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HospitalBum

What is a reasonable management for me??? Thoughts please!

28 year old Asian male here - been suffering from acne vulgaris since age of 13-14, and have been conservatively treated with topicals (differin, BP, clinda, etc.) and occasional antibiotics, with varied responses (never 100%), until I was 25 (2014) when I had a pretty bad breakout. My derm in NY considered it "moderate" cystic acne, though it was causing a lot of scarring and psychological effects at the time, which he placed me on isotretinoin for 6 months. I responded very well, clear for about 8 months, until I started to break out again. I was at a different location in NY at that point, and saw a different derm, who placed me on conservative medications (topicals) because he did not believe that my acne will progress even worse. He was then convinced, and placed me on isotretinoin for a 2nd course (40 mg/day for 4 months). I cleared again and 4 months after completing the course started to break out bad. I saw a separate derm outside of NY because of a temporary move. She immediately put me on minocycline 200mg/day for 3 months, which cleared me well. About 2 months later, I began breaking out again. This stretched for a few months before I moved back to NY, and saw the derm that placed me on my second course of isotretinoin. He placed me on minocycline as the non-NY derm did on an "as needed" basis. I responded fairly well over the course of a month, and so I began tapering off, which inevitably caused the return of my acne in a matter of a week. I went back on it strictly again but recently noticed that I am developing more comedones (black heads) that result in a bumpy appearance on my cheeks/jawline. I think this is because the isotretinoin effects from previous courses is finally wearing off completely and has been sprouting more acne. Therefore, I am not responding to the minocycline/doxycycline as well! All this while, I am developing many blemishes and predict future scarring. But my derm isn't convinced and wants me to stay on the antibiotics, though he added vitamin A. He said the only way he can see me going on isotretinoin again is if I wait a month without taking anything to see if it gets bad enough... How valid is this "management"? I have a long history of persistent acne which returns when I stop my medications, and now with antibiotics that previously worked is now becoming less effective! I am tired of the "get better, get off meds, and wait to get worse again" game.

Should I seek a new dermatologist for a possible 3rd course of isotretinoin? Or do you think I should stay with my antibiotics+vitamin A regimen? What can I do to manage the increasing numbers of comedones that are forming (e.g. masks, cleansers)?

Thanks a lot guys!

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