Oral A Acid: Why Isn't It Working for My Acne? - Dermatology

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Oral isotretinoin, commonly referred to as A acid, is a powerful medication primarily used to treat severe acne. While many patients experience significant improvement in their skin condition, some may find that their acne persists despite prolonged use. If you have been taking isotretinoin for over ten months at a daily dosage of 20 mg and are still experiencing breakouts, there are several factors to consider.

First, it’s essential to understand that isotretinoin works by reducing the size and activity of sebaceous (oil) glands, decreasing sebum production, and preventing clogged pores. However, the response to the medication can vary significantly from person to person. Some individuals may experience a delayed response, while others may not respond as effectively due to various underlying factors.

One possibility is that your acne may not be solely caused by excess oil production. Acne can also be influenced by hormonal changes, bacterial overgrowth, and inflammation. If your acne is primarily hormonal, isotretinoin may not be the most effective treatment. In such cases, hormonal therapies, such as oral contraceptives or anti-androgens, may be more beneficial.

Another consideration is the dosage of isotretinoin. While 20 mg is a common starting dose, some patients may require higher doses to achieve significant results. The total cumulative dose of isotretinoin is often more critical than the daily dose. A higher cumulative dose over the treatment period can lead to better outcomes. Discussing your treatment plan with your dermatologist may help determine if an increase in dosage is appropriate for you.

Additionally, the duration of treatment can also play a role in effectiveness. While some patients see improvement within a few months, others may need a longer course of treatment. If you have not experienced any improvement after ten months, it may be worth discussing alternative treatment options with your healthcare provider.

Skin peeling and dryness are common side effects of isotretinoin, and while moisturizing can help alleviate these symptoms, it may not address the underlying acne issue. If you find that topical moisturizers are ineffective, consider discussing with your dermatologist about prescription-strength moisturizers or other topical treatments that may complement your isotretinoin therapy.

Lastly, it’s crucial to ensure that you are following your dermatologist’s recommendations closely. Regular follow-up appointments are essential to monitor your progress, adjust dosages, and address any concerns. If you feel that your current treatment plan is not working, do not hesitate to communicate this with your healthcare provider. They can provide guidance, reassess your condition, and potentially explore alternative therapies or adjunct treatments that may be more effective for your specific situation.

In summary, while isotretinoin is a highly effective treatment for many patients with severe acne, individual responses can vary. If you have been on isotretinoin for an extended period without improvement, consider discussing your treatment plan with your dermatologist to explore potential adjustments or alternative therapies. Remember, managing acne can be a complex process, and finding the right treatment may take time and collaboration with your healthcare provider.