Severe Acne & Androgenetic Alopecia Management in a 23-Year-Old Male – Case Report from Village Dermatology in Katy & Houston, Texas
At Village Dermatology, we often treat patients managing more than one skin or hair condition at the same time. This case highlights the treatment approach for a young man with severe acne with scarring and androgenetic alopecia, showing how a comprehensive plan can address both concerns effectively.
Patient Background
A 23-year-old male presented for a new evaluation of acne and a follow-up for androgenetic alopecia.
Acne history:
Present for several years
Affects the face and trunk
Includes blackheads, whiteheads, inflammatory pimples, cysts, and post-inflammatory pigmentation
Moderate severity, previously untreated except for OTC products
Hair loss history:
Diagnosed with androgenetic alopecia in February 2025
On oral minoxidil 2.5 mg daily and finasteride 1 mg daily since diagnosis
Reports no significant side effects and is satisfied with results so far
Clinical Examination
Scalp: Diffuse, non-scarring hair loss with patterned thinning
Face and back: Inflammatory papules, pustules, comedonal papules, and acne scarring
Management of Androgenetic Alopecia
The patient was counseled on the chronic, progressive nature of male pattern hair loss and the role of finasteride and minoxidil in slowing or reversing hair thinning.
Treatment continued:
Finasteride 1 mg PO daily – reviewed potential side effects (decreased libido, gynecomastia, depression)
Oral minoxidil 2.5 mg PO daily – reviewed potential side effects (swelling, dizziness, unwanted hair growth)
Follow-up: Every 6 months for hair monitoring
Management of Severe Acne
Given the severity, scarring, and lack of response to OTC treatments, the patient was counseled extensively on isotretinoin (Accutane) as the best treatment option.
Treatment plan:
Isotretinoin 40 mg PO daily with a fatty meal (pending baseline lab results)
Goal: 1 mg/kg cumulative dose of 200–220 mg/kg over 6–8 months
Monthly follow-up required due to iPledge regulations
Lab monitoring: Baseline hepatic function panel and triglycerides, then recheck after 2 months
Side effects discussed: Dryness, joint aches, mood changes, photosensitivity, rare effects like increased intracranial pressure, high cholesterol, and abnormal liver function tests
Precautions: No blood donation, no sharing medication, avoid elective surgery for 6 months after completion, avoid driving at night if vision is affected
Patient Education
The patient received counseling on:
Skin care for acne: Use non-comedogenic cleansers, moisturizers, and SPF 30+ sunscreen daily
Hair care for alopecia: Consistent use of prescribed medications and awareness of realistic expectations
Monitoring for side effects from both acne and hair loss treatments
Follow-Up
Acne: Return in 1 month to review lab results and start isotretinoin
Alopecia: Continue current medications and follow up in 6 months for reassessment
