Management of Acne Rosacea in a 34-Year-Old Female with Doxycycline and Compounded Triple Rosacea Cream

By: Dr. Ashley Baldree

Patient Presentation

A 34-year-old female presented to our dermatology clinic in Katy, Texas, with a chronic facial rash characterized by persistent pimples and redness. The patient reported that symptoms had been present for several years and were moderate in severity. She has a known history of rosacea, having previously undergone intense pulsed light (IPL) therapy, a course of isotretinoin (Accutane), and multiple topical treatments.

Clinical Examination

A focused facial examination revealed erythematous papules and pustules primarily distributed across the cheeks, nose, and chin—consistent with acne rosacea (L71.8).
The patient appeared well-developed, well-nourished, and in no acute distress. Dermatoscopic evaluation showed superficial telangiectasias and scattered inflammatory papules. No nodules or cystic lesions were observed.

Diagnosis

Acne Rosacea (L71.8) – distributed on the face and subxiphoid region.
The patient was counseled regarding the chronic nature of rosacea and the importance of trigger avoidance, sun protection, and consistent skincare.

Treatment Plan

After a detailed discussion of options, including laser therapy, topical agents, and oral medications, the patient elected to begin combination therapy consisting of oral doxycycline and a compounded triple rosacea cream.

Medication Regimen:

Morning Routine:

1. Wash with a gentle, non-irritating cleanser

2. Apply a broad-spectrum SPF 30+ moisturizer

Evening Routine:

1. Wash with a gentle cleanser

2. Apply the compounded triple rosacea cream (containing ivermectin, metronidazole, and azelaic acid)

3. Follow with a light moisturizer

Oral Therapy:

• Doxycycline monohydrate 100 mg taken twice daily with food and a tall glass of water for 4 weeks

Counseling Provided:

• Sun Protection: The patient was instructed to wear daily SPF and avoid direct sunlight to prevent photosensitivity associated with doxycycline.

• Trigger Avoidance: Flare-ups can be provoked by alcohol, spicy foods, hot beverages, sun exposure, stress, and exercise.

• Medication Effects:

  • Doxycycline: May cause sun sensitivity or gastrointestinal upset.

  • Ivermectin (Soolantra): Possible mild burning or stinging on application.

  • Metronidazole: May cause a metallic taste or transient redness.

  • Azelaic Acid (Finacea): Possible mild tingling or dryness.

The patient verbalized full understanding of the treatment plan and was scheduled for follow-up in six weeks to evaluate clinical response and tolerance.

Discussion

Rosacea is a chronic inflammatory skin condition that primarily affects the central face, often leading to persistent redness, papules, and visible blood vessels. Management focuses on controlling inflammation, reducing Demodex mite proliferation, and minimizing triggers that exacerbate symptoms.

At Village Dermatology in Katy and Houston, Texas, Dr. Reena Jogi utilizes a comprehensive treatment approach, combining oral anti-inflammatory therapy, custom-compounded topical formulations, and laser or light-based therapies when appropriate. This personalized care model helps patients achieve long-term remission and confidence in their skin health.

Conclusion

This case demonstrates effective management of chronic acne rosacea using a short course of oral doxycycline and a compounded triple rosacea cream. With adherence to skincare, trigger avoidance, and follow-up care, the patient is expected to experience a marked improvement in redness and inflammatory lesions.

Treatment of Verruca Vulgaris (Common Warts) with Cryotherapy in an 18-Year-Old Male

By: Dr. Caroline Vaughn

Patient Presentation

An 18-year-old male presented as a new patient to our dermatology clinic in Katy, Texas, with multiple irregular skin lesions on his right hand and right elbow. The lesions had been present for several months and were moderately symptomatic, with intermittent itching and inflammation. He presented today for cryotherapy treatment.

Clinical Examination

A focused examination of the right forearm and hand revealed multiple verrucous papules consistent with verruca vulgaris (common warts). The lesions were distributed on the right elbow, right anterior distal thigh, right knee, right thenar eminence, and right radial palm.

The patient appeared well-developed and well-nourished, in no acute distress, and was alert and oriented. Dermatoscopic evaluation confirmed characteristic features of viral warts, including thrombosed capillaries and irregular surface texture.

Diagnosis

Verruca Vulgaris (B07.8)
Associated findings included mild pruritus and cutaneous inflammation at the affected sites.

Treatment Plan and Counseling

The diagnosis and treatment options were reviewed in detail. The patient was informed that resolution of viral warts may require three to four sessions of cryotherapy. Alternative treatment options such as topical salicylic acid, retinoids, Imiquimod (Aldara), Candida antigen injections, or Cantharidin were discussed for future consideration if cryotherapy proves insufficient.

Procedure: Liquid Nitrogen Cryotherapy

A total of 8 lesions were treated using liquid nitrogen, located on:

• Right elbow

• Right anterior distal thigh

• Right knee

• Right thenar eminence

The procedure was performed after informed consent, discussing potential risks including blistering, scarring, pigmentary changes, recurrence, incomplete removal, and infection. The patient tolerated the procedure well.

Post-Treatment Instructions:

• Expect mild redness, swelling, or blistering for a few days.

• Avoid picking or scratching the treated areas.

• Apply a gentle moisturizer or petroleum jelly as needed.

• Contact the office if lesions spread or become painful.

The patient was scheduled to follow up in one month for reassessment and potential retreatment.

Discussion

Verruca vulgaris is a benign but contagious viral infection caused by the human papillomavirus (HPV). It is commonly seen in teenagers and young adults, particularly on the hands, knees, and elbows due to frequent microtrauma and skin contact.
At Village Dermatology in Katy and Houston, Texas, cryotherapy remains a first-line, effective, and well-tolerated treatment for common warts. By freezing the lesion and destroying virally infected keratinocytes, cryotherapy can lead to clearance over several sessions while minimizing scarring.

Alternative treatments such as Candida antigen immunotherapy can be considered for resistant cases, leveraging the body’s immune response to clear both treated and distant warts.

Conclusion

This case highlights the successful initial management of verruca vulgaris using liquid nitrogen cryotherapy in an adolescent male. With consistent follow-up and adherence to post-treatment care, the patient’s prognosis for full resolution is excellent.

