Which treatment is best for my face skin and to remove all these acne and freckles? (Photo)

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

I'm sorry to hear that you're struggling with persistent skin issues. It's important to approach this comprehensively, as different treatments work for different people. Given your history with Accutane, microdermabrasion, and carbon laser treatments, it might be time to consider a multifaceted approach. Here are some steps and treatments you might consider, but please discuss these with your dermatologist to tailor the plan to your specific needs:

### 1. **Re-evaluation by a Dermatologist**
- **Thorough Assessment:** A detailed re-evaluation by a dermatologist can help understand why previous treatments haven't worked and guide you towards more effective options.
- **Patch Testing:** Sometimes, underlying allergies or sensitivities can exacerbate skin issues. Patch testing can help identify any contributing factors.

### 2. **Skincare Routine Optimization**
- **Gentle Cleanser:** Use a mild, non-comedogenic cleanser twice daily to avoid irritation.
- **Moisturizer:** Ensure you're using a suitable moisturizer, even if you have oily skin. Look for non-comedogenic options.
- **Sunscreen:** Daily use of a broad-spectrum sunscreen (SPF 30 or higher) is crucial, especially for treating freckles and preventing further pigmentation.

### 3. **Topical Treatments**
- **Retinoids:** Topical retinoids can help with both acne and pigmentation. They encourage cell turnover and can improve skin texture.
- **Hydroquinone:** This can be effective for treating hyperpigmentation and freckles. However, it should be used under the guidance of a dermatologist.
- **Azelaic Acid:** Useful for both acne and hyperpigmentation, it can be less irritating than some other treatments.

### 4. **Professional Treatments**
- **Chemical Peels:** These can help with both acne and pigmentation. Options like glycolic acid or salicylic acid peels might be beneficial.
- **Microneedling:** This can help with acne scars and pigmentation. When combined with PRP (platelet-rich plasma), it can enhance results.
- **Laser Treatments:** Other types of laser treatments, such as fractional lasers, might be more effective for your specific skin concerns.
- **IPL (Intense Pulsed Light):** This can be effective for pigmentation and improving overall skin tone.

### 5. **Lifestyle and Diet**
- **Diet:** A balanced diet rich in antioxidants, vitamins, and minerals can support skin health. Avoid high-glycemic foods and dairy, which can sometimes exacerbate acne.
- **Hydration:** Ensure you're drinking plenty of water to keep your skin hydrated from within.
- **Stress Management:** Stress can worsen acne, so incorporating stress-relief practices like yoga, meditation, or regular exercise can be beneficial.

### 6. **Under-Eye Dark Circles**
- **Topical Treatments:** Ingredients like caffeine, vitamin K, and hyaluronic acid can help reduce dark circles.
- **Lifestyle Changes:** Ensure adequate sleep, manage allergies, and consider using a cold compress to reduce puffiness and dark circles.
- **Professional Treatments:** Dermal fillers, lasers, and chemical peels can also be effective for treating under-eye darkness.

### 7. **Follow-Up and Patience**
- **Consistent Follow-Up:** Regular follow-ups with your dermatologist are essential to monitor progress and make necessary adjustments.
- **Patience:** Skin treatments can take time to show results. Consistency and patience are key.

Given the complexity of your case and the treatments you've already tried, a personalized approach with a dermatologist who specializes in difficult-to-treat acne and pigmentation issues is essential. They can help tailor a treatment plan that addresses all aspects of your skin concerns.