How do I manage stubborn acne despite my skin care routine?

Hi,

Welcome to icliniq.com.

I understand your concern.

From your history, it appears that you have persistent inflammatory acne predominantly on the chin and cheeks, which worsens cyclically around your periods. This suggests a hormonal component, even though you have regular menstrual cycles and only mild facial hair.

Long-standing acne like yours can also lead to post-inflammatory hyperpigmentation (dark marks) and open pores, which are common sequelae.

As your previous treatments with Adoxa (Doxycycline) and Benclin (Benzoyl peroxide and Clindamycin) have not been effective, you need to switch to oral Isotretinoin and a topical medium-strength retinoid such as Adapalene rather than Skin-A (Tretinoin), as it is more potent and can cause purging acne in many people.

When patients do not respond to Doxycycline, according to standard textbooks and international guidelines, treatment is shifted to Isotretinoin. This medication needs to be taken for at least three to four months under strict medical supervision.

It is very important to understand the contraindications and precautions before starting treatment. Isotretinoin is highly effective for long-standing acne.

Contraindications and precautions you must follow you must follow are:

1. Isotretinoin must not be taken during pregnancy, as it can cause severe birth defects. Women of childbearing age must use reliable contraception during treatment and for at least one month after stopping the drug. It is also not recommended during lactation.

2. Avoid using Isotretinoin if you have a known allergy or any of its components.

3. Isotretinoin is contraindicated in individuals with active liver disease.

4. Isotretinoin can increase lipid levels, so patients with pre-existing severe hyperlipidemia should avoid it. In otherwise healthy patients, it is generally safe when monitored.

Please get the following tests done before starting treatment: liver function tests (LFTs), fasting lipid profile, and a pregnancy test (for married women).

Isotretinoin is considered the gold-standard treatment for resistant and stubborn acne.

The treatment plan is to:

• Start capsule Actrac (Isotretinoin) 20 mg once daily for one month (follow up after one month).

• Adapco gel (Adapalene): Apply a pea-sized amount at bedtime, leave on for four hours, then rinse.

• Acsolve gel (Clindamycin): Apply in the morning after cleansing.

These topical treatments help reduce inflammation, control bacterial growth, and prevent new acne.

Use UVion (Zinc oxide and Titanium oxide) sunscreen daily to prevent dark marks from worsening. Apply Dermive (colloidal oatmeal, ceramides, and glycerin) sensitive moisturizer to maintain the skin barrier and reduce irritation.

Avoid harsh scrubs or over-washing, as these can aggravate acne and pigmentation. Maintain a consistent skincare routine and avoid picking or squeezing pimples. Keep hair and hands away from the face to reduce flare-ups.

With consistent use of this combination therapy and appropriate skincare, you should see a gradual reduction in acne, inflammation, and dark marks. Please follow up after one month of Isotretinoin use, or earlier if you have any concerns or queries.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.