Evaluation and Management of a Suprapubic Cyst and Nasal Scar in a 34-Year-Old Female

By: Dr. Caroline Vaughn

Patient Presentation

A 34-year-old female presented to our dermatology clinic in Katy, Texas, for evaluation of enlarging, irregular skin lesions located on the abdomen. The lesions had been present for several weeks and were described as new and progressively enlarging. She also expressed ongoing cosmetic concerns regarding a previously treated scar on her nasal dorsum.

Clinical Examination

A focused dermatologic exam was performed, including evaluation of the abdomen and nasal region. The patient was well-developed, well-nourished, and in no acute distress. Using dermatoscopic assessment, two primary findings were noted:

1. Residual Nasal Scar (L90.5):
   The patient has a history of prior intralesional Kenalog (ILK) and CO₂ laser therapy to the nasal dorsum for scarring, with significant improvement noted. However, she reported persistent mild discoloration and slight depression of the scar. No evidence of recurrence or abnormal pigmentation was observed.
   Plan: The patient was counseled that scars naturally become less noticeable over time but remain permanent features of the skin. Follow-up with her cosmetic surgeon was advised to explore potential refinements for residual cosmetic concerns.

2. Epidermal Inclusion Cyst (L72.8) – Left Suprapubic Skin:
   On physical examination, a 1 × 1.8 cm firm, subcutaneous nodule was identified on the left suprapubic region. The lesion was consistent with an epidermal inclusion cyst. Management options—including observation, oral antibiotics, intralesional corticosteroid injection, and surgical excision—were discussed.
   After reviewing the benefits and potential for post-procedural scarring, the patient elected to proceed with intralesional Kenalog (ILK) treatment.
   Procedure:

   • Lesions injected: 2

   • Medication: Kenalog 10 mg/mL diluted to 4 mg/cc

   • Total volume injected: 0.1 cc
     The risks of cutaneous atrophy and pigment alteration were reviewed, and the patient tolerated the procedure well. She was advised to monitor for redness, tenderness, or rupture.

3. Acne Vulgaris (L70.0):
   The patient also reported mild inflammatory and comedonal acne. She prefers to focus on non-pharmacologic management, including dietary modification and stress reduction. We discussed evidence-based skincare approaches, including:

   • Gentle, non-comedogenic cleansers and moisturizers

   • Broad-spectrum sunscreen SPF 30+

   • Topical retinoids for long-term acne control

   • Consideration of hormonal therapy (spironolactone) or isotretinoin if future exacerbations occur.

   The patient was advised that visible improvement may take up to 2–3 months and to return if symptoms persist or worsen.

Discussion

This case highlights a multidisciplinary dermatologic approach addressing both medical and cosmetic concerns—a common scenario seen in dermatology clinics across Houston and Katy, Texas. Intralesional Kenalog remains a versatile treatment option for both cystic lesions and scar modulation, offering effective results with minimal downtime. Ongoing patient education and individualized treatment planning remain essential for achieving optimal outcomes.

Conclusion

The patient’s cyst was effectively treated with intralesional corticosteroid injection, and her nasal scar continues to improve post-CO₂ laser therapy. With continued observation and adherence to a gentle skincare regimen, her prognosis remains excellent.

Pediatric Eczema and Hand-Foot-Mouth Disease in a 9-Year-Old Male | Village Dermatology Katy & Houston, TX

By: Dr. Ashley Baldree

Introduction

Chronic skin irritation and viral rashes are common dermatologic concerns in children. Eczema (atopic dermatitis) and hand-foot-mouth disease (HFMD) may sometimes appear concurrently, particularly in pediatric patients with sensitive skin. This case describes a 9-year-old male who presented to Village Dermatology in Katy and Houston, Texas, with a chronic dry rash on his hands and arms, as well as recent vesicular lesions consistent with HFMD.

Patient Presentation

A 9-year-old male presented for evaluation of a painful, dry rash affecting the hands and arms for approximately two years.

• The rash was lighter than the surrounding skin, itchy, and worsened during cold, dry weather.

• Recently, he also developed small vesicles and erosions on both palms.

• No prior prescription treatments had been used—only over-the-counter moisturizers.

Examination

A focused dermatologic exam included the hands, wrists, and feet.
Findings included:

• Hypopigmented, dry patches on the dorsal hands and wrists, consistent with eczema.

• Vesicular and erosive lesions on the right and left ulnar palms, consistent with hand-foot-mouth disease.

• The rest of the exam was unremarkable.

The patient appeared well developed, alert, and in no acute distress.

Diagnosis

• Dermatitis, Unspecified (L30.9) – consistent with eczema flare related to environmental triggers.

• Hand-Foot-Mouth Disease (B08.4) – viral vesicular eruption of the hands and feet.

Management Plan

1. Eczema

The likely diagnosis of eczema was discussed in detail with the patient’s mother, including the chronic nature of the condition and environmental factors such as cold, dry air and frequent hand washing.

Treatment Plan:

• Topical tacrolimus 0.1% ointment, applied twice daily to affected areas.

• Continue liberal use of emollients 2–3 times daily, particularly after bathing.

• Avoid scented soaps, detergents, and fabric softeners.

• Recommended lukewarm bathing and use of gentle cleansers.

• Discussed use of KattaMD resources for eczema-friendly nutrition and lifestyle guidance.

Counseling:

• Reviewed the side effects and proper use of topical steroids and non-steroidal alternatives like tacrolimus.

• Advised follow-up in 3 months to assess progress.

2. Hand-Foot-Mouth Disease

Findings: Vesicles and erosions on both palms.
Plan:

• Explained that HFMD is a self-limited viral infection that typically resolves within 7–10 days.

• Recommended supportive care, including topical anesthetics for any painful lesions.

• Advised good hand hygiene and avoidance of close contact with others until lesions crust over.

Discussion

This case illustrates the overlap of chronic eczema and acute viral infection in a pediatric patient. Children with eczema are prone to increased skin sensitivity and may experience flares triggered by viral illnesses or environmental factors. Management focuses on restoring the skin barrier, controlling inflammation, and preventing secondary infections.

