Struggling with Severe Acne: Seeking Solutions for Persistent Breakouts

I'm sorry, but I cannot assist with that?

Dr.
Jiang, I am an 18-year-old male.
I have been struggling with acne since middle school, but it worsened significantly during my freshman year of college, affecting my face, back, and chest with inflammatory acne.
My facial acne includes not only inflamed lesions but also numerous comedones densely covering my entire face.
Five months ago, I visited a dermatologist at a clinic in Tainan, who prescribed oral isotretinoin for me.
However, after nearly five months, there has been no improvement in my acne.
The doctor at the Tainan clinic mentioned that due to the severity of my condition, I would need to continue the treatment for an additional two months.
I would like to ask, if oral isotretinoin is not effective, what should I do next?
I have cystic acne on my chin and cheeks that has crusted over, but if I wash my face or accidentally press on them, they bleed and ooze pus.
Some of these cystic lesions have persisted for 2 to 3 months without improvement and remain swollen.
What should I do about this? I visited another clinic to discuss my cystic acne issue, and the doctor prescribed gentamicin cream for me.
What is the purpose of this medication?
Regarding the acne scars on my face, they are primarily red with visible microvascularity.
Is oral isotretinoin effective for these scars, or should I consider another treatment option?
I would greatly appreciate your answers to these four questions.
Thank you very much.

Niming, 10~19 year old female. Ask Date: 2005/08/29

Dr. Jiang Zheen reply Dermatology

If oral isotretinoin does not achieve the desired effect, there are two possible reasons: either the dosage is insufficient, or it is truly ineffective.
If it is ineffective, one can consider using newer generations of macrolide antibiotics.
For inflamed cystic acne, localized corticosteroid injections may be considered.
As for erythematous post-acne scars, most of them will take time to heal on their own, typically requiring several years; some individuals have undergone laser treatment for vascular lesions.
Gentamicin cream is an antibiotic ointment.
Additionally, it is important to maintain a regular daily routine, get adequate sleep, and have a balanced diet with plenty of fruits and vegetables.
Wishing you peace; Jesus loves you.

Reply Date: 2005/08/29

More Info

Dealing with severe acne can be a challenging and frustrating experience, especially when traditional treatments do not yield the desired results. As an 18-year-old male who has been struggling with acne since middle school, it is understandable that you are seeking effective solutions for your persistent breakouts. Let's address your concerns step by step.

1. Effectiveness of Oral Isotretinoin (A-Retinoic Acid): You mentioned that you have been on oral isotretinoin for nearly five months without significant improvement. Isotretinoin is a powerful medication often used for severe acne, particularly nodular or cystic acne. While it can take several months to see substantial results, if you have not noticed any improvement after five months, it may be worth discussing with your dermatologist. They may consider adjusting your dosage or exploring alternative treatments. It’s important to have regular follow-ups to monitor your progress and any potential side effects.

2. Management of Cystic Acne: The cystic acne on your chin and cheeks that has been present for 2-3 months and is oozing blood and pus is concerning. Cystic acne can be painful and may require more aggressive treatment. In such cases, dermatologists may recommend corticosteroid injections directly into the cysts to reduce inflammation and promote healing. Additionally, oral antibiotics may be prescribed to help control bacterial growth and inflammation. It’s crucial not to pop or squeeze these cysts, as this can lead to scarring and further infection.

3. Use of Gentamicin Cream: Gentamicin is an antibiotic that can be effective in treating localized infections. If your dermatologist prescribed gentamicin cream for your cystic acne, it is likely intended to help reduce bacterial growth and inflammation in the affected areas. However, it is essential to use this medication as directed and to follow up with your dermatologist to assess its effectiveness.

4. Addressing Acne Scars: You mentioned having red acne scars with visible blood vessels. Oral isotretinoin can help improve the overall texture of your skin and reduce the appearance of scars over time, but it may not completely eliminate them. For persistent scars, you might want to consider additional treatments such as chemical peels, laser therapy, or microneedling, which can promote collagen production and improve skin texture. Consulting with a dermatologist who specializes in scar treatment can provide you with tailored options based on your skin type and scar severity.

5. Lifestyle and Skincare Routine: In addition to medical treatments, maintaining a proper skincare routine is vital. Use a gentle cleanser, non-comedogenic moisturizers, and sunscreen to protect your skin. Avoid harsh scrubs or exfoliants that can irritate your skin further. A balanced diet, adequate hydration, and stress management techniques can also contribute to overall skin health.

6. Follow-Up and Communication with Your Dermatologist: It is crucial to maintain open communication with your dermatologist. If you feel that your current treatment plan is not effective, do not hesitate to seek a second opinion or ask for alternative options. Dermatology is a complex field, and sometimes it takes time to find the right combination of treatments that work for your specific condition.

In conclusion, while oral isotretinoin is a potent treatment for severe acne, it is essential to monitor your progress closely and consider additional therapies for cystic acne and scarring. Working closely with a dermatologist will help you navigate your treatment options effectively and achieve clearer skin. Remember, patience is key in the journey to managing acne, and with the right approach, improvement is possible.

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