I took tetracycline for two years and it cleared my skin up beautifully. However, my acne returned full blown this year. My dermatologist told me to take the tetracycline again but it has lost effectiveness in my opinion, very little improvement in three months and still getting flare ups.

Should i ask to swap to another tetracycline? Whats the best antibiotic? Or is accutane the way forward if i'm getting major PI Hyper pigmentation?

 

Isotretinoin is typically used to treat cystic acne, acne that scars (including psychologically), acne that is recalcitrant to other treatments, or a combination of these three. It doesn't directly treat postinflammatory hyperpigmentation, but it's by far the most efficacious medicine against acne. Hydroquinone would be a popular choice to directly treat the red marks, but it only makes sense to use this when the acne is already under control.

There's no best antibiotic since people respond differently to them. To find the best one for you would require trial and error. If the tetracycline is not as effective as it once was, you may have developed a resistance to it, which is not uncommon. If you choose to stick with antibiotics, erythromycin may be worth a shot, so I'd bring that up to your dermatologist.

If you choose isotretinoin, know that there's a potential interaction between it and tetracyclines, so it's not advisable to take both at the same time. What I don't like about antibiotics is that they're not long-term solutions. It happens frequently that when they are no longer used, the acne comes back. Isotretinoin, on the other hand, often clears the patient for years, and almost never does the acne return to the severity of its previous state.

Bactrim is the antibiotic gold standard for acne. It worked wonders for me for years but eventually stopped working and alas also caused very painful kidney stones so I stopped taking it years ago. There are other antibiotics too but long term it is not good for your gut, I can attest to that personally. Accutane is an option, which will work great for almost all while on it. But there is the possibility for severe side effects and depending on your skin type for some people (myself included) does not produce a long term remission. Knowing what I know now, I would suggest having your hormones checked first before resorting to more antibiotics or accutane. This is not something a derm knows how to do, so you would need to get this done by your primary care doc or perhaps an endo or since your female gyno. Acne's root cause is a hormonal imbalance. I just recently cured myself with over the counter Vitamin D (which is a pro-hormone). I have a vitamin D deficiency which for me appears to be the root of my oily acne prone skin. It's too long a story to post here but you can check out my post under the vitamin board under "Vitamin D cured my oily skin and acne".

I tried so many different antibiotics for my acne, it would also help I optimally but I would build resistance to it after a few months. I'm now on accutane, and yea definitely don't take it with any antibiotic!

Accutane isn't to be taken lightly, and it depends on the severity of your acne. I did a ton of research and it also helped that I know 5 people that used it and have had no acne since and no bad health problems. If you read the negative experiences thread here you'll get discouraged, but honestly, you only hear about the bad cases because most people have success and don't post about it. They monitor your blood every month and you should monitor your own health very carefully. It's a last resort. Talk to your derm abou it!