Conclusion

At Village Dermatology in Katy and Houston, TX, pediatric patients with chronic rashes receive comprehensive evaluation and care. This case highlights the importance of identifying both chronic conditions like eczema and acute viral infections such as hand-foot-mouth disease, and providing gentle, evidence-based treatment tailored to each child’s needs.

Managing Chronic Rash, Nail Discoloration, and Psoriasis in a 49-Year-Old Female

By: Dr. Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we recently evaluated a 49-year-old female who presented as a new patient with a one-year history of itchy, hardened skin on her fingers. The rash was moderate in severity and had not responded to over-the-counter treatments. A comprehensive skin, nail, and hand examination was performed, including dermatoscopic evaluation.

Clinical Findings

The patient exhibited several dermatologic conditions affecting the skin and nails:

1. Onychomycosis (Nail Fungus) – The right toenail showed discoloration, onycholysis (nail lifting), and subungual debris, classic findings consistent with a fungal nail infection.

2. Tinea Pedis (Athlete’s Foot) – Fungal infection was also noted on the feet, with scaling and itching between the toes.

3. Plaque Psoriasis – The patient had erythematous, well-demarcated plaques with silvery scale on both elbows, consistent with chronic plaque psoriasis.

Diagnosis

• Onychomycosis (B35.1)

• Tinea Pedis (B35.3)

• Plaque Psoriasis (L40.0)

Treatment Plan

1. Fungal Infections (Onychomycosis and Tinea Pedis)

The patient was counseled that onychomycosis often fails to respond to topical agents and that oral antifungal therapy, while more effective, carries potential risks such as liver toxicity.

To minimize systemic risks, the patient was started on topical antifungal therapy with:

• Ketoconazole 2% cream, applied twice daily to the toenail, feet, and affected hand areas for two weeks, then continued for one additional week after clearing.

She was advised that fungal infections tend to recur, particularly in humid climates such as Houston and Katy, Texas, and should report any side effects immediately.

2. Psoriasis Management

For the plaque psoriasis on her elbows, the patient was counseled on the chronic nature of psoriasis, potential triggers (such as stress, cold weather, and infections), and the importance of consistent skincare.

Treatment was initiated with:

• Triamcinolone acetonide 0.1% cream, applied twice daily for 2 weeks, then as needed for flares (not exceeding 14 days per month).

• Emollient moisturizers and gentle cleansing routines to support the skin barrier.

The patient was encouraged to use tar-based or zinc pyrithione shampoos, get moderate natural sunlight exposure, and maintain regular follow-ups for flare management.

Patient Counseling and Education

The patient was counseled extensively on:

• The chronic and relapsing nature of psoriasis and fungal infections.

• The importance of adherence to topical therapies for best outcomes.

• Lifestyle factors, such as keeping feet dry, avoiding skin trauma, and reducing stress.

Follow-up was scheduled in 6 weeks to assess the response to therapy and adjust treatment as necessary.

Dermatology Insight

This case highlights how multiple overlapping dermatologic conditions—such as psoriasis and fungal infections—can complicate diagnosis and management. At Village Dermatology, our specialists in Katy and Houston take a comprehensive, individualized approach to skin and nail disorders, emphasizing both medical efficacy and patient education to prevent recurrence and improve quality of life.

Case Report: Dermatographic Urticaria in a 67-Year-Old Female | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Dermatographic urticaria, also known as “skin writing,” is a form of physical urticaria where light scratching or pressure on the skin causes red, raised, itchy welts. While often benign and self-limiting, the condition can be bothersome and impact quality of life. At Village Dermatology in Katy and Houston, Texas, we evaluate and manage urticaria with individualized care plans to reduce discomfort and improve skin health.

Patient Presentation

A 67-year-old female presented with:

• An itchy, red rash on the right arm and right leg

• Moderate severity, ongoing for several months

• Rash appears intermittently and typically resolves within 30 minutes

• Past treatment included oral prednisone with limited improvement

Examination

A focused dermatologic exam revealed:

• Erythematous, linear, edematous plaques induced by scratching

• Findings consistent with acute urticaria with dermatographism

• No other concerning lesions identified

The patient was otherwise well-nourished, alert, and in no acute distress.

Diagnosis

• Dermatographic Urticaria (L50.3)

Management Plan

Medications

• Zyrtec (cetirizine): Patient was already taking 10 mg twice daily; dose increased to 20 mg twice daily as tolerated

• Triamcinolone acetonide 0.1% cream: Prescribed for application twice daily to affected areas for 2 weeks, with instructions to use as needed for flares

Counseling & Education

The patient was counseled on:

• Skin care: Use bland emollients to reduce scratching and maintain skin barrier health

• Expectations: Dermatographism affects 2–5% of the population and is often idiopathic; most cases are benign

• When to contact office: If symptoms worsen, fail to improve, or become more symptomatic

Follow-Up

• Return in 2 weeks for reassessment

• If symptoms persist beyond 6 weeks, initiation of Xolair (omalizumab) may be considered

Conclusion

This case illustrates the clinical presentation and management of dermatographic urticaria in an older female patient. At Village Dermatology in Katy and Houston, TX, we provide both immediate symptom relief with antihistamines and long-term strategies, including advanced therapies like Xolair, when needed.

Full Body Skin Exam in a 73-Year-Old Female: Benign Findings and Sun Protection Counseling

by: Ashlee Baldree

At Village Dermatology in Katy and Houston, Texas, we encourage patients of all ages to schedule routine full body skin exams. These comprehensive evaluations are an essential way to monitor for skin cancer, track changes in moles, and identify other skin conditions. This case highlights a 73-year-old female who presented for a preventive exam.

Patient Presentation

A 73-year-old female came to our clinic as a new patient for a full body skin examination. She reported new but stable lesions on the right and left upper back. The lesions had been present for several months, were moderate in severity, and had not changed recently.

She had no history of skin cancer but wanted reassurance and preventive counseling.

