Does Accutane reduce skin oiliness permanently, and are there any alternatives?

Doctor's Answers 1

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Dr Joanna Chan

Aesthetic, General Practitioner

Acne is the most common skin disease, affecting up to 95% of adolescents. Severe episodes of acne can cause considerable physical and psychological scarring. All forms of severe acne require systemic treatment.

The available options include oral antibiotics, hormonal antiandrogens for female patients and oral isotretinoin, as well as combination treatments. Oral isotretinoin is the only drug available that affects all four pathogenic factors of acne, the first of which is excess sebum production. This may explain why it is so effective. A dose of 0.5–1.0 mg/kg/day of isotretinoin dramatically reduces sebum excretion by the order of 90% within 6 weeks (Dermatoendocrinol. 2009 May-Jun; 1(3): 162–169.).

Studies have been done on changes in long-term oil production following isotretinoin therapy. In one study published, sebum production was measured in patients in whom isotretinoin had been discontinued for at least 20 weeks. A 30% to 80% reduction in sebaceous gland activity was still present for as long as 80 weeks in some subjects (J Am Acad Dermatol.).

There are other options, like you enquired about, to reduce facial sebum production and help in acne.

The hormonal antiandrogens, Oral contraceptive pills and spironolactone, also target factors affecting sebum production in the skin. You may speak to your doctor to find out if you are suitable for these, as I noticed you mentioned you have tried antibiotics and topicals but not any of these treatments.

A few of the more studied topical compounds include topical 2% niacinamide (study in 100 subjects showed lowered sebum excretion after 2 and 4 weeks of use), topical 3% green tea emulsion, and topical 2% L-carnitine. Certain procedures such as chemical peels and lasers can also help.

However, acne is a complex interplay of factors; aside from excess sebum production, comedogenesis (formation of blackheads/whiteheads), P. acnes bacteria and inflammation are other factors to be controlled to achieve successful treatment of your acne. I would suggest you follow up with your doctor to discuss your concerns regarding isotretinoin therapy and your options.

Similar Questions

Is it possible to be rid of acne and bumps on my face entirely?

Nothing in life is permanent. It is true! except scars. So you are right, its important that we try to minimise the outbreaks when possible. If you are a male patient, I would opt to do Accutane and then tail down the dose and keep on a very low maintenance dose (which virtually eliminates side effects) and yet keeps the oiliness and pimples at bay. Topical products actually play a huge role in skin care. I have seen so many patients who come completely clueless, and using the most oily Korean moisturisers for their already oily skin--- because Korean stars are using it.

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Answered By

Dr Winston Lee

Aesthetic

What is the best acne treatment for recurrent breakouts at temple, jawline and chin?

I noticed that I tend to breakouts after holidays. Yes, weather and humidity changes can sometimes trigger breakouts. Stress/poor quality of sleep due to jet lag and time differences can also contribute. Speaking from personal experience here; I tend to break out much worse in Singapore than I did living in the UK. Went to national skin centre for consultation, and was given some watery creams and Cetaphil products to use. Hard to comment on what you were given, but from what you’ve described here, NSC doesn’t seem to have given you anything specifically for acne treatment.

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