Accutane relapse after three courses

Question

Since age 9, I've battled acne with three rounds of Accutane. In sixth grade, a 6-month course briefly cleared my skin before it relapsed. Eighth grade's 8-month, 240 mg/day course also failed. High school's 1.5-year Spironolactone treatment showed little improvement. Senior year's year-long low-dose Accutane briefly cleared my skin, but it relapsed after four months. Now on Spironolactone and antibiotics for four months, my skin worsens. Is Accutane even worth anther try?

Anna Chacon, MD, FAAD · Answer

I'm sorry to hear about your ongoing struggles with acne and the challenges you've faced with multiple treatments. Given your history, it's understandable to question whether another course of Accutane (isotretinoin) is the best approach. Here are some considerations and potential next steps:

Considerations for Another Round of Accutane:
1. **Cumulative Dose**: The total cumulative dose of isotretinoin over multiple courses can impact long-term remission rates. It's important to review with your dermatologist the total amount you've received and whether another course might be effective.

2. **Underlying Causes**: Persistent acne despite multiple treatments may indicate underlying hormonal imbalances, such as polycystic ovary syndrome (PCOS), or other conditions that need to be addressed. Have you had a thorough hormonal evaluation?

3. **Adjunctive Therapies**: Combining isotretinoin with other treatments, such as hormonal therapy or laser treatments, might offer a more comprehensive approach. Discuss with your dermatologist whether combining therapies could be beneficial.

4. **Lifestyle and Skincare Routine**: Sometimes, changes in diet, stress management, and skincare routines can complement medical treatments. Ensure you are using non-comedogenic products and following a dermatologist-recommended skincare regimen.

Alternative Treatments to Consider:
1. **Hormonal Treatments**: Given your history with Spironolactone, other hormonal treatments like oral contraceptives might be worth exploring if not already tried.

2. **Antibiotics and Anti-inflammatory Agents**: Long-term use of antibiotics isn’t typically recommended due to resistance issues, but short courses combined with topical treatments might help.

3. **Topical Retinoids**: These can be used alongside other treatments to help maintain clear skin after systemic treatments.

4. **Laser and Light Therapies**: Procedures like laser therapy, photodynamic therapy, or blue light therapy can be effective for some patients with resistant acne.

5. **Dietary Adjustments**: Some evidence suggests that diet, particularly reducing high glycemic index foods and dairy, can impact acne severity.

Recommendations:
1. **Consult with a Dermatologist**: Given the complexity of your case, a detailed consultation with a dermatologist who specializes in acne is crucial. They can provide a personalized treatment plan based on your history and current condition.

2. **Consider a Multidisciplinary Approach**: If hormonal imbalances are a concern, working with an endocrinologist alongside your dermatologist may provide more comprehensive care.

3. **Long-term Management Plan**: Focus on developing a long-term management strategy that includes regular follow-ups, lifestyle modifications, and potentially combining treatments to maintain skin health.

4. **Psychological Support**: Chronic acne can impact mental health. Consider seeking support from a mental health professional if your acne is affecting your emotional well-being.

Whether to try Accutane again should be a decision made in consultation with your healthcare provider, taking into account your medical history, previous responses to treatment, and current skin condition.

Accutane relapse after three courses

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