Acne Treatment: Is Oral Isotretinoin Right for You?

Q: Acne Treatment: Is Oral Isotretinoin Right for You?

Hello： For large painful lesions, local steroid injections can be used for treatment. <br>For deep cystic acne that cannot be drained, oral isotretinoin can be taken, and chemical peels with alpha hydroxy acids can also be used to expedite the removal. <br>Regarding lymph node pa

There are still a few questions?

Doctor, after reading your response, I have a few more questions.
I have been taking anti-inflammatory and steroid medications for about two months, and I have also been using topical isotretinoin (Accutane) for approximately three months, which has shown some improvement.
Currently, I am experiencing acne in the same area.
Is oral isotretinoin suitable for patients with more severe acne symptoms? My acne count is not high; it is just concentrated in one area, and the pain feels different from typical acne—it resembles muscle pain in my neck.
When I press on my neck, I feel pain, while the acne itself is only mildly painful.
Additionally, there is a noticeable lump on the left side of my neck that seems to be located near a lymph node.
If I massage that area, the lump visibly reduces, but after a night's sleep, it swells up again.
Is this also considered acne? The area where I have acne corresponds to the left side of my neck and cheek, where lymph nodes pass through, and the condition on my face is milder with fewer breakouts.
Can I discuss the possibility of taking oral isotretinoin with my dermatologist?

Arctic, 20~29 year old female. Ask Date: 2008/10/05

Dr. Zhang Zhibo reply Dermatology

Hello: For large painful lesions, local steroid injections can be used for treatment.
For deep cystic acne that cannot be drained, oral isotretinoin can be taken, and chemical peels with alpha hydroxy acids can also be used to expedite the removal.
Regarding lymph node pain, it is generally associated with infection; acne does not cause lymphadenopathy unless there is localized cellulitis.
If possible, please attach a photo to better assess whether oral isotretinoin should be prescribed!

Reply Date: 2008/10/05

More Info

When considering the treatment of acne, particularly with oral isotretinoin (commonly known as Accutane), it's essential to understand the nature of your acne and the underlying factors contributing to it. Isotretinoin is a powerful medication primarily used for severe cases of acne that have not responded to other treatments. It works by reducing the size and activity of sebaceous (oil) glands, decreasing oil production, and promoting skin cell turnover, which helps prevent clogged pores.

From your description, it seems you have been experiencing localized acne that is painful but not extensive in number. The fact that you have been using anti-inflammatory medications and topical retinoids (like A acid) for a few months and have seen some improvement is a positive sign. However, the persistent pain and the nature of the bumps you describe, particularly in the neck area, raise some important considerations.

Firstly, the bumps you are feeling on your neck that seem to be related to lymph nodes could be indicative of something other than acne. Lymph nodes can become swollen due to various reasons, including infections, inflammation, or other underlying conditions. If these bumps are tender and fluctuate in size, it might be worth consulting a healthcare provider to rule out any potential issues, especially if they are not responding to typical acne treatments.

Regarding the use of oral isotretinoin, it is typically reserved for cases of nodular or cystic acne that are widespread and have not improved with other treatments. Given that your acne is localized and not extensive, it may not be the first-line treatment recommended by your dermatologist. However, if your acne is causing significant discomfort or if you have concerns about scarring, discussing isotretinoin with your dermatologist could be appropriate. They can evaluate your specific situation, including the characteristics of your acne and any associated symptoms, to determine the best course of action.

It's also important to consider the potential side effects of isotretinoin, which can include dry skin, chapped lips, and more serious risks like liver damage and teratogenic effects (risk of birth defects if taken during pregnancy). Therefore, thorough discussions with your dermatologist about the benefits and risks of isotretinoin are crucial.

In addition to isotretinoin, there are other treatment options available for acne, including hormonal therapies (like birth control pills for women), antibiotics, and other topical treatments. These may be more suitable for your situation, especially if your acne is not severe.

In summary, while oral isotretinoin can be an effective treatment for severe acne, it may not be necessary or appropriate for your current condition, especially if your acne is localized and not extensive. It is essential to have a thorough discussion with your dermatologist about your symptoms, the nature of your acne, and any other concerns you may have, including the painful bumps on your neck. They can provide personalized recommendations and help you find the most suitable treatment plan for your acne.

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