Recently Developed Acne

Dr. Rockoff,

When I was a teen (mostly middle school and high school), I would have occasional breakouts, but never needed to see a dermatologist. I never had more than 4-5 at a time and by the time I got to late high school and college, I would get maybe 2-3 zits a month. However, I started breaking out very bad this past January with cystic acne on my chin and neck. I saw a derm which prescribed Bactrim for 1 month and Differin. This helped, but now it is coming back again.

I went to see another derm (I moved) and they prescribed Oracea. Also, they mentioned that if it didn't work after a couple months we may want to try Accutane. I currently have 7 active lesions and 3 of them are the deep, painful kind. I am a 24 year old male. This is my background which should help you answer my 3 questions below. Please answer all of them. Thanks.

1. I read that Oracea was for Rosacea patients. How will this help my acne go away? Do you know if it works for moderate acne?

2. About 1 year ago, I developed intestinal cramps and diarrhea. After noticing trace amounts of blood I went to a Gastroenterologist and he did colonoscopy and found scattered ulceration in my colon. The biopsy came back somewhat inconclusive but he didn't think it was ulcerative colitis or Crohn's, thought maybe infectious but wasn't sure. It has gotten alot better and acts more like IBS than IBD now. I have read reports about Accutane causing Crohn's disease. However, the Derm seemed to think Accutane was better for the bowels than long-term antibiotics. For mild-moderate acne, does it work just as well to use lower doses to avoid the serious side effects?

3. I had a very traumatic event happen in my marriage about 1 month before I started having these acne problems. Could it be that the trauma shook me into some sort of hormonal imbalance that needs to be corrected? It seems like I am too old to start getting bad acne at 24.

Thanks so much, I really want to get this resolved.

[Alan Rockoff, MD]

