I'm an adult woman who gets very severe back acne in the winter months, typically Jan / Feb with completely clear back skin in the spring/summer/fall. This past year though was the first that the issue lasted into spring and early summer. During this time I had tried a variety of medications that I had on hand from other dermatological treatments, including retin-a, retin-a micro, BP, SA, clindamycin, etc. I also had a tube of ketoconazole as well as some other anti-fungals, steroids creams, etc (I have very sensitive skin and have been to the derm a lot in the past). I hadn't gone to the derm for my back acne in the past though, as it typically cleared up before I could get into an office due to long scheduling times around here.

I was rotating my medications to see if anything had an impact - not the smartest maybe but I was desperate when going on vacation and it hadn't cleared up. When I started using ketaconzale, the difference was almost immediate. Prior to this usage, I had scheduled a new derm appt about 3 months out. By the time I went to the derm, she was in disbelief that I had a problem, other than what she referred to as old scars. These were not old scars, but healing "hives" from a few weeks prior.

I explained about the ketoconazole and she was firm that there was no way that is what helped and she prescribed retin-A and told me to discontinue the ketoconazole. So I did. Within about a week the rash part started to come back but I called in and was told that it was just the retin-a initial period. I would say that this very mild rash and otherwise generally clear skin lasted about 3 mths. However the full on rash / hives thing is now back. I went back to the derm to look again, and she prescribed minocycline and a selenium sulfide wash in addition to saying to continue retin-a. She said that it was clearly acne and not fungal, so she again was firm that the ketoconazole would not work and would not prescribe. Which was fine, I was able to get some elsewhere (but it's not a sustainable source).

I am again putting it on my back and after a few days is about 30% improved, much less red, and no new bumps. I am not sure what the deal is - i mean I believe someone who is a doctor and went to school, etc. But then in another way, what is the harm of trying? Is there something really bad about it? I mean so bad that she would want me on antibiotics before even trying it? I have been on minocycline for face/chest acne as a teenager and yes I tolerated it well but it seems to have a lot of possible side effects that a topical would not. So what's the deal?

Note that this stuff does nothing at all for my facial acne which responds fairly well to retin-a. These are very different skin issues. Should I find a new derm?