Brief Answer:
If not using topical creams treatment suboptimal

Detailed Answer:
Hi,
Thanks for writing to us.
Firstly I would like to know if you have been prescribed with any topical medicines or not
Secondly If you have any hormonal imbalance in form of delayed or irregular cycles, excessive or unwanted hair over face, weight gain, dandruff or hair fall.

Aldactone is an antiandrogen drug helpful in acne if there is an underlying hormonal imbalance
Azithromycin is an antibiotic helpful in acne
everpene contains lycopene, minerals antioxidants etc.

Acne treatment depends upon the type of lesions and severity of lesions, so also let me know if you are having too many lesions or less number of lesions. Similarly if you have small red bumps, blackheads, pus filled lesions or big cysts or nodules.
Answering these queries would help me in suggesting most suitable treatment for you.
Scars require peels, microdermabrasion or dermarollers for resolution. What woyld suit you can only be ascertained by examining the scars. Hence I would advise you to answer all the above queries and also upload an image of concerned area.

waiting for your reply so that we can take the discussion forward.
Take care

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Brief Answer:
I would like to make slight change in medicines

Detailed Answer:
Hi,
Thanks for providing me with details and image(though its not very clear)
In my clinical practice I believe in a multipronged approach ie
First step should be to get all your black heads, white heads removed by a dermatologist
The pus field lesions if big and painful should be drained and if large cysts and nodules are there intralesional steroid should be injected.
If patient is willing a single session of salicylic acid peels should be added( though you are not ready for same)

All the above steps comprise active acne surgery. These help in faster resolution of lesions and minimise scar formation.
Along with above steps, I would have added isotretinoin 20 mg daily in your case along with tablet azithromycin and topical drugs( you may continue with faceclin a) along with a mild face cleanser for oily skin cetaphil os.
Aldactone or oral contraceptive pills work well if there is a hormonal disorder or if acne is of adult onset. Right now I would just advise you to start with these atleast for a month and then depending on response we may add an ocp or any other hormonal preparation.

Isotretinoin is a wonder drug for acne but has certain specifications which should be advised to the patient and certain contraindications should be ruled out. So for the same XXXXXXX a dermatologist nearby.

Hope that helped.
Take care

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Brief Answer:
isotretinoin can be started in lower dose

Detailed Answer:
Hi,
Thanks for writing back.
Let me summarise your skin concern-
20 mg isotretinoin didnt suit you
salicylic acid peels costly and in effective
oily skin
hair fall
skin pigmentation.

1) side effects like dryness of skin and cracked lips are common with isotretinoin but can be managed with moisturisers meant for oily skin. These can also be limited by use of isotretinoin in low dose like 10 mg daily or 20 mg every other day.
2) as I said, go with active acne surgery and follow it up with single session of salicylic acid peel. Salicylic acid peels may cost anywhere from 500 to 5000 depending on the set up and city but almost all have same efficacy
3) isotretinoin reduced oil secretion from face too. So its use would help in reducing acne as well as oiliness.
4) for hair fall- improve your diet. Increase intake of proteins, vitamins and minerals by incorporating eggs, lean meats, soy, lentils, sprouts, fruits, nuts and green vegetables in diet. Use of minoxidil solution would help too in reducing the hair fall.
5) pigmentation can be reduced by use of kojic acid or hydroquinone creams at pigmented spots.

Now the above treatment plan would help considering you would consider taking isotretinoin with your original medicines. However if you wish not to take it then in case a more conservative treatment plan taking all your skin concerns in mind would be

1) use glycolic acid 6 percent face wash(melawash) two times in a day. Apply it for two minutes over face and then wash off. This would reduce marks, oiliness as well as acne.
2) use salicylic acid gel(sebonac) over face. Apply it and wash off after two hours. This would reduce acne, marks, oiliness. The mode of action is just like peels however as the concentration is low so effect would take time to be visible
3) If you are my patient I would suggest Tablet Doxycycline 100 mg two times in a day. This needs prescription to buy at the pharmacy.
4) Apply Clindamycin benzoyl peroxide(clindoxyl, clinoxid) combination gel in morning. Can get it over the counter.
5) Apply Tretinoin gel in the evening over acne marks and spots too.

Caution has to be taken while applying gels. Apply in minutest possible quantity, sufficient enough to cover the lesion.

Hope this would help you out. Please do consult your doctor prior to starting any treatment.
Take care

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