Can a non-hormonal therapy clear acne in a 25-year-old?

Question

Hello doctor,

I am 25 and have had acne since my teenage years. It was severe at age 18 and responded well to two courses of Roaccutane. My skin stayed clear for a few years. After some years, the acne came back. After over a year, I cleared up with topical Tretinoin and the Yasmin combined pill. I also had Dermapen for post-inflammatory pigmentation.

Unfortunately, I had to stop Yasmin due to high blood pressure. I was switched to Cerelle (Desogestrel-only mini pill), but now I constantly get spots again, mainly around my mouth. I still use topical Tretinoin (either 0.05 or 0.025 percent), but the acne is not improving. I have read that progestogen-only pills can make acne worse. I had low sex hormone-binding globulin levels during my teenage years, but recent blood test results were reported as normal by my general practitioner.

Would stopping Cerelle altogether be better for my skin? Or should I consider a non-hormonal option or a different pill? I am getting married and would like to manage my skin before then. What would be the best approach in my case?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern regarding recurring acne, especially considering your previous treatments with Roaccutane (Isotretinoin) and the Mini pill (Progestin-only oral contraceptive). While both have shown benefit in reducing acne severity, they are not meant for long-term use. The acne can reappear due to various internal and external factors. It is essential to identify and address these triggers to achieve better control over breakouts.

Acne can result from a variety of factors, both internal and external. Genetics plays a significant role, as individuals with a family history of acne are more prone to developing it. Hormonal imbalances, particularly conditions like polycystic ovary syndrome (PCOS), are common among young women and can trigger persistent acne; a gynecological evaluation is essential to rule this out.

Fluctuations in androgen levels can also lead to increased sebum (oil) production, which contributes to clogged pores and breakouts. Lifestyle factors such as diet, climate, the use of certain skincare products, and underlying medical conditions can all influence the severity and frequency of acne flare-ups.

A few steps I advise you to follow are:

Discontinue the mini pill, but only after consulting the prescribing doctor. It is important to keep them informed for proper follow-up.
Use a gentle face wash twice daily. Massage gently in circular motions for one minute and rinse off. It is safe for long-term use.
Apply 2.5 percent of Duac gel (Clindamycin + Benzoyl Peroxide) to active spots every morning. This helps reduce inflammation and bacteria.
Continue Tretinoin cream at night. Use a very thin layer on acne spots only, as overuse can irritate the skin.
Doxycycline 100 milligrams capsule twice daily after food for 10 days can help control inflammation and bacterial growth.
To avoid the acidity of antibiotics, take 40 milligrams of Pantoprazole 30 minutes before meals (breakfast and dinner) for 10 days.
Chemical peels using Glycolic and Salicylic acid every week for six sessions can control oil production and active acne.
Alternatively, laser therapy (Q-switched + carbon laser) once every three weeks for six sessions is effective but may be more expensive.

Certain lifestyle and skincare habits can significantly influence the management of acne. I advise you to do the following -

Avoid oily and fried foods, sugar, red meat, milk, and other dairy products, as these may contribute to the worsening of acne. Instead, one should focus on maintaining a balanced diet that includes a variety of fruits, vegetables, and dietary fiber.
It is also important to stay well-hydrated by drinking at least ten glasses of water each day.
With regard to skincare, it is best to discontinue the use of unnecessary cosmetic products during periods of active acne, as they may irritate the skin or block the pores.
Sunscreen should be avoided temporarily until the acne subsides, since certain formulations can lead to further clogging of pores.

Although acne can be recurrent and distressing, a combination of appropriate medical treatment and healthy lifestyle changes can lead to effective control. In cases where a hormonal or gynecological condition, such as polycystic ovary syndrome, is suspected, it is essential to consult a gynecologist in person for proper evaluation and guidance.

I hope this information has been helpful.

Regards.