Understand the frustrations. Relapse of acne after Isotretinoin is not uncommon. But usually the recurrence is milder than the baseline acne condition since the medications change the pathophysiology of the skin (less oily).
Various issues like hormonal or stress can lead to a pro-androgenic state which results in more congestion. However, more importantly is, what can be done.
Since isotretinoin is no longer a possibility, in view of the desire for children, spironolactone or oral contraceptives and antibiotics are probably not great ideas either. That leaves us with topical treatments.
I would suggest combining topical salicylic/glycolic acid peels, be it at home or in clinic setting, changing your home skin care products to primarily gel-based products. Other treatments like lasers/LED light therapy can also be considered.
Hope that helps!
Dr Winston Lee
