These answers are for informational purposes and do not replace a physician head-to-head visit. A patient-physician relationship is not established.

Hello

Would it be possible to forward a photograph soI can see what we are dealing with? Thank you.

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.

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.

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.

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 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.

Doxycycline 100 mg. twice a day.

Basically, that is what I would recommend.