Why are the pimple spots not reducing after Roaccutane use?

Question

Hello doctor,

I am in my seventh month of taking Roaccutane. My weight is 125.66 Ibs and I am taking 40 mg daily. I am still getting acne and blemishes. I have one large blemish that is getting small in some days. I find it getting bigger once I wake up in the morning. I always tell my doctor about this blemish. She is saying it is going to take time to clear. Now she wants to stop the course for two months and start again later as all my blood tests results are good. What do you suggest? What is the solution? I have attached photographs.

Answer 1

Hello,

Welcome to icliniq.com.

I saw your clinical picture (attachment removed to protect the patient's identity). It is looking like acne cyst for me. The probable diagnosis is acne grade 4 with scars. Is the blemish raised and painful? Can you feel that with your finger or is it just flat red blemish?

If it is raised, as I am seeing in that picture, then you will need an intralesional injection of Triamcinolone (glucocorticoid) into to affected area. This will help to clear it faster compared to Roaccutane (Isotretinoin). If it is flat red and blemishes then I would suggest you use Brimonidine (alpha-2 adrenergic agonist) gel to the affected area twice a day for one week and massage a little. This clears up the redness. I feel seven months of Isotretinoin is quite long treatment duration, but the treatment regimen varies from country to country. I usually see good results with three months of Roaccutane (Isotretinoin) 20 mg. It also depends on skin type and body response. Consult your specialist doctor, discuss with him or her and with their consent take the medicines.

I suggest you also take an intralesional injection of Triamcinolone. I am sorry I really cannot comment on Isotretinoin therapy from your dermatologist. But you can discuss with your dermatologist regarding the intralesional injection of triamcinolone. Please attach the clinical picture with good visibility of skin lesion.

Answer 2

Hello,

Welcome back to icliniq.com.

Thank you for the clinical pictures (attachment removed to protect the patient's identity). I feel you should discuss regarding Brimonidine and intralesional injection of Triamcinolone with your dermatologist. Because both of them are prescription medicines. They are not available over-the-counter.