Brief Answer:
Oral and topical antiacne; Oral biotin and Iron; Topical Minoxidil solution

Detailed Answer:
Hello. Thank you for writing to us

I have gone through your query and I have noted down your concerns.

You seem to have acne and spots. Dark spots are due to post-inflammatory hyperpigmentation which is a common complication of acne.

I would outline the broad treatment approach that should be followed in your case.
The exact treatment would only be possible one you visit a dermatologist in person who would be able to visually assess and prescribe accordingly.

If I was the treating doctor I would have suggest you to use topical benzoyl peroxide gel for your active acne during day time. It is available in 2.5%, 3.5% and 4% strengths and is marketed by various pharma companies.
Another option is to use nadifloxacin 1% gel for active acne during day time.

At night I usually ask my patients to use adapalene 0.1% gel over whole of acne affected area. Adapalene is comedolytic as well as helps fade away dark spots of acne. Tretinoin, which you have earlier used is also a similar type of product but it tends to cause more irritation, redness as compared to adapalene.

Since you seem to have inflammatory type of acne therefore I think that you would also require to be put on one of Oral antiacne e.g Doxycycline Or Minocycline. They may be continued for a few weeks depending on the severity of acne and response to antiacne treatment.

Oral Isotretinoin is also an option for severe Or moderately severe acne vulgaris, specially in patients who have had long standing and re-ocurring acne that tends to scar. Isotretinoin is also useful for oily skin nad open pores.
Isotretinoin requires a few baseline investigations like liver function tests and serum lipid profile testing before it can be started.

In addition to topical and oral antiacne treatment enumerated above, you may also opt for a few sessions of salicylic acid chemical peel.
Salicylic peel is useful for acne, open pores as well as fading away the spots
A peel session once every 2 weeks would be advisable and a total of 4-6 sessions would achieve desired results.

Regarding hair fall I would have liked to know whether you have dandruff?
If yes, you must use an antidfandruff shampoo e.g Nizral shampoo Or Triatop shampoo every alternate days.
Increased hair shedding can be due to other causes like chronic telogen effluvium and androgenetic alopecia which can only be known by close examination.

Besides an Oral biotin supplement e.g Revilus tablet Or H-vit forte tablet Or Kerashine tablet are soem suggestions and are usually available on prescription of a dermatologist I also suggest you to take an Oral Iron supplement e.g Tab Autrin once daily on empty stomach.

Topically you may use a hair growth solution e.g Minoxidil 2% solution, 1 ml twice daily at scalp skin.

These are all prescription medications and should be used under supervision and guidance of a dermatologist and not to be used on your own. Therefore I suggest that you visit a dermatologist in your region for a discussion regarding your concerns and the most appropriate solution for the same.

Regards

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Brief Answer:
Adapalene gel at night and clindamycin for active acne during daytime

Detailed Answer:
Hi. Thank you.

I have reviewed the images.
At present you have only a few active acne. You mainly have post-inflammatory hyperpigmentation (PIH)/ dark spots from previous active acne.
You may use clindamycin 1 %gel for active acne/ pimples during day time.
At night I suggest you to use adapalene gel 0.1% once daily at night. It is comedolytic as well as antiinflammatory therefore helps exisitng acne as well prevents new acne formation. Adapalene also helps fade away dark spots/ PIH from previous active acne.
After your acne is clear I would suggest you to continue with adapalene 0.1% gel as a maintenance therapy i.e once every alternate days Or twice a week for continued improvement since acne problem can last for a long time.
I think this regime would prove effective for your severity and grade of acne.
Your acne severity does'nt mandate oral treatment at present.

Regards

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