Brief Answer: Acne;oral isotretinoin+oral antibiotics+topicals Detailed Answer: Hello and welcome to healthcaremagic I am Dr. Kakkar, I have gone through your concern and I have understood it. Thanks for the pictures. I could see that you have inflammatory acne on both the cheeks. Though you have been on the right kind of treatment but I guess just 10mg isotretinoin is too less for an adult. You need a higher does for the severity of your acne!!. For severe acne OR for acne unresponsive to traditional anti-acne medications, Isotretinoin is the drug of choice. It the only drug which offers any chance of long term cure and after a full course of isotretinoin significant number of people never have a recurrence of there acne. However it should be given in the right dose and for the right duration. Total Cumulative dose of Isotretinoin that should be taken is 120-140mg/kg. For a complete course in e.g a 60 kg man it comes out to be 12 months of 20mg, once daily or 6 months of 20mg, twice daily. The chances of relapse are more likely, if the course is incomplete. I normally start Isotretinoin at 20mg and make it 40 mg after a month, which i continue till the total cumulative dose has been given (i.e 120-140mg/kg) For you, in addition to Isotretinoin, I would suggest an oral antibiotics as well, to bring down the flare/inflammatory papules/pustules. For inflammatory acne(papules and pustules) I usually advice my patients to start with Azithromycin 500mg. The antibiotic can be continued for 4-12 weeks depending on the response. In addition to oral retinoids and oral antibiotics you must also use topical antiacne remedies e.g benzoyl peroxide gel OR Clindamycin+nicotinamide gel (as you have been using already). General measures to follow: -Use a mild cleanser like cetaphil twice daily. Harsh cleansing causes the skin to become excessively dry which in turn causes rebound oiliness. -Avoid all the regular use creams, moisturizers, sunscreens that you may be using for the time being till you are on anti-acne treatment. -Avoid taking facials. -Avoid picking your acne. Since Acne and seborrheic dermatitis/dandruff are usually associated it is advisable to use an Anti-dandruff shampoo since acne is worsened by dandruff. regards

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Brief Answer: Acne;oral isotretinoin+oral antibiotics+topicals Detailed Answer: Hi. Thank you for appreciating. If I was the treating doctor I would have started you on 20mg, twice daily. So that would take roughly around 6-7 months for the total cumulative dose of isotretinoin, to be attained. As your acne looks inflammatory, therefore azithromycin 500mg needs to be restarted as before i.e 3 consequtice days/week for 4-6 weeks. Cant take daily. Apart from this you should use topical benzoyl peroxide gel 2.5% twice daily rather than clindamycin phosphate gel as benzoyl peroxide is more effective antibacterial as well as has keratolytic and comedolytic properties unlike clindamycin. Use a gentle cleanser for face wash e.g cetaphil cleansing lotion, rather than using a salicylic acid based cleanser. That's because both oral isotretinoin (now in increased dosage) and benzoyl peroxide gel would cause skin dryness which would be further exacerbated by salicylic acid based cleanser, if you continue with it. So, it is preferable to use a gentle cleanser, which does'nt over dry the skin further. I would suggest that you consult another dermatologist since your past dermatologist is unapproachable. Get a prescription, as these are prescription medicines. You wont get it OTC. Moreover, while you are on oral isotretinoin, your Lipid profile and Liver function tests need to be monitored at regular intervals, therefore it is all the more necessary to follow up with a dermatologist while you are on Isotretinoin. I am sure your dermatologist would increase the dose of isotretinoin to the appropriate level and also start you on oral antibiotics, so that your acne improves the way they should. regards Take care

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