Suffered from acne for 8 yrs. Started off with oily skin and light acne and has progressed to moderate acne (back & face). Now my skin has become more oily - to a point where you can see visible patches of surface oil on my nose and forehead with a huge increse in blackheads. I have been prescribed oxytetracycline, lymecycline, benzyl peroxide (2.5/5) and topical retinoids (adapaline). The condition has still deteriorated in the sense of visable scarring. I still cannot get a referal.
Is It Time I Started Taking Accutane or at Least See a Dermatologist?
Doctor Answers 2
Is it time for Accutane?
You don't mention your age in your email. There are many factors that play a role in acne, age, hormonal status, sex of the patient as males tend to have worse acne than females, family history (someone with a family history of severe acne is more likely to have severe acne), medications that you take, whether periods are regular or not.
Also, there is new data that high consumption of milk and milk products can contribute to severity of acne.
To decide whether you are a good canditate for Accutane, all those factors need to be considered. For a woman, also the consideration is whether she is planning a pregnancy in the near future, as pregnancy is out of the question while on Accutane (6 months of therapy) and for two months after therapy. The other important factors are normal liver function and normal cholesterol levels, as both of those are necessary to begin therapy.
So what you need is a thorough history and examination to evaluate all the factors before a decision for Accutane can be made. Accutane is a great medication. It is the only one that can actually cure acne. It also requires a strict adherence to taking the medication regularly, getting the appropriate lab studies every month, making sure that there are two methods of birth control to avoid pregnancy.
If you cannot get a referral to a dermatologist, speak to your internist about the fact that scarring is a permanent change in the skin that is difficult to reverse, and would require methodologies like laser treatments. Scarring acne needs to be addressed as soon as possible.
It is also important not to pick at or squeeze acne lesions, as that can contribute to scarring as well.
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Accutane should be considered for all patients with acne scarring
Once acne begins to scar (and preferably before), one should definitely consider isotretinoin (Accutane). This medication is still the gold standard for acne treatment, and works better than any other regimen for most patients. I would recommend visiting a dermatologist to discuss the risks and benefits of treatment. All medications, including isotretinoin, have risks associated, and should be taken under medical guidance.
I treat many patients with this medication, and the level of satisfaction is second to none for most patients.