I have gentle hormonal acne that is less than mild, should I start Accutane?

Question

I'm 20 y/o and I've had hormonal acne since I was 13. I've tried tons of topical gels & creams, but my small acne problems always come back. I've never tried any pills & was recommended I try Spironolactone before trying Accutane (since I do NOT have huge breakouts or cystic acne). Except, I don't want to take a diuretic & then not have it work. I rather go straight onto Accutane and have no more breakouts. However, I'm scared it will make my skin worse and the side effects will not be worth it.

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

All of my accutane/isotretinoin/acne patients do our accutane protocol (see link).  if you want to get rid of acne completely you do accutane at an earlier age and combine skincare, lasers in office, and aerify peels with microrolling MTS roller at home.

Acne requires a combination approach to get long term improvement.; For all patients on isotretinoin, we require them to be on skin care such as vitamin C (Skinceuticals Phloretin CF, EmerageSkin AOX-C), glycolic cream (jan Marini bioclear, EmerageSkin enzymatic polish) , kojic acid serums (Skinceuticals phytoplus) and hyaluronic acid serum (IS clinical hydra cool serum, Skinceuticals B5, EmerageSkin hyla B) in the morning and retinols  (reve skin 1.0 and sente biocomplete serum) and salicylic acid (reveskin acne purifying enhancer), growth factors and peptides (anetageMD, EmerageSkin Re-Fit Face/Eye) night.

All of our patients get clear+brilliant non ablative laser along with a microsecond YAG laser such as aerolase or laser genesis and microneedling with PRP or microneelding RF like intensif or fractora monthly to help improve breakouts, speed the healing process, and improve scarring and facial redness while on the isotretinoin/accutane.  LED light therapy, cosmelan/enlighten/AERIFY peels, salt facial or dermalinfusion can be done as well to speed up the improvement. I suggest tyou go to an expert who combines skin care, lasers, microneedling, PRP, and facials while on oral medications for acne.  Best, Dr. Emer.

Morgan Rabach, MD · Answer

I'm sorry you're having difficulty with acne; it can be very stressful! I would recommend speaking to your board-certified dermatologist and explaining these concerns to her/him. With topical gels and creams sometimes you have to consistently use them to maintain a decrease in breakouts. They usually do not completely prevent stubborn acne after short term usage. Additionally, while spironolactone is considered a diuretic, depending on the severity of your acne, it is often possible to work with a low dose that maintains the skin benefits with little to no additional side-effects. In order to determine which route is best for you it is important to have a physician look at your skin and make a recommendation.

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Thank you for your question. Accutane is an effective treatment for stubborn acne, however, it does not treat hormonal acne. Spironolactone works well for hormonal acne and is safe to take long term. I highly recommend you consult with a board certified dermatologist regarding your acne and appropriate treatment options that suit your needs. Take care and good luck.

I have gentle hormonal acne that is less than mild, should I start Accutane?

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