Indications/Patient Presentation:
- 20-year-old female with severe facial acne
- College student who rides horses and spends time outdoors and, in a barn, (dusty, dirty, sweaty environment)
- Topical and compounded antibiotic acne creams have not worked
- Wants to have clear skin as she is embarrassed about her appearance
Objective Findings:
- Physical exam shown to be non-contributory
- Healthy female with history of severe facial acne
- Patient has NKA and takes no medications, she has a hormonal birth control implant
- Severe acne and acne scarring on face, with severe erythema and dry skin
Treatment:
- Decision to treat with isotretinoin (Accutane), patient counseled on risks and benefits and requirement for 2 forms of birth control during therapy (she has a hormonal birth control implant and will use latex condoms)
- Labs drawn and sent to Quest, including: CBC, CMP, Lipids, TSH, T4, Serum pregnancy test
- Serum pregnancy test (negative)
- CMP, CBC, TSH, T4 and Lipids WNL
- Urine pregnancy test (negative)
- Prior authorization for Accutane filed with health insurance carrier (approved)
- Enrolled patient in iPledge program for isotretinoin
- Stared on isotretinoin 20mg daily after results of pregnancy tests confirmed
- I dispensed Rion Aesthetics (plated)™ Skin Science Intense Serum (platelet exosomes) for application twice daily
- I instructed her to stay out of the sun and use a good sunscreen with at least SPF 32
- Followed up with in-office monthly visits as per iPledge requirements, including urine pregnancy tests monthly, and counseling on use of 2 forms of birth control
- Patient took 2 months of isotretinoion 20mg po daily
- I increased the dose to 30mg for months 3-5
- I further increased the dose to 40mg for months 6-9
See Figure 1 for before and after photos.
Figure 1. Before acne treatment (Figure a), 8-week follow-up visit (Figure b), conclusion of acne treatment at 36 weeks (Figure c).
Photos are the property of UltaMed Corporation. Not for re-use or distribution.
Follow-up at 8 weeks:
- Patient still had moderate acne on cheeks, with mild erythema, very dry skin and chapped lips
- Urine pregnancy test negative
- iPledge counseling provided
- Increased dose of isotretinoin to 30mg po daily
- Dispensed more (plated) Intense Serum for twice daily application
- See Figure 1b
Follow-up at 24 weeks:
- Patient still had mild pustular acne on the cheeks
- Urine pregnancy test negative
- iPledge counseling provided
- Labs drawn and sent to Quest: CBC, CMP, Lipids were WNL
- Increased dose of isotretinoin to 40mg po daily
- Dispensed more (plated) Intense Serum for twice daily application
Follow-up at 36 weeks:
- Patient’s skin is clear with mild acne scarring (which I will treat with Morpheus8 in the future)
- Urine pregnancy test negative
- Isotretinoin discontinued
- Dispensed more (plated) Intense Serum for twice daily application
Conclusion:
Patient very satisfied with outcome and is no longer embarrassed about her appearance. She has a new boyfriend.
