Atypical facial scarring after the initiation of isotretinoin

Presenter: Wai Ping Chan DO, Kevin Svancara DO, Vernon T. Mackey DO

Dermatology Program: Advanced Desert Dermatology

Program Director: Vernon T. Mackey

Submitted on: August 27, 2014

CHIEF COMPLAINT: Scarring and cystic acne of the face and neck after receiving 5 months of isotretinoin for nodulocystic acne by his previous dermatologist

CLINICALHISTORY: 17 y/o, healthy Caucasian male presents with scarring and cystic acne of the face and neck after receiving 5 months of isotretinoin for nodulocystic acne by his previous dermatologist. Painful cystic acne with scarring and fluctuant masses formed on the face and neck for 18 months. The patient denies involvement of other body areas including the chest, back, axilla, lower abdomen, or groin area. The patient denies any fever, joint pain, muscle aches, or other systemic complaints.

Previous Treatment: Benzoyl peroxide, clindamycin, iodosorb, doxycycline, isotretinoin, and Prednisone after the exacerbation during isotretinoin therapy.

Other information: The patient denies any history of anabolic steroid use or a family history of severe cystic acne. The patient stated that his acne had progressively worsened during the course of isotretinoin therapy with the development of more acne lesions, interconnecting abscesses, and keloidal scarring.

PHYSICAL EXAM:
Multiple erythematous papules, pustules, plaques with underlying fluctuant, tender cystic nodules, atrophic and keloidal acne scars.