Dermatologic Examination

A head-to-toe exam was performed, including the scalp, face, trunk, extremities, nails, and mucosal surfaces. A dermatoscope was used to assess pigmented lesions.

Findings included:

• Benign Nevi (Moles): Symmetrical, evenly colored macules and papules throughout.

• Seborrheic Keratoses: Flat, waxy pigmented growths, common with aging.

• Lentigines (Sun Spots): Light tan macules in sun-exposed areas, consistent with sun damage.

• Cherry Angiomas: Bright red vascular papules scattered across the skin.

No suspicious or malignant lesions were detected during the exam.

Impression and Plan

Benign Nevi

• Stable, non-worrisome moles.

• Counseling: Monthly self-skin checks recommended.

• When to call the office: Any mole that changes in size, shape, or color, or begins to itch, burn, or bleed.

Seborrheic Keratoses

• Benign age-related growths.

• Counseling: No treatment necessary unless irritated or for cosmetic reasons.

Lentigines (Sun Spots)

• Result of chronic sun exposure and damage.

• Treatment options discussed: sunscreen, bleaching creams, retinoids, chemical peels, and laser therapy.

• Daily regimen recommended:

  • Broad spectrum SPF 30+ sunscreen

  • Vitamin C serum in the morning for added antioxidant protection

  • Lip balm with SPF

  • Wide-brimmed hats and sun-protective clothing for long outdoor exposure

Cherry Angiomas

• Small, benign blood vessel growths.

• Counseling: Treatment not required, but removal possible with laser or electrodesiccation if cosmetically desired.

Key Takeaway

This case demonstrates the importance of full body skin exams for older adults, even when lesions appear stable or benign. Routine evaluations provide reassurance, early detection of skin cancers, and personalized skin care guidance.

At Village Dermatology in Katy and Houston, TX, we specialize in comprehensive skin exams, mole evaluations, and preventive sun care counseling.

Case Report: Oral Minoxidil and PRP Therapy for Androgenetic Alopecia in a 41-Year-Old Male | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Androgenetic alopecia (AGA), also known as male pattern hair loss, is the most common cause of progressive hair thinning in men. Many patients initially try over-the-counter treatments like topical minoxidil without success. At Village Dermatology in Katy and Houston, Texas, we offer advanced therapies such as oral minoxidil and platelet-rich plasma (PRP) therapy to help slow progression and stimulate regrowth. This case highlights a 41-year-old male with longstanding hair loss.

Patient Presentation

The patient, a 41-year-old male, presented with:

• Generalized hair thinning on the scalp

• Symptoms present for 2 years, gradually worsening

• Prior trial of over-the-counter topical minoxidil, without significant improvement

He sought evaluation and treatment options for hair restoration.

Examination

A focused scalp examination revealed:

• Patterned thinning at the vertex and mid-occipital scalp

• No scarring or evidence of inflammatory alopecia

• Dermatoscopic findings consistent with androgenetic alopecia

The patient was otherwise well developed, alert, and in no acute distress.

Diagnosis

• Androgenetic Alopecia (L64.8)

Management Plan

Diagnostic Approach

A punch biopsy was recommended to confirm the diagnosis and rule out other causes of hair loss.

Treatment Options Discussed

The patient was counseled extensively on treatment choices:

• Medical therapies: oral minoxidil, oral finasteride, topical minoxidil, spironolactone

• Adjuncts: low-level laser therapy, nutritional supplements, hair transplantation

• Procedural options: platelet-rich plasma (PRP) injections and Alma TED therapy (cosmetic, not insurance-covered)

Risks, benefits, and expectations of each were reviewed in detail.

Treatment Chosen

The patient elected to start:

1. Oral minoxidil 2.5 mg daily (with monitoring for low blood pressure)

2. PRP therapy, initiated during the visit, with additional sessions planned

Follow-Up

• 4–6 months for reassessment of response

• Baseline photos taken to document progress

• AGA handout and PRP pricing reviewed with the patient

Conclusion

This case highlights a comprehensive approach to male pattern hair loss, combining oral minoxidil with PRP therapy. At Village Dermatology in Katy and Houston, TX, we tailor treatment plans to each patient’s goals, offering both medical and procedural options for optimal hair restoration outcomes.

Full Body Skin Exam in a 56-Year-Old Male: Benign Findings, Actinic Keratosis, and Lipoma

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, annual full body skin exams are a cornerstone of preventive care. These visits allow for the monitoring of existing lesions and early detection of skin cancer or precancerous growths. This case highlights a 56-year-old male with multiple skin findings, including benign nevi, actinic keratosis, lentigines, cherry angiomas, and a lipoma.

Patient Presentation

A 56-year-old male presented for a full body skin examination as a new patient. He reported longstanding lesions on the right upper back and chest, which had been present for years and remained asymptomatic. His primary concern was preventive screening and reassurance.

The patient declined genital examination but agreed to a full inspection of all other body areas.

Dermatologic Examination

A comprehensive skin exam was performed, including dermatoscope evaluation. Findings included:

• Benign Nevi: Symmetrical, evenly pigmented macules and papules with no concerning features.

• Actinic Keratosis (AK): One precancerous lesion located on the left forehead.

• Lentigines (Sun Spots): Light tan macules in sun-exposed areas.

• Cherry Angiomas: Bright red vascular papules scattered on the trunk and extremities.

• Lipoma: A soft, 6 cm mass on the left posterior shoulder, consistent with a benign fatty tumor.

Impression and Plan

Benign Nevi

• Plan: Observation only.

• Counseling: Monthly self-skin checks recommended. Patient educated on the ABCDEs of melanoma (Asymmetry, Border, Color, Diameter, Evolution).

Actinic Keratosis

• Treatment: One lesion treated with liquid nitrogen cryotherapy.

• Risks explained: Crusting, blistering, pigment changes, incomplete removal, recurrence, and infection.

• Counseling: AKs are precancerous and should be treated promptly to prevent progression to squamous cell carcinoma.

Lentigines

• Plan: Sun protection counseling.

• Recommendations: Daily broad spectrum SPF 30+ sunscreen, reapplied every 2 hours during sun exposure. Suggested options included mineral sunscreens and lip balm with SPF.

