Concerns About Acne Treatment: When to Consult a Dermatologist?

Q: Concerns About Acne Treatment: When to Consult a Dermatologist?

Hello： Regarding your question, oral isotretinoin is currently the only medication that effectively inhibits the main mechanisms involved in acne formation, including sebaceous activity, keratin metabolism, inflammation, and Propionibacterium acnes. <br>It is especially the first

About the skin?

I would like to ask about my worsening chin condition.
I've been taking isotretinoin for over three months, one pill daily, but I don't see any improvement.
When I asked my friends, they said they thought my skin looked better before I started the medication, and now they feel it has deteriorated.
I found online that most people see significant improvement after 3 to 4 months on the same dosage.
I hope I'm not an exception, but I'm increasingly worried about my situation.
My friends have also suggested considering stopping the medication.
Since it's been almost four months, I'm contemplating whether I should schedule an earlier follow-up appointment.
Would it make a difference at this point, or should I wait until I finish the medication before returning for a check-up?

Mr. Gua, 20~29 year old female. Ask Date: 2008/03/25

Dr. Cai Changlin reply Dermatology

Hello: Regarding your question, oral isotretinoin is currently the only medication that effectively inhibits the main mechanisms involved in acne formation, including sebaceous activity, keratin metabolism, inflammation, and Propionibacterium acnes.
It is especially the first-line treatment for patients with predominantly cystic acne.
The medication you are using is absolutely correct.

Regarding your previous inquiry about pigmentation, the noticeable red pigmentation on your cheeks from acne is due to the inflammatory process associated with cystic lesions that has not yet resolved.
The resolution of inflammation takes time, but oral isotretinoin has excellent anti-inflammatory effects, which can significantly expedite the healing process compared to not taking the medication.
Many patients experience substantial improvement after just one pill over three to four months.
This varies depending on individual factors such as the type of acne, the proportion of cystic lesions, and personal constitution.

Since everyone's condition is different, others' experiences may not be fully applicable to your situation.
Some patients see significant improvement after just one month, while others with more severe cases may require multiple pills a day and still not see improvement after three months, necessitating a longer treatment duration.

As we are not clear about your current condition, I recommend scheduling a follow-up appointment with your physician.
This will provide a more objective assessment of your acne and allow for a discussion of your concerns and treatment plan.

Wishing you good health,
Dr.
Tsai Chang-Lin,
Director of Dermatology, Keelung Hospital, Department of Health

Reply Date: 2008/03/25

More Info

When it comes to acne treatment, particularly with the use of oral retinoids like isotretinoin (commonly known as Accutane), it's essential to monitor your skin's response closely. Your concerns about worsening acne after three months of treatment are valid and warrant a discussion with your dermatologist.
Firstly, it's important to understand that while many patients experience significant improvement within the first few months of treatment, others may not see the same results immediately. Acne can sometimes worsen before it gets better, a phenomenon often referred to as the "purging" phase. This occurs as the medication accelerates skin cell turnover, which can initially lead to an increase in breakouts. However, if your condition continues to deteriorate or if you are experiencing severe side effects, it is crucial to consult your dermatologist sooner rather than later.

In your case, since you have been on isotretinoin for over three months without noticeable improvement, it would be wise to schedule an appointment with your dermatologist. They can assess your skin condition, review your treatment plan, and determine whether any adjustments are necessary. This could include changing the dosage, switching to a different medication, or even considering additional treatments such as topical retinoids or antibiotics.

Regarding your friends' observations, it's not uncommon for those close to you to notice changes in your skin, but their opinions should not replace professional medical advice. Each person's skin reacts differently to treatment, and what works for one individual may not work for another.
If you are contemplating stopping the medication, it's essential to discuss this with your dermatologist. Stopping isotretinoin abruptly can lead to a resurgence of acne, and your doctor can provide guidance on the best course of action. They may recommend continuing the treatment for a bit longer, as the full effects can sometimes take several months to manifest.

In terms of follow-up appointments, it's generally advisable to have regular check-ins with your dermatologist while on isotretinoin. These visits allow for monitoring of your skin's progress, management of any side effects, and adjustments to your treatment plan as needed. If you feel that your skin is worsening, don't hesitate to reach out for an earlier appointment.

In summary, if you are experiencing worsening acne after three months of isotretinoin treatment, it is crucial to consult your dermatologist. They can provide personalized advice based on your specific situation, assess whether the treatment is effective, and make any necessary adjustments. Remember, effective acne treatment often requires patience and close collaboration with your healthcare provider.

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