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What is the treatment for severe recurring acne?

Q: I was prescribed Isotroin-20 for severe acne. I took the medicine for 5 months and visible changes were noticed. However after 2 months, the severe acne started occurring again. I am again taking the same drug for the past one and a half month. For how long should I continue the drug, so that the acne does not recur? Should I take the liver test again? I have taken the test only once, i.e. before I started the course. Is there any other care or precaution that I need to take since the problem is recurring?

A:The cause of acne, if present, should be determined. For example acne could be due to Polycystic Ovarian Syndrome (PCOS); hence a gynaecologist may need to be consulted. If there is no cause, then a step by step approach needs to be adopted i.e. oral erythromycin + topical cream; if no improvement then cyproterone with oestrogen may be used in females. Only in unresponsive, resistant, very severe cases one should prescribe isotretinoin (Isotroin). However before using an oral preparation, it is worth using a skin preparation containing the same medicine (sold under the trade name of Eudyna). Oral isotretinoin is a very potent drug with large number of potentially serious side effects with many precautions to be taken. In the case of females, pregnancy MUST be excluded before starting Isotroin and adequate contraceptive steps taken to ensure that the patient does not become pregnant since babies born to such mothers can have serious and severe body defects. During treatment, eyes and liver function tests must be performed. In addition triglyceride (in blood) levels should be monitored. Isotroin should be taken on prescription from an experienced skin specialist. Initially it should be given for 4 weeks and the treatment extended for no more than 12 weeks (thus no more than 4 months in all). Repeat courses are not recommended.

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