Why have my blemishes not improved even after extended use of Roaccutane?

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.

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.