Suggest treatment for persistent acne
Add Oral antibiotics; I suggest switching to Adapalene 0.1% gel & a gentle cleansing lotion
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You seem to have moderately severe inflammatory acne i.e red, papules and nodules as well as post-inflammatory hyperpigmentation/ marks.
Though topical medications that you have been using seem quite Ok but the fact that they have not been very effective in controlling the severity of your acne requires that some modifications/ additions be made to your acne treatment.
If I was the treating doctor I would have added one of the Oral antiacne antibacterial agents e.g azithromycin, minocycline Or doxycycline.
Oral antibiotics are more effective in inflammatory acne and bring about faster control in addition to topical antiacne medications.
Oral antibiotics can be continued for 4-12 weeks depending on the severity of your acne and response to treatment.
Oral antibiotics are prescription drugs and therefore I suggest that you talk to a dermatologist in your vicinity for the needful.
In my patients I prefer adapalene 0.1% gel in place of topical azaleic acid gel. Adapalene is a better comedolytic than azaleic acid.
Adapalene gel should be used once daily at night. Benzoyl peroxide during day.
Salicylic acid face wash would be too drying and may cause irritation along with benzoyl peroxide and other topical agents, therefore, I suggest you to use a gentle cleanser for face wash e.g cetaphil cleansing lotion, twice daily in place of salicylic acid face wash.
I am sure these modifications/ additions would be more effective in your case.
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