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Are there any good alternatives to Accutane for cystic acne?

Acne & Scars

I had a severe breakout of acne on my face, which worsened into cystic acne about 2 weeks later. I got cortisone injections to treat the cystic acne but new ones keep appearing. What alternatives to Accutane do I have to treat cystic acne?

DOCTOR’S ANSWER (2)

Cortisone shots are but a temporary solution to acne; they target inflammed acne and quickly reduce its size. This can help for urgent acne management (before social events) and to reduce the likelihood of scarring from large, ruptured acne. Side effects, however, like dimpling from shrinking of the fat around the acne (from the steroid injection) is possible. Hence benefits vs risks of such injections should be weighed before employing its use.

Acne management should first and foremost consist of a good baseline skincare regimen. This includes the use of acidic toners, retin/differin gels for prevention, as well as benzyl peroxide or clindamycin gels for active acne. 

Addition of procedures such as chemical peels, certain lasers and even more permanent solutions such as AGNES  radio-frequency needle ablation of oil glands are all good-to-haves in further  helping to manage acne resistant to topical therapy.

Oral medication such as antibiotics are a possible option too, but its use is to mitigate temporary flares of acne and is not a permanent solution.

The other oral medication available, accutane/isotretinoin, is a more permanent and quick way of acne management. This is particularly useful in severe acne (such as nodulocystic acne) or recalcitrant acne that fails to respond to the above other modalities. There is a risk of affecting one's cholesterol and liver, so a close follow-up with your doctor is required. About 70% of patients have a permanent resolution of their acne issues after the first cycle that can last 7 to 10 months, but some need a second or third round before their acne gives.

If you truly have cystic acne, a quick and swift approach to manage it is the best idea. This would involve topicals, some clinical treatments, as well as possible accutane. This will help prevent further breakouts and further scarring.

As you can see, acne management can be slightly complex and a multi-pronged approach is required. 

Do feel free to get a proper physical consult so a proper plan can be drawn out for yourself. The sooner you manage the acne, the less the long term sequelae of untreated acne.


Cheers, and Merry Christmas,

Dr Shane Abucewicz Tan

0 174 views 20 Dec 2018
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For large cystic acne, really, I feel that Isotretinoin is the best option as it goes down to the pathophysiology of reducing oil secretion. Combining it with antibiotics would solve it systemically.

Cortisone injections is a directed therapy for large cystic acne, and there is the risk of skin dimpling due to poor technique.

I would also suggest that you consider carbon laser therapy which has shown some efficacy in reducing the severity of cystic acne in a study.

Seek the right treatment after discussing with your physician

Winston

0 97 views 25 Dec 2018
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