrates a structured, safety-focused approach to Accutane initiation in young female patients. At Village Dermatology in Katy and Houston, TX, our dermatologists emphasize patient education, regular monitoring, and comprehensive acne treatment to achieve long-term skin health and reduce scarring risk.
