How long have you been using bp?If you have been using it for more than two month and seeing no results I would recommend azelaic acid. You might also add a bha (salicylic acid) treatment. Paula's choice makes great bha products.

Hi -

Severe nodular-cystic acne is notoriously resistant to treatment with topicals, however, if your insurance allows, aczone might help. You could also try a retinoid (although this can make it worse in the short run). The problem with nodular-cystic acne is the infection occurs too deep in the skin to be affected by topicals - which only treat the very top layers of the skin. This is why antibiotics and accutane are often recommended.

I'm already using Tretinoin 0.5mg cream few times a week which is a type of Retinoid cream. Although I need to switch to the gel form.

I've never heard of Aczone(Dapsone gel). Does it work better than Benzoyl Peroxide?

There's so many topical creams out there and I don't know which ones works the best on nodular, cystic acne prone-skin.

How about these topical creams?

• Topical gel
  • Antibiotic
    • Clindamycin
    • Benzoyl Peroxode 2.5%
    • Aczone(Dapsone)
    • Sodium Sulfacetamide
  • Retinoid
    • Differin (Adapalene)
    • Tretinoin 0.5mg (only tried the cream form which is comedogenic so I need to try the gel form as well)
    • Tazorotine
    • Retin-A Micro
  • Combination
    • Duac
    • Benzaclin
    • Epiduo

I'm going to ask my dermatologist for Aczone and Tretinoin gel. Is there any other good prescription topical cream I should ask for my moderate to severe nodular acne?

Bump.

My GP has prescribed me with Isotrex gel. I've been on it for over two weeks and the initial breakout has been horrendous. I'm still in it but I'm going to persevere because I've heard good things about it. I have persistent nodular acne and I've been prescribed Differin (both cream and gel) with no success and Duac, which was great at first but I think I developed a resistance to the clindamycin because it doesn't really do anything for me.

Isotrex gel in combination with Minocycline is my doctor's last ditch attempt before Accutane so I'd see how you go with the former.

Lots and lots of luck!

Pee x

Agree with what's been said previously that nodular-cystic acne is really difficult to treat with topicals alone. That being said, my dermatologist prescribed Aczone and a compound of clindamycin in a hypoallergenic/sensitive skin/oil-free moisturizer, which along with oral antibiotics have worked well for me. My story is a bit complicated though by the fact that I got a severe contact dermatitis (which destroyed my skin) from using Epiduo, which precluded the use of any topicals for a good 6 months afterwards... I've just been started on Tazorac as well, which my dermatologist says should help heal the redness left over from the contact dermatitis.

I love Duac. It's made a huge difference.

Hey Heinstar, reading your post I can really relate. I have been battling with acne for thepast 10 years. Tried every single product out there. About a year and a half ago I started developing severe cystic acne. Thus ending in celullitis which is a serious skin infection, leading me to do numerous antibiotic treatments. I've gone to many dermatologist and it seems the only answer I get is acutane. Which I am reluctant to take because I know of many cases were people have developed serious side effects, including life threatning. I was prescribed epiduo along with oral amoxicillin antibiotic, and birth control ortho tri cyclen. After just 1 month my face chamged completely. No one can believe the change my skin did. My face acne had nearly dissaperared. Living free and clear was a nice change. Unfortunately, the antibiotic treatment ended, and due to some other events in my life that caused severe stress, and the fact that birth control was making me very moody,

All the progress slowly died. I have far more complications because I also have rosacea. Roseace with acne is no fun. Recently rosace developed in my ears, which is rare, casuing custic acne along my ear and behind it. I was just put on again on doxyciclone 100 mg daily and aczone. I've never tried aczone. Honestly I cant complain about epiduo, it just seems that epiduo does not wirk for rosacea, but derm says aczone does. Have you started yet? If so how is it going? Also what moisturizer are you using? Needles to say my skin is really dry. Thanks for your help.

My dermatologist told me that topical gels are ineffective for my cystic acne since they won't penetrate deep enough and told me to stick with whatever I'm using.

But I still tried to get his recommendation so he suggested Epiduo since it has Retinoid and Benzoyl Peroxide combined.

Hes opinions other topical gels were:

Tretinoin gel - he said they are too harsh on the skin and that Differin works better.

Isotrex gel - Istrex isn't available in Australia anymore probably due to low demand.

Clindamycin gel - he said they're useless for my cystic acne since it wont penetrate deep enough.

Aczone/Dapson gel - He didnt know about it so I couldnt get his opinion on it.

After getting his opinions, he again stressed the fact that topical gels are useless for my acne and that my only option is Accutane or Antibiotic. But I told him that I know it's at least helping me because if I wasn't using Benzoyl Peroxide gel, I would get even more cystic break outs. I'm not sure if Epiduo is really the most effective topical cream for my acne but that's all I could get from him.

I'm now on 100mg Doxycycline and although it's reducing my cystic acne, I still need to keep using Benzoyl Peroxide otherwise I still get cystic breakouts whenver my skin comes in contact with "]My dermatologist told me that topical gels are ineffective for my cystic acne since they won't penetrate deep enough and told me to stick with whatever I'm using.

But I still tried to get his recommendation so he suggested Epiduo since it has Retinoid and Benzoyl Peroxide combined.

Hes opinions other topical gels were:

Tretinoin gel - he said they are too harsh on the skin and that Differin works better.

Isotrex gel - Istrex isn't available in Australia anymore probably due to low demand.

Clindamycin gel - he said they're useless for my cystic acne since it wont penetrate deep enough.

Aczone/Dapson gel - He didnt know about it so I couldnt get his opinion on it.

After getting his opinions, he again stressed the fact that topical gels are useless for my acne and that my only option is Accutane or Antibiotic. But I told him that I know it's at least helping me because if I wasn't using Benzoyl Peroxide gel, I would get even more cystic break outs. I'm not sure if Epiduo is really the most effective topical cream for my acne but that's all I could get from him.

I'm now on 100mg Doxycycline and although it's reducing my cystic acne, I still need to keep using Benzoyl Peroxide otherwise I still get cystic breakouts whenver my skin comes in contact with sweat, dirt, bacteria, excess oil etc. And I'd rather keep using topical cream to keep my acne under control rather than increasing the dose of Antibiotic.

I'm also working on reducing my acne by improving my diet and fixing my existing health issues which I've mentioned in another thread. But I created this thread to get suggestion on the most effective topical cream for my acne. And it seem like Epiduo is the best one out there so I'll stick to that. Thanks everyone.