Persistent Acne: Seeking Solutions for Long-Term Skin Issues - Dermatology

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Persistent acne can be a frustrating and challenging condition, especially when it has lasted for over a decade despite various treatments. It’s commendable that you have been proactive in seeking medical help and have tried multiple therapies, including both Western and traditional Chinese medicine, chemical peels, oral isotretinoin (A酸), and antibiotics. However, the persistence of your acne, especially with the presence of green pus, indicates that there may be underlying factors that need to be addressed.

First and foremost, it’s essential to understand that acne is a multifactorial condition. Hormonal fluctuations, genetics, diet, stress, and skin care routines can all contribute to the development of acne. Since you mentioned that you maintain a healthy lifestyle and avoid sugary drinks and snacks, it might be worth exploring other potential triggers. For instance, hormonal imbalances, particularly related to androgens, can lead to increased oil production and acne. A consultation with an endocrinologist may be beneficial to evaluate any hormonal issues.

The green pus you are observing in your acne lesions suggests a possible bacterial infection, which may be due to the presence of bacteria such as *Propionibacterium acnes*. This could indicate that your current treatment regimen is not adequately addressing the bacterial component of your acne. While antibiotics can be effective, they often lead to resistance if used for extended periods, which may explain why you experience a resurgence of acne after stopping them.
Given your history of using isotretinoin, it’s important to note that while it can be highly effective for severe acne, it is not a permanent solution for everyone. Some individuals may experience a relapse after discontinuation. If you have not already done so, discussing the possibility of a second course of isotretinoin with your dermatologist could be worthwhile, especially if your acne is severe and resistant to other treatments.

In addition to isotretinoin, there are other treatment options that may be considered. For instance, hormonal treatments such as oral contraceptives or anti-androgens like spironolactone can be effective for women with hormonal acne. These medications can help regulate hormones and reduce oil production, potentially leading to a decrease in acne lesions.

Moreover, incorporating topical treatments that contain benzoyl peroxide or salicylic acid can help manage acne by reducing bacteria and exfoliating the skin. However, it’s crucial to use these products carefully, especially if your skin is sensitive or reactive.
Lastly, consider the importance of a comprehensive skincare routine. Gentle cleansing, adequate moisturization, and sun protection are vital components of managing acne-prone skin. Avoiding harsh scrubs or overly drying products can help maintain the skin barrier, which is essential for overall skin health.

In conclusion, persistent acne can be a complex issue requiring a multifaceted approach. It is advisable to continue working closely with a dermatologist who can tailor a treatment plan specific to your needs. This may involve re-evaluating your current medications, considering hormonal treatments, and ensuring a proper skincare regimen. Remember, patience is key, as finding the right combination of treatments may take time.