Hello, I am a 32 year old Asian Male living in NY and I am very very frustrated because until now I still have acne. I have moderately oily skin and I get acne scars (pigmented) easily. I don't' have sensitive skin. I mostly get the papules and postules type and occasionally (1-2x /month) the pustules grow big enough that I think they might be nodules. I rarely get whiteheads and blackheads.My Daily AM regimen :salicylic acid (5%) neutrogenaGlycolic Acid (10%) every other dayMoisturizer with SPF 15 or 30 (I have both)PM Regimen:salicylic acid (5%) neutrogenaBenzoyl Peroxide (10%) - sometimes I put ice packs over my face for 10mins when the acne is severe and reapply before going to bedEvery 2 weeks, I put Queen Helene Mint Julep Masque overnight to tighten my pores.I try not to touch my face during the day.I sleep on my back.I try to eat fruits and vegetablesI don't eat junk food, soda, coffee, or alcoholI consume 8-12 glasses of water daily, adn 2 glasses soy milkI work out 3x/week, I stay away from stressI take multi-vitamins, probiotics, protein shakes, & omega-3 oil dailyI drink green tea, I stayed away from dairy products (2 years now)I sleep 6 hours every night. And I have been doing this for the past 2 years! The BP, I've been doing for the past 6 years but I still get breakouts :(I usually get them on my cheeks and chin area. Rarely on the forehead and nose. Recently (2 weeks now), I have too many papules and postules grow. i now have around 15 in my face. everytime one heals, another 2-4 grow back. I did not do any changes, no stress or anything. My questions are:1. Am I doing anything wrong? Does my regimen have to be overhauled?2. I am thinking the BP doesn't prevent any papules and postules, could it be an internal problem? Maybe I should be taking meds instead of using BP?3. Also are there any fast and cheap way (I know this is impossible) to get rid of acne scars? I have used 2% hydroquinone and bio oil before without any success.4. Also, what is the best (and most economical) laser acne scar removal options that is fit for my skin? I have a lot of red marks and they don't go away for 2-3 months.Please help! :(
Person's Gender: Male
Person's Age: 32
These answers are for informational purposes and do not replace a physician head-to-head visit. A patient-physician relationship is not established.
Would it be possible to forward a photograph soI can see what we are dealing with? Thank you.
Hi, Thank you for your response. Pls see attached pictures. Those are current. I amy also be able to find an older one a few months ago when my acne was worse than that.
Thank you for the photographs.
Before, considering laser treatment for the acne scars and discolorations, I would strongly recommend oral antibiotic therapy. Minocycline, especially in the form of Solodyn, would be the most effective treatment, but Doxycycline is nearly as effective and much less expensive. I would also add a combination product such as Ziana or Veltin. This can be applied at night.
You are actually doing a lot of good things for your skin but you have pustular acne with a cystic component and that generally requires an antibiotic. I would also add Vitamin C 500 mg. twice a day, zinc gluconate 25 mg. a day and Barberry.
While this treatment would keep your acne under control, Accutane would be a medication that would cure it. I realize that due to plethora of lawyer ads, trolling the waters for clients, many are reluctant to take this drug, but it remains our best weapon fro treating acne. Laser in the form of the Smoothbeam would be another option if you do not want to take an oral medication. This is an effective treatment, though it will not do much for scarring. Similarly, photodynamic therapy using the blue light and pre-treament with 8 amino-levulinic acid is also excellent. However, both PDT and the Smoothbeam laser do not promise the cure of Accutane.
You might use Brand Md's HQRA's Skin Ligthtening cream to help with the pigmentary scarring.
This is OTC.
It has hydroquinone too but other skin lightening ingredients.
By the way, the Smoothbeam should be acceptable on darker skin types. But in my opinion the cost would be far more substantial than Accutane.
Yes, that is what I as thinking. The BP only treats the whiteheads/blackheads and not the postular ones. I am wary of taking accutane yes mainly because of advertisments and what i read about it. I realize that minocycline is not OTC? how much is the dosage?
Also, i was thinking of laser to treat the scarring not the acne as I feel it wouldn't be sustainable in the long run. Any laser treatments you can recommend to remove and/or lighten the scarring?
Solodyn is body weight dosed which makes it safer
Generally, 100 mg. twice a day for the other forms.
Fraxel or one of the other fractionated lasers would be the safest.
As far as Accutane, if there is no personal or family history of depression or Ulcerative colitis, and the patient is followed carefully, the odds are very low of anything bad happening. I have been using it for thirty years without a problem, but O guess I am like an airplane pilot telling people flying is safe.
Ok. Yes because I was under the impression that Accutane is only for very severe acne mostly the nodular types? Will it in any way react with all the protein shakes and vitamins that I am taking?
ONly excessive Vitamin A would be a problem
I would recommend an antibiotic. Tetracycline is very safe and cheap.
Meant to say I would recommend an antibiotic first before starting Accutane.
Ok. I remember taking Tetracyline a few times before. My doctor recommended it to me. How many times do i need to take the antibiotics (2 months?) then do I cycle it or is it only on an as needed basis? ALso why do i get pustular acne in droves on some months and sometimes I am clear in others? Is it genetic or is it just a cycle that I need to accept?
It is hard to tell in a male what flares it up. Females it is usually due to the menstrual cycle. Maybe stress but hard to quantitate.
Generally, you have to be on an antibiotic for a longer term and not just with flares.
Usually stay on the antibiotic until it resolves.
Usually we use antibiotics on a prn basis when patients are usually doing well but flare occasionally.
prn = permanent? Ok so that is something I should consider before trying accutane. How many weeks does the antibiotic take to clear up my skin? Are there OTC antibiotics?
prn means as needed.
No decent OTC antibiotics besides BP.
I would try an oral such as Doxycycline or Minocycline before Accutane, yes.
Usually takes about two weeks to really help.
Ok. So to sum up: I'll try Doxycycline first and I would also add Vitamin C 500 mg. (twice a day), zinc gluconate 25 mg. a day and Barberry (1x/day)
Then for my scars: Brand Md's HQRA's Skin Ligthtening cream OR Fraxel laser
If nothing helps Accutane is to be considered.
By the way, what is the dosage and frequency for Doxycycline?
Doxycycline 100 mg. twice a day.
Basically, that is what I would recommend.
30 years practice in general and cosmetic dermatology