Why does my acne keep recurring despite multiple treatments?

Hello,

Welcome to icliniq.com.

I understand your concern.

Thank you for sharing detailed information about the acne condition. Acne can be painful and distressing, and the concern is understandable. Based on the history and the attached image (attachment removed to protect the patient's identity), the findings suggest persistent and resistant inflammatory acne, predominantly affecting the cheeks.

Long-standing acne of this nature can also lead to post-inflammatory hyperpigmentation (PIH), which appears as dark marks, along with enlarged or open pores. These are common sequelae of chronic acne.

Previous treatment with oral Doxycycline and topical Adapalene has not provided adequate improvement. In cases where acne does not respond to standard antibiotic therapy, international treatment guidelines recommend switching to oral Isotretinoin along with a topical retinoid combination, such as Adapalene with Benzoyl peroxide.

When patients do not respond to antibiotics as expected, Isotretinoin is considered the next line of treatment. This medication is usually prescribed for a duration of three to four months, strictly under medical supervision. Isotretinoin is highly effective for long-standing, resistant acne; however, it is essential to understand its contraindications and precautions before starting therapy.

Contraindications and precautions of Isotretinoin include:

• Isotretinoin must not be used during pregnancy due to the risk of severe birth defects. Women of childbearing age must use reliable contraception during treatment and for at least one month after discontinuation. It is also not recommended during breastfeeding.

• Isotretinoin should be avoided in individuals with a known allergy to the drug or its components.

• Isotretinoin is contraindicated in patients with active liver disease.

• Isotretinoin may increase cholesterol and triglyceride levels. Patients with severe pre-existing lipid abnormalities should avoid its use. In otherwise healthy individuals, it is generally safe when monitored.

Before starting Isotretinoin, baseline investigations are required, including liver function tests (LFTs), a fasting lipid profile, and a pregnancy test in married or sexually active women. Isotretinoin is considered the gold standard treatment for resistant and stubborn acne.

I would suggest the following measures:

• Start oral Isotretinoin 20 milligram capsule once daily for one month, followed by a review after one month.

• Apply Adapalene with Benzoyl peroxide gel in a pea-sized amount at bedtime. Leave it on for four hours and then rinse.

• Apply Clindamycin phosphate with Benzoyl peroxide gel in the morning after gentle cleansing. These topical medications help reduce inflammation, control bacterial growth, and prevent new acne formation.

• Use a broad-spectrum sunscreen daily to prevent worsening of dark marks.

• Apply a gentle, fragrance-free moisturizer to maintain the skin barrier and reduce irritation.

• Avoid harsh scrubs, excessive washing, or picking and squeezing pimples, as these can worsen acne and pigmentation. Maintain a consistent skincare routine, and keep hair and hands away from the face to minimize flare-ups.

With regular use of this treatment combination and proper skin care, gradual improvement in acne, inflammation, and dark marks can be expected. Follow-up is advised after one month of isotretinoin use or earlier if there are any concerns.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.