Effective Treatment Options for Cystic Acne: Your Questions Answered

Treatment for cystic acne?

Hello, Doctor.
I am currently undergoing treatment for acne with oral doxycycline and diclofenac sodium, along with topical medications such as Acne Control and Retin-A.
It has been nearly a month, and I am seeing gradual improvement.
However, my doctor mentioned that if the results are not satisfactory in two weeks, I may need to start oral isotretinoin for treatment.
I previously underwent a six-month course of antibiotics for acne, which was successful, and I only experienced occasional breakouts until now, when it suddenly flared up after five years.
I have three main questions for you:
1.
Is the duration of my current antibiotic treatment too short?
2.
My BMI is only 16; will taking oral isotretinoin increase the risk of side effects for me, considering a dosage of 20 mg per day?
3.
Is it necessary to take oral isotretinoin for a full six months? My doctor recommends early isotretinoin treatment to minimize scarring, but I am quite hesitant due to the potential side effects (such as initial breakout, liver impact, dry eyes, mood changes, etc.).
However, I am also very concerned about the possibility of developing significant pitted scars.
I feel quite anxious about these issues, so I would appreciate your guidance on these three questions.
Thank you.

Songzi, 20~29 year old female. Ask Date: 2017/12/14

Dr. Wu Yuxin reply Dermatology

1.
It is generally recommended to consider using retinoic acid after 1-3 months if traditional treatments are ineffective or unsatisfactory.
2.
Weight should be assessed, not just BMI.
3.
The decision to use retinoic acid may not necessarily take 6 months; it is somewhat subjective, but a choice must be made.
If traditional treatments are ineffective and there is still a desire to treat acne, it may sometimes be necessary.

Reply Date: 2017/12/14

More Info

Cystic acne, also known as nodulocystic acne, can be a challenging condition to treat, and it often requires a multifaceted approach. Based on your current treatment regimen, which includes doxycycline and topical treatments, it seems you are on the right track. However, I understand your concerns regarding the potential transition to oral isotretinoin (commonly referred to as Accutane) if your condition does not improve significantly in the next couple of weeks. Let’s address your questions one by one.

1. Duration of Antibiotic Treatment: The duration of antibiotic therapy for acne can vary significantly depending on the severity of the condition and the individual’s response to treatment. While one month may seem short, it is not uncommon for dermatologists to prescribe antibiotics for several months, especially if the acne is severe or cystic. If you have been seeing gradual improvement, it may be worth continuing the doxycycline for a bit longer before making a decision about switching to isotretinoin. However, if your doctor suggests that the response is insufficient, they may recommend isotretinoin sooner rather than later to prevent further scarring.

2. BMI and Isotretinoin Side Effects: Your BMI of 16 indicates that you are underweight, which can indeed influence how your body metabolizes medications, including isotretinoin. Isotretinoin is known for its potential side effects, including dryness of the skin and mucous membranes, potential liver enzyme elevation, and mood changes. While being underweight does not necessarily increase the risk of these side effects, it is essential to discuss your concerns with your dermatologist. They may want to monitor you more closely or adjust the dosage based on your weight and overall health. The standard starting dose for isotretinoin is typically around 0.5 to 1 mg/kg/day, so at 20 mg, you would be on the lower end of the dosing spectrum, which may help mitigate some side effects.

3. Duration of Isotretinoin Treatment: The typical course of isotretinoin treatment lasts about six months, but the exact duration can vary based on the severity of your acne and how well you respond to the medication. Some patients may see significant improvement in a shorter time frame, while others may require the full six months or even longer. The goal of isotretinoin is not only to clear existing acne but also to reduce the risk of future breakouts and scarring. Early intervention with isotretinoin can indeed help minimize scarring, which is a valid concern given your history of cystic acne.
It is understandable to feel anxious about the potential side effects of isotretinoin, especially considering the risk of an initial worsening of acne (often referred to as the "purging" phase) and other side effects. However, many patients find that the benefits of isotretinoin, including significant long-term improvement in their skin condition, outweigh the temporary discomfort of side effects.
In conclusion, I recommend having an open and honest discussion with your dermatologist about your concerns regarding isotretinoin, including your anxiety about side effects and your previous experiences with acne treatment. They can provide personalized advice and may suggest additional monitoring or supportive treatments to help manage side effects. Remember, the goal is to achieve clear skin while minimizing risks, and your healthcare provider is there to help you navigate this process.

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