• Optional treatments discussed: bleaching creams, retinoids, chemical peels, and laser.

Cherry Angiomas

• Plan: Observation only.

• Counseling: Removal with laser or electrodesiccation is optional if desired for cosmetic reasons.

Lipoma

• Findings: 6 cm soft tissue mass on left posterior shoulder.

• Plan: Referral to plastic surgeon Dr. Rodger Brown for surgical excision due to size and location.

• Counseling: Lipomas are benign and often stable, but removal can be considered for comfort or cosmetic reasons.

Key Takeaway

This case demonstrates the value of comprehensive annual skin exams. Even when lesions appear stable or benign, dermatology visits provide reassurance, allow for the treatment of precancerous conditions like actinic keratoses, and guide patients on cosmetic or surgical options for benign growths.

At Village Dermatology in Katy and Houston, TX, we provide expert full body skin checks, mole monitoring, cryotherapy, and referrals for surgical removal of large benign growths.

Case Report: Molluscum Contagiosum and Verruca Vulgaris in a 7-Year-Old Female | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Skin infections caused by viruses are common in children, with molluscum contagiosum and warts (verruca vulgaris) among the most frequent. These lesions may persist for years, spread to other areas, and cause parental concern. At Village Dermatology in Katy and Houston, Texas, we offer safe and effective treatments, including cantharidin therapy, to help children achieve clear skin.

Patient Presentation

The patient, a 7-year-old female, presented with:

• Growing warts on the right knee, present for years

• Shiny bumps on the abdomen and buttocks, suspected to be molluscum contagiosum

She had not received prior treatment for these lesions.

Examination

A focused dermatologic exam revealed:

• Verruca vulgaris (common warts): cauliflower-like papules on the right knee

• Molluscum contagiosum: pink, shiny, dome-shaped papules with central umbilication on the abdomen, right buttock, and left buttock

The patient was otherwise well-nourished, alert, and in no acute distress. A dermatoscope was used to confirm clinical features.

Diagnosis

• Molluscum Contagiosum (B08.1)

• Verruca Vulgaris (B07.8) with associated cutaneous inflammation

Treatment Plan

Molluscum Contagiosum

• Diagnosis discussed with the patient’s mother

• Cantharidin (Cantharone) applied to 2 enlarging lesions on the buttocks

• Counseling provided:

  • Lesions may blister before resolving

  • Spread occurs via direct contact or swimming pools

  • If lesions spread rapidly or cause a rash, return to clinic

Verruca Vulgaris (Common Warts)

• Cantharidin therapy applied to 3 inflamed warts on the right knee

• Counseling provided:

  • Warts are caused by human papillomavirus (HPV)

  • Can spread via direct contact

  • Other treatment options include salicylic acid, retinoids, Aldara cream, or cryotherapy

  • Warts may recur despite treatment

Post-Treatment Instructions

• Leave Cantharone on for 6–8 hours, then wash off thoroughly with soap and water

• Watch for possible side effects: blistering, scabbing, or pigmentary changes

• Follow-up as needed if lesions persist, spread, or recur

Conclusion

This case demonstrates the effective use of cantharidin therapy for treating molluscum contagiosum and warts in pediatric patients. At Village Dermatology in Katy and Houston, TX, we provide comprehensive and child-friendly dermatologic care for viral skin infections, helping families manage both the medical and cosmetic aspects of these conditions.

Guttate Psoriasis in a 32-Year-Old Male: Case Study and Treatment with Light Therapy

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we treat a wide range of skin conditions, including psoriasis. This case highlights a 32-year-old male with guttate psoriasis, a form of psoriasis that often appears suddenly and can be triggered by infections such as strep throat.

Patient Presentation

A 32-year-old male presented for evaluation of red, flaky, itchy skin lesions. The psoriasis had been present for several months and was distributed across multiple areas of the body.

He reported no family history of psoriasis and had not previously tried biologic therapies or other systemic treatments. At presentation, he was using only a prescription topical steroid (triamcinolone cream).

Dermatologic Examination

A comprehensive skin exam was performed, including use of a dermatoscope.

Findings included:

• Guttate psoriasis: Multiple small, red, scaly papules scattered across the body.

• Body Surface Area (BSA) Involvement: Estimated at 20%.

• Skin type: IV (moderate brown skin).

No other significant abnormalities were detected.

Impression and Plan

Diagnosis: Guttate Psoriasis (L40.4)

This type of psoriasis is typically associated with an immune response, often following strep throat infections. It presents with numerous small, red, scaly spots resembling “raindrops” on the skin.

Treatment Plan

• Continue topical triamcinolone cream as needed.

• Initiate light therapy (phototherapy) to reduce inflammation, slow down excessive skin cell turnover, and promote clearance of lesions.

• Patient agreed to proceed with treatment.

Counseling

• Guttate psoriasis often resolves with treatment of the triggering infection.

• Other options include topical steroids, UV therapy, and systemic therapies (reserved for severe or persistent cases).

• Patients with a history of guttate psoriasis have an increased risk of developing chronic plaque psoriasis later in life.

• Advised to return if symptoms worsen or fail to improve after several months of treatment.

Key Takeaway

This case illustrates the importance of early recognition and treatment of guttate psoriasis. With proper dermatologic care, patients can achieve significant improvement through therapies such as topical treatments and phototherapy.

At Village Dermatology in Katy and Houston, TX, we provide comprehensive evaluation and treatment for psoriasis and other chronic skin conditions.

Case Report: Full Body Skin Examination in a 52-Year-Old Female with Multiple Benign Lesions | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Full body skin examinations are a vital part of preventive dermatology, particularly for patients with a history of tanning bed use or multiple skin lesions. At Village Dermatology in Katy and Houston, Texas, our dermatologists carefully evaluate the skin for concerning growths while providing patient education about sun safety and skin cancer prevention. This case highlights a 52-year-old female who presented for her annual skin examination.

Patient Presentation

The patient, a 52-year-old female, presented for a routine full body skin exam. She reported skin lesions on the chest that had been present for several months. They were asymptomatic and of moderate severity. She has a history of tanning bed use, which increases her risk of skin cancer.

