Is Accutane the best treatment for my skin? I'm mainly focused on scarring more than anything (Photo)

Question

I went to a dermatologist a month ago expressing my concerns with scarring/texture, red marks, and acne. While scarring was my main issue, the PA instantly said accutane saying it will fill in my scars (which I know is not true.) I don't believe my acne is that severe to be put on accutane. I also have several fresh piercings and I don't want them to reject and get affected. Is there any way I can treat my cystic acne, scarring, and red marks WITHOUT going on accutane? Thx!

Raffy Karamanoukian, MD, FACS · Answer

Accutane is a go-to medication for patients with recalcitrant cystic acne. It can reduce pore size and also reduce sebum production in your skin, making it less oily; and in turn, dryer. Accutane can be used to control acne, but patients receiving the medication should be carefully monitored. In terms of skincare, always wear an appropriate sunscreen and reduce direct sun exposure. In my patients, I recommend a good ceramide moisturizer such as Elevase whenever they are on Accutane. This will keep the skin hydrated and reduce the oiliness of the skin that is associated with oil-based moisturizers.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

A combination approach will give the most improvement. These types of scars need a combination of Cosmelan, lasers, microneedling/prp, subcision, salt facials and fillers. It may take a series of treatments and may need some treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Amy Y. Paul, DO, FAAD · Answer

Thanks for your question.  Sorry you did not have a great experience at your doctor's office.  It is too bad you did not get to see the dermatologist, who would likely have had more options for you to consider.  Accutane is a very effective and helpful medication, but not everyone wants to go that route.  Scars can't really be filled in with accutane either, that is a strange concept!  Getting the active acne under control would be helpful, and some people do well with topical retinoids and topical antibiotics, or may need a few months of a light dose of minocycline or doxycycline to help with the deeper inflammatory lesions.  Procedures that are helpful for scars include microneedling and laser resurfacing, and some types of chemical peels with subcision.  Maybe seek a second opinion from a dermatologist who is known for helping with acne scars and has some other treatment options besides just accutane.  Best of luck!

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Thank you for your question and photographs.
It's difficult to evaluate your skin through photos, but from what I can see, it looks like you have a combination of acne: inflammatory lesions (red bumps) and comedones (whiteheads and blackheads). A variety of treatment options include topical and oral antibiotics, topical retinoids, Accutane, light therapy, chemical peels, laser treatments, etc. In my experience, a combination of oral and topical antibiotics, and topical retinoids have been effective, but results take time - at least 3-4 months. I highly recommend you consult with a board certified dermatologist to have your skin evaluated and to discuss treatment options that best suit your needs. Take care and good luck.

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