I Have Mild/moderate Persistent Adult Acne. What Other Options Do I Have?

I have done topicals: retin A Retin A Micro Differin Ziana Antibiotics birth control BP accutane (an incomplete course) chemical peels What else is there for me to try. I really want to try completing another course of accutane and then maintain with topicals as i have a feeling my acne will be me for a long time Need a derm recommendation in NYC (GHI) willing to look into accutane or spiro or other treatments other than topicals and antibiotics. Thanks!

Doctor Answers 8

Help with treating adult acne

Thanks for your question. You need to be evaluated by a board-certified dermatologist who can examine your skin and determine an appropriate acne treatment regimen that will control your acne. We have several newer oral and topical medicines for acne that allow the derms to individualize your treatment plan to the kinds of pimples you have. Then there are several procedures that can be done that can make significant positive changes for you. This includes the pulsed light device known as the Solta Isolaz, which we use regularly in our clinic for acne. The Aerolase Neo also makes acne better in many cases. And then is the use of photodynamic therapy, which I have written on and lectured on for years – this is when we apply a photosensitizer to the skin and then use either blue light or an IPL or a pulsed dye laser to treat the skin. This will greatly improve your acne and your skin at the same time.

So make an appointment with a derm, learn your treatment options, and get your adult acne under control.

Nashville Dermatologic Surgeon
4.0 out of 5 stars 18 reviews

Spiro - great for adult acne. (Females only)

As a dermatologist, I prescribe all treatments from mild Retin A creams thru to Accutane. My fav. in adult female hormonal acne is Spiro. Usually start at 50 , and go upto 100. At higher doses, potassium levels need to be carefully monitored. 

Spiro has a few advantages over low dose isoteretinoin/ Accutane-

1. Side effects are minimal ( read PI for all the side effects)

2. We don't have to worry about birth defects - however you should immediately stop spironolactone if you are pregnant or contemplating pregnancy.

3. Blood test don't need to be regular (with the exception of potassium levels)

4. There will be no flare up of your acne (seen in Accutane)

Each to their own, however spironolactone is a good choice for hormonal acne. (As is low dose Accutane). The choice will depend on your lifestyle factors as well. Dr Buka has a point regarding long term advantages of isotret. orally over spiro.


DR Davin Lim 
Laser Dermatologist
Brisbane, Australia. 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 75 reviews


I reserve the use of isotretinoin for two types of patients - those that have very severe nodulocystic acne and those that have tried everything under the sun and still have significant acne, even if not the most severe. The unique benefit to isotretinoin, unlike all other medications used in acne, is that it has a beautiful durability of affect - helping acne long after the medication course has completed.

This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

Bobby Buka, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Adult acne

You should consult a dermatologist who can assess your acne and order any investigations if necessary and then decide which treatments would be best for you.  If Accutane is indicated, you need to follow your dermatologist's advice about monitoring you while on treatment. 

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 22 reviews

Female adult acne treatment

Spironolactone, by itself or in combination with oral antibiotics, can be very helpful for female adult acne.  Low dose Accutane, taken on a regular basis, can also be helpful.  Topical dapsone (Aczone), used twice daily, is another helpful treatment you may not have tried yet.  Newer treatments include Nd:Yag lasers or photodynamic therapy for acne, but you will likely get the best results using lasers in combination with a medication regimen.  Consult with a dermatologist in your area for a specific treatment plan tailored to your skin.

Anita Shetty, MD
Atlanta Dermatologist

Resistant acne generally needs Accutane

If you have resistant acne that is not responding to oral antibiotics or lasers such as the V-Beam or IPL lasers, then you may need to complete a course of Accutane.  I would make sure that there is no hormonal or other medical cause for your acne first by getting a through exam from a board certified dermatologist.  Please let me know how it turns out.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Acne Treatment Option

Acne occurs when a sebaceous oil gland surrounding a hair follicle becomes clogged and inflamed. Bacteria growth in this clogged environment causes infection and acne blemishes.
I personally use Elos Laser Acne treatment. It works by combining Bi-Polar Radiofrequency and Blue Light energies to penetrate the skin to precisely target and destroy active acne-causing bacteria, while simultaneously slowing excessive sebaceous oil production. Treatments help to reduce active acne and speeds up healing time.
Elos Laser Acne treatment is effective in all skin types and the number of treatments depends upon the severity of acne. Treatments are made comfortable by the placement of topical numbing crème, with further comfort provided by cooling the skin surface. There is no associated down time with treatments, and normal activities can be started immediately the procedure is performed.

Daniel Shapiro, MD
Scottsdale Plastic Surgeon
4.8 out of 5 stars 107 reviews

Acne treatment help in NYC

Adult acne has so many effective treatments.  Of course there is accutane and oral antibiotics, also spironolactone and birth control pills, also chemical peels and topicals, etc.  There is also Photodynamic therapy, which is not fda approved for acne, but is a well accepted alternative treatment, as well as other lasers and lights.  You need a great dermatologist to manage your acne.  Happy to help you, but not through GHI, I don't know many doctors who take GHI.  Good luck and don't lose hope, there are lots of effective treatments. 

Rebecca Baxt, MD
Paramus Dermatologic Surgeon
4.8 out of 5 stars 27 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.