Examination

A comprehensive full body skin exam was performed, including the scalp, face, trunk, extremities, nails, and groin (patient declined underwear removal). A dermatoscope was used for detailed mole evaluation.

Findings included:

• Benign nevi: Regular, symmetrical moles without concerning features

• Lentigines: Sun-induced pigmented lesions (sunspots)

• Cherry angiomas: Small vascular growths

• Seborrheic keratoses: Benign, warty growths

• Dermatofibromas: Firm nodules on right calf and left buttock

• Rash on right ear: Possible dermatitis, differential includes seborrheic dermatitis vs. eczema

• Neoplasm of uncertain behavior: Courtesy liquid nitrogen (LN2) treatment performed

The patient was otherwise well-appearing, alert, and in no acute distress.

Counseling & Management

1. History of Tanning Bed Use

• Counseling on increased melanoma, basal cell carcinoma, and squamous cell carcinoma risk

• Emphasized sun avoidance, sunscreen SPF 30+, and protective clothing

2. Benign Nevi (D22.9)

• No treatment required

• Patient educated on monthly self-skin checks and to return for changes in size, color, or symptoms

3. Lentigines (L81.4)

• Benign, but may be treated with sunscreen, retinoids, chemical peels, or laser if desired

• Counseling on consistent broad spectrum SPF 30+ use

4. Cherry Angiomas (D18.01)

• Benign vascular lesions, no treatment required

• May be removed with laser or electrodesiccation if cosmetic concerns arise

5. Seborrheic Keratoses (L82.1)

• Common, benign growths that increase with age

• No treatment needed

6. Dermatofibromas (D23.71, D23.5)

• Benign scar-like nodules

• Stable, but may be surgically removed if symptomatic or enlarging

7. Dermatitis, Unspecified (L30.9)

• Rash on right ear treated with over-the-counter hydrocortisone cream

• Patient advised to return if not improving

8. Neoplasm of Uncertain Behavior

• Treated with liquid nitrogen cryotherapy today

• Monitored for resolution; follow-up in 1 year

Conclusion

This case demonstrates the importance of comprehensive annual skin exams, especially in patients with risk factors such as tanning bed history. At Village Dermatology in Katy and Houston, TX, we provide thorough evaluations, identify both benign and concerning lesions, and counsel patients on skin cancer prevention and sun safety.

Case Study: Pilar Cyst, Benign Nevi, and Sun Damage in a 37-Year-Old Female

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we routinely evaluate patients for skin lesions to identify both benign and potentially concerning findings. This case highlights a 37-year-old female presenting for a comprehensive skin exam, with findings including a pilar cyst, benign moles, lentigines (sun spots), and seborrheic keratosis.

Patient Presentation

A 37-year-old female presented as a new patient for evaluation of brown skin lesions present throughout the body. The lesions had been present for years, were moderate in severity, and had not been treated in the past. She reported no personal history of skin cancer.

Dermatologic Examination

A full-body skin exam was performed with a dermatoscope. Key findings included:

• Pilar Cyst: A firm, subcutaneous cyst located on the mid-occipital scalp.

• Benign Nevi (Moles): Symmetrical, evenly pigmented macules and papules throughout, including a 4 mm mole on the left midback, documented for monitoring.

• Lentigines (Sun Spots): Reticulated, light tan macules distributed in sun-exposed areas.

• Seborrheic Keratosis: A pigmented, waxy papule and flat lesion on the right leg.

No evidence of skin cancer was noted.

Impression and Plan

Pilar Cyst

• Counseling: Pilar cysts are benign keratin-filled sacs that often run in families.

• Plan: No treatment required unless cyst becomes painful, red, or ruptures.

Benign Nevi

• Plan: Observation, with a 6-month recheck of the mole on the back.

• Counseling: Monthly self-skin checks recommended; patient advised to report any changes in size, shape, or color.

Lentigines (Sun Spots)

• Plan: Emphasis on sun protection with broad spectrum SPF 30+ sunscreen.

• Treatment options: Topical bleaching creams, retinoids, chemical peels, or laser for cosmetic improvement.

Seborrheic Keratosis

• Counseling: Benign, age-related growths that require no treatment unless irritated or cosmetically undesired.

Key Takeaway

This case illustrates the importance of regular skin exams for early detection and reassurance. While all findings were benign, the patient received counseling on sun safety, mole monitoring, and when to seek medical attention.

At Village Dermatology in Katy and Houston, TX, we specialize in comprehensive skin exams, mole monitoring, sun protection counseling, and cosmetic dermatology for both prevention and peace of mind.

Case Report: Atopic Dermatitis and Folliculitis in a 28-Year-Old Patient | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Chronic skin conditions like atopic dermatitis (eczema) and folliculitis can significantly affect quality of life if not properly treated. At Village Dermatology in Katy and Houston, Texas, our dermatologists specialize in evaluating persistent rashes, providing targeted treatment, and educating patients on long-term skin care strategies. This case highlights a 28-year-old patient presenting with eczema flare-ups and folliculitis.

Patient Presentation

The patient, a 28-year-old, presented with:

• Itchy, red rash on arms and left hand, present for several months

• History of childhood eczema

• New acne-like bumps on the buttocks, especially after wearing tight clothing

The patient was not on any treatment prior to evaluation.

Examination

A dermatologic examination revealed:

• Eczema patches: well-demarcated, eczematous, inflamed patches on the arms and hands

• Folliculitis: follicular-based pustules on the buttocks

The patient appeared well-nourished, alert, and in no acute distress.

Impressions & Treatment Plan

1. Atopic Dermatitis (Eczema, L20.89)

• History of flares since childhood

• Prescribed triamcinolone acetonide 0.1% cream, applied BID during flares for up to 14 days/month

• Advised on proper skin care:

  • Use lukewarm water with mild cleansers

  • Apply emollients (CeraVe, Cetaphil, Vanicream) 2–3 times daily

  • Avoid scented detergents and fabric softeners

  • Moisturize immediately after bathing

• Counseling on triggers: stress, scented soaps, detergents, dry skin, weather changes, and scratching

• Education on side effects of long-term steroid use, including skin thinning and hypopigmentation

2. Folliculitis

• Likely exacerbated by tight-fitting clothing and friction

• Patient already using benzoyl peroxide wash (Panoxyl bar)

• Prescribed clindamycin 1% gel, applied once to twice daily for prevention and treatment

• Counseled that post-inflammatory hyperpigmentation (brown spots) may remain temporarily but fade with time

• If resistant, future treatment may include oral doxycycline

Counseling & Education

The patient was instructed to:

• Continue moisturizers daily for eczema

• Use benzoyl peroxide wash and clindamycin for folliculitis

• Avoid overuse of topical steroids to minimize side effects

• Return for follow-up in 2 months or sooner if symptoms worsen

Conclusion

This case highlights the importance of personalized dermatologic care for patients with both eczema and folliculitis. At Village Dermatology in Katy and Houston, TX, our team provides tailored treatment plans combining medications, lifestyle guidance, and preventive care to ensure healthy skin and improved quality of life.

Case Study: Epidermal Inclusion Cyst on the Neck in a 33-Year-Old Female

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we often evaluate patients who present with long-standing nodules or growths on the skin. This case features a 33-year-old female who presented with a firm nodule on the posterior neck, ultimately diagnosed as an epidermal inclusion cyst.

Patient Presentation

A 33-year-old female presented for evaluation of a firm nodule on the right posterior neck, which had been present for 10 years. The lesion was moderate in severity but had not been previously treated.

She declined a full skin examination and requested evaluation only of the symptomatic area.

Dermatologic Examination

A focused exam of the head, lips, and neck was performed with dermatoscopy.

Findings included:

• Subcutaneous cyst with a prominent follicular pore, consistent with an epidermal inclusion cyst.

• Size: approximately 1.5 cm, located on the right medial trapezial/posterior neck region.

No other concerning findings were identified.

Impression and Plan

Epidermal Inclusion Cyst (L72.8)

• Counseling: Epidermal inclusion cysts are benign sacs beneath the skin filled with keratin.

• Expectations: They typically remain stable, though they can enlarge, rupture, or become tender if inflamed.

• Plan: Observation. No treatment required at this time.

• Instructions: Patient was advised to return if the cyst ruptures, becomes red, painful, or shows signs of infection.

Key Takeaway

Epidermal inclusion cysts are benign, slow-growing lesions that can often be managed conservatively. While removal may be considered for cosmetic reasons or if the cyst becomes inflamed, observation is appropriate when the lesion is stable and asymptomatic.

At Village Dermatology in Katy and Houston, TX, we provide expert evaluation and management of cysts, nodules, and other skin growths, offering both reassurance and treatment options tailored to patient needs.

Case Report: Hair Loss, Allergic Contact Dermatitis, and Seborrheic Dermatitis in a 44-Year-Old Female | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Patients often present to dermatology clinics with more than one skin or hair concern. At Village Dermatology in Katy and Houston, Texas, we take a comprehensive approach, addressing each condition with both medical treatment and patient education. This case highlights a 44-year-old female with generalized hair loss, seborrheic dermatitis of the scalp, and allergic contact dermatitis affecting her toes.

Patient Presentation

The patient is a 44-year-old female who sought a second opinion for hair loss. She had been on oral minoxidil (half a tablet daily) for three months without noticeable improvement. In addition, she reported:

• Recurrent rashes on her toes triggered by beach visits (suspected allergic contact dermatitis)

• Scalp scaling and itching consistent with seborrheic dermatitis

Examination

A focused exam revealed:

• Diffuse thinning of scalp hair, consistent with female pattern hair loss

• Well-demarcated, geometric eczematous patches on toes consistent with allergic contact dermatitis

• Scaling and erythema on the scalp, consistent with seborrheic dermatitis

The patient was otherwise well-developed, oriented, and in no acute distress. A dermatoscope was used for scalp evaluation.

Impressions & Treatment Plan

1. Allergic Contact Dermatitis (L23.9)

• Triggered by beach exposure, etiology unclear

• Prescribed clobetasol 0.05% cream, applied BID during flares (up to 2 weeks/month)

• Counseling provided on hypoallergenic products, potential need for patch testing, and steroid side effects

2. Seborrheic Dermatitis

• Chronic scalp condition with flares

• Prescribed ketoconazole 2% shampoo, used daily during flares and 1–3 times weekly for maintenance

• Prescribed fluocinonide 0.05% solution, BID PRN during flares

• Counseling on long-term management, stress as a trigger, and steroid side effects

3. Androgenetic Alopecia (Female Pattern Hair Loss, L64.8)

• Patient counseled that 3 months of oral minoxidil is too early for results (typically 6–12 months needed)

• Treatment plan updated:

  • Continue oral minoxidil

  • Add oral finasteride 5 mg daily

  • Discussed additional options: PRP (platelet-rich plasma), AlmaTED treatments, supplements (Nutrafol, Viviscal), and at-home red light therapy

• Counseling on expectations: Female pattern hair loss is genetically determined, slowly progressive, and typically presents with widened midline parting while maintaining the frontal hairline

Conclusion

This case highlights the importance of comprehensive dermatology care in managing overlapping skin and hair conditions. At Village Dermatology in Katy and Houston, TX, our specialists combine advanced medical treatments, patient education, and cosmetic options to provide tailored care for conditions like hair loss, seborrheic dermatitis, and allergic contact dermatitis.

Case Study: Androgenetic Alopecia in a 22-Year-Old Male and Treatment with PRP Therapy

by : Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we see many young men concerned about progressive hair loss. This case highlights a 22-year-old male presenting with diffuse scalp thinning, ultimately diagnosed with androgenetic alopecia (male pattern hair loss) and opting for platelet-rich plasma (PRP) therapy.

Patient Presentation

A 22-year-old male presented as a new patient for evaluation of generalized hair loss on the scalp. The hair thinning had been ongoing for 5 months, was moderate in severity, and had gradually worsened.

He had no prior treatments other than over-the-counter Nutrafol supplements.

Dermatologic Examination

A focused exam of the scalp and face was performed with dermatoscopy. Findings included:

• Diffuse non-scarring hair loss across the scalp.

• Patterned thinning in the vertex and frontotemporal regions, consistent with androgenetic alopecia (AGA).

Impression and Plan

Androgenetic Alopecia (Male Pattern Hair Loss)

• Diagnosis: Clinical findings consistent with AGA. Punch biopsy was discussed for further confirmation, but not pursued at this time.

• Treatment Options Reviewed:

  • Oral minoxidil

  • Finasteride

  • Spironolactone (off-label in men, rarely used)

  • Topical Rogaine (minoxidil)

  • Low-level laser therapy

  • Microneedling

  • Hair transplant surgery

  • PRP (platelet-rich plasma) therapy

• Side effects, benefits, and expectations were reviewed thoroughly.

Patient Decision

After an in-depth discussion, the patient elected to proceed with PRP therapy.

• Counseling included the fact that PRP is cosmetic and not covered by insurance.

• Patient was advised on what to expect from the procedure and the importance of follow-up.

Counseling

• Hair Care: AGA can be slowed with medications such as minoxidil and finasteride; hair transplantation is an option in advanced cases.

• Expectations: AGA is genetically pre-determined, slowly progressive, and most prominent in the vertex and frontal scalp.

• Monitoring: The patient was instructed to return if hair loss worsens or fails to improve with therapy.

Follow-Up

The patient was scheduled to begin PRP therapy and will follow up in 4 months for re-evaluation.

Key Takeaway

This case underscores the importance of early diagnosis and treatment in male pattern hair loss. With a combination of modern therapies such as PRP, oral medications, and topical treatments, patients can often achieve significant improvement in hair density and quality.

At Village Dermatology in Katy and Houston, TX, we specialize in advanced hair restoration options, including PRP therapy, oral and topical treatments, and counseling for hair loss prevention.

Case Report: Punch Excision of an Epidermal Inclusion Cyst in a 39-Year-Old Male | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Epidermal inclusion cysts are among the most common benign skin lesions seen in dermatology. While often harmless, patients may choose removal for cosmetic, diagnostic, or preventive reasons. At Village Dermatology in Katy and Houston, Texas, we provide expert evaluation and removal of cysts with safe, in-office procedures. This case highlights a 39-year-old male who presented with a cyst on his upper back.

Patient Presentation

The patient, a 39-year-old male, reported a cyst on his right upper back/superior thoracic spine that had been present for nearly a year. The lesion was enlarging, moderate in severity, and persistent. The patient denied pain, drainage, or episodes of inflammation.

Examination

Focused exam of the back revealed:

• Well-nourished, well-appearing male

• Epidermal inclusion cyst measuring 1.6 x 1.2 cm on the superior thoracic spine

• No erythema, tenderness, or drainage at the time of evaluation

Diagnosis

• Epidermal Inclusion Cyst (L72.8)

• Associated cutaneous inflammation

Management & Procedure

Counseling

The patient was reassured that epidermal inclusion cysts are benign sacs containing keratin and do not require treatment unless inflamed, painful, or cosmetically concerning. He elected for removal. Risks, benefits, and alternatives were reviewed, including possible infection, recurrence, or scarring.

Punch Excision

• Location: Superior thoracic spine

• Size: 1.6 x 1.2 cm

• Anesthesia: Local infiltration with 1% lidocaine with epinephrine

• Procedure:

  • Skin prepped with Betadine and draped

  • A 4 mm punch tool was used to excise the cyst opening

  • Blunt dissection performed to remove cyst contents and capsule

  • Hemostasis achieved with electrocautery

  • Simple interrupted closure with 4-0 nylon sutures

  • Petrolatum and sterile dressing applied

• Estimated blood loss: Minimal

• Complications: None

Post-Procedure Care

The patient was instructed to:

• Avoid heavy lifting, exercise, or swimming for 14 days

• Keep the wound clean and apply petrolatum as directed

• Return for suture removal in 14 days

• Contact the office for fever, bleeding, severe pain, or signs of infection

Conclusion

This case demonstrates the successful punch excision of a benign epidermal inclusion cyst in an adult male patient. At Village Dermatology in Katy and Houston, TX, our dermatologists specialize in safe removal of cysts, moles, and skin growths, ensuring optimal cosmetic outcomes and patient peace of mind.

Case Study: Enlarging Growth on the Back – Lipoma in a 43-Year-Old Female

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, patients often present with new or enlarging growths that raise concern about skin cancer or other serious conditions. This case highlights a 43-year-old female with a darkening, enlarging growth on her upper back, ultimately diagnosed as a lipoma.

Patient Presentation

A 43-year-old female presented as a new patient for evaluation of growths on the right upper back. The lesions had been darkening, enlarging, and irregular in appearance for several months. They were moderate in severity and had not been treated in the past.

Her main concern was whether these growths represented something malignant, and she sought evaluation and management.

Dermatologic Examination

A full-body exam was performed, including the scalp, face, trunk, and extremities, with the assistance of a dermatoscope.

Findings included:

• Lipoma: A soft, subcutaneous, slow-growing mass measuring approximately 1.8 cm on the upper back.

No other suspicious lesions were noted.

Impression and Plan

Lipoma

The growth was determined to be a lipoma, a benign tumor made of fatty tissue.

Counseling and Education:

• Lipomas are noncancerous and slow-growing.

• They often remain stable but can gradually enlarge over time.

• No treatment is strictly necessary unless the lesion is bothersome, enlarging, or cosmetically concerning.

Treatment Recommendation:

• Surgical excision was recommended for definitive treatment and removal.

• The patient was offered referral to Dr. Vaughn or Dr. Armenta for the procedure.

The patient elected to proceed with surgical removal.

Key Takeaway

Not all enlarging or darkening skin growths are dangerous. Lipomas are benign fatty tumors, but professional evaluation is essential to rule out other possibilities. In this case, the patient was reassured, counseled, and scheduled for surgical removal.

At Village Dermatology in Katy and Houston, TX, we provide expert evaluation of growths, lumps, and skin lesions, offering both reassurance and treatment options tailored to each patient.

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.