Hi everyone,

The goal of this topic is to get some advice concerning the next step in my medication. Therefore I will inform you all of my medication history (so that you know what I have been on before).

I am currently 22 years old and my acne started when I was 14. So I have been dealing with it for approximately 8 years. In the beginning I used topical antibiotics such as Eryacne (Erytromycine). This helped but (obviously) only temporary. Then I struggeled with retinoids such as Differin for about a year but these did not seem to do much.

The next step was good old accutane. My first course was a very low dosage (I believe it was 20mg/month) which lasted for about 6 months (way too short for such as low dose ofcourse, but little did I know). I stayed clear for about 6 consecutive months and then it came back. I was put on another course for another 6 months. I started out with (I believe) 40mg/month. I asked my derm to up my dosage because I believed it was still too low. The dosage got doubled but I didn't last longer than a month due to side-effects (especially the dry eyes). I went back on 40mg/month and finished a 6 month course. The total dosage was higher than my first course of accutane but still not high enough to reach the desired mg/bodyweight ratio (I weigh about 80kg). So I remained clear for about 6 months again and it came back. It did come back less worse than it used to be though, so atleast the second course did something. I started my third course when I was 19 and stayed on it for about 8 months (I switched derms halfway because the first one obviously did not know about the mg of accutane/weight ratio, which is why the course took so long). This time I did obtain the desired total dosage. Sadly, after about 6 months (again) the acne came back. It seems to have been reduced a bit again but not as dramatic as after the second course.

Anyway, 3 rounds of accutane in 3 years is not the healthiest thing one can do to a body. So when it came back again I decided I wanted to try retinoids (in combination with antibiotics) again to give my body some time to recover from the accutane. I hoped retinoids would actually work now because my acne wasn't as bad as it used to be. I first tried differin for about a year. I stayed clear throughout the course because I first started to use Eryacne again (I wasn't immune anymore), and when my body got used to that again I started taking oral minocycline. Eventually I went off the antibiotics in the hope the differin would do its job independently. Sadly though my acne came back after 2 months. I went back on antibiotics and decided to give Retin-A (topical cream) a go. I have been using it for about 6 months now and have stopped the antibiotics. Once again my acne has come back, so apparently the Retin-A is not helping either.

Now finally for my question (now that you know my history it might be easier to answer): Retin-A and Differin did not help. What retinoid should I try next? Or is there something new I can try (I have not been keeping up with new developments since 2012)? Accutane is still out of the question for atleast a couple of years.

P.S. The kind of acne I am currently dealing with is mild/moderate, and is concentrated around my mouth/chin. Luckily I don't get any cysts/nodules anymore but just whiteheads (which are are very inflammatory though).