Case Report: Treating Severe Truncal Acne With Isotretinoin in a Young Adult Male
by: Dr. Ashley Baldree
Patient Presentation
A 20-year-old male presented to Village Dermatology as a new patient with a long-standing history of moderate-to-severe truncal acne involving the chest, abdomen, and back. The acne had been present for several years and consisted of inflammatory papules, pustules, comedones, and cystic nodules, causing significant physical discomfort and concern for future scarring.
The patient was otherwise healthy and reported no systemic symptoms. Given the chronicity and severity of his acne, he sought dermatologic care to explore more effective treatment options.
Clinical Examination
A focused dermatologic examination was performed, including inspection of the chest, abdomen, and back, with dermoscopic evaluation. The patient appeared well-developed and well-nourished, was alert and oriented, and exhibited no signs of acute distress.
Findings included:
Numerous inflammatory papules and pustules
Open and closed comedones
Cystic and nodular acne lesions on the trunk
These findings were consistent with severe inflammatory acne vulgaris (L70.0).
Diagnostic Evaluation
Given the consideration of systemic therapy with isotretinoin (Accutane), baseline laboratory studies were ordered, including:
Hepatic Function Panel
Triglyceride levels
These tests are standard for patients starting isotretinoin due to its potential effects on liver function and lipid levels.
Treatment Plan: Isotretinoin (Accutane) Initiation
After an extensive discussion of treatment options, risks, and benefits, the patient elected to proceed with oral isotretinoin therapy, an FDA-approved medication for severe, scarring acne.
Treatment protocol included:
Isotretinoin 40 mg orally twice daily, taken with a fatty meal
Target dose of 1 mg/kg/day
Goal cumulative dose of 220 mg/kg
The patient was counseled extensively on:
Common side effects such as dryness, joint aches, photosensitivity, and mood changes
Rare but serious risks including elevated liver enzymes, triglyceride abnormalities, and increased intracranial pressure
Monthly laboratory monitoring and follow-up visits
iPLEDGE compliance and medication safety precautions
Although isotretinoin carries significant teratogenic risk in females, all patients—including males—must comply with monthly monitoring and follow-up visits, which was reviewed in detail.
Supportive Skin Care Counseling
The patient received education on proper acne skincare, including:
Use of non-comedogenic cleansers and moisturizers
Daily broad-spectrum sunscreen SPF 30+
Avoiding harsh or abrasive skin products
He was advised that improvement typically occurs over 2–3 months, with up to 60–80% reduction in acne severity during treatment.
Additional Diagnosis: Eruptive Vellus Hair Cysts
During the visit, the patient was also noted to have eruptive vellus hair cysts on the epigastric skin (L72.8). These benign cysts were discussed in detail.
Management options included:
Observation (often self-resolving)
Topical retinoids
Extraction or minor procedural removal if persistent
At this time, conservative management and reassurance were recommended.
Follow-Up and Monitoring
The patient will return in 1 month for:
Isotretinoin follow-up
Laboratory review
Side effect monitoring
Ongoing monthly visits are planned throughout the treatment course to ensure safety and optimal outcomes.
Why Early Treatment Matters
Severe truncal acne can lead to permanent scarring, pigment changes, and emotional distress if left untreated. At Village Dermatology, we offer evidence-based acne treatments—including isotretinoin therapy—to help patients achieve clear, healthy skin.
If you are struggling with persistent or severe acne in Katy or Houston, Texas, our board-certified dermatology team is here to help.
