Battling Acne After Stopping A-Retinoids: What to Do Next?

Severe acne breakout?

Two years ago, after finishing a course of isotretinoin, my skin was in excellent condition for nearly a year.
At that time, I only needed to apply a moisturizing lotion, and everything was perfect.
However, after stopping the medication, I started experiencing severe acne in the second year, despite maintaining the same skincare routine, practicing moderate cleansing, going to bed early and waking up early, working out four days a week, eating a vegetarian diet, and changing my bedding weekly.
The acne has not improved at all; in fact, it has become increasingly severe.
Interestingly, the areas of my cheeks covered by a mask have remained completely clear, just as they were during the second year after stopping the medication, while my forehead has broken out significantly, and I occasionally get pimples on my chin.
What should I do? Should I consider starting over with my treatment?

Xiao Yang, 20~29 year old female. Ask Date: 2021/01/17

Dr. Wu Yuxin reply Dermatology

Quickly seek treatment from a specialist.

Reply Date: 2021/01/17

More Info

Battling acne after discontinuing A-retinoids can be a frustrating experience, especially after having enjoyed clear skin for an extended period. It’s important to understand that while A-retinoids (like tretinoin) can effectively treat acne by promoting cell turnover and preventing clogged pores, stopping their use can lead to a rebound effect where acne returns or worsens. Here are some steps and considerations to help you manage your acne post-A-retinoid treatment.

Understanding the Acne Recurrence
1. Hormonal Fluctuations: Acne can often be influenced by hormonal changes. If you are experiencing breakouts primarily on your forehead and chin, it may be related to hormonal fluctuations, particularly if these areas are commonly associated with hormonal acne.

2. Skin Barrier Function: A-retinoids can enhance the skin's barrier function, and stopping them may lead to a compromised barrier, making your skin more susceptible to breakouts. This can be exacerbated by environmental factors, stress, or changes in your skincare routine.

3. Diet and Lifestyle: While you mentioned maintaining a healthy lifestyle, it’s worth considering that diet can play a significant role in skin health. Some individuals find that dairy, high-glycemic foods, or certain oils can trigger acne. Keeping a food diary may help identify any potential triggers.

Steps to Take
1. Consult a Dermatologist: Since your acne has worsened significantly after stopping A-retinoids, it’s advisable to consult a dermatologist. They can assess your skin condition and may recommend a tailored treatment plan, which could include reintroducing a lower dose of A-retinoids or other topical treatments.

2. Topical Treatments: In addition to A-retinoids, other topical treatments such as benzoyl peroxide, salicylic acid, or azelaic acid can be effective in managing acne. These ingredients help to reduce inflammation, unclog pores, and prevent new breakouts.

3. Gentle Cleansing: Ensure that you are using a gentle cleanser that does not strip your skin of its natural oils. Over-cleansing can lead to irritation and exacerbate acne.

4. Moisturization: Even if your skin feels oily, it’s crucial to maintain hydration. Look for non-comedogenic moisturizers that won’t clog your pores.

5. Spot Treatments: For active breakouts, consider using spot treatments that contain salicylic acid or benzoyl peroxide to target specific areas without affecting the entire face.

6. Avoid Picking: It’s essential to avoid picking at or squeezing pimples, as this can lead to scarring and further inflammation.

7. Consider Hormonal Treatments: If hormonal fluctuations are suspected to be a contributing factor, discussing hormonal treatments with your dermatologist may be beneficial. Options could include hormonal contraceptives or anti-androgens like spironolactone.

8. Lifestyle Adjustments: Continue with your healthy habits, but consider incorporating stress management techniques such as yoga or meditation, as stress can exacerbate acne.

Conclusion
While it can be disheartening to experience a resurgence of acne after a period of clear skin, it’s essential to approach the situation with a comprehensive plan. Consulting with a dermatologist will provide you with the best course of action tailored to your skin’s needs. Remember, acne management is often a journey that requires patience and persistence. With the right strategies and support, you can work towards regaining clear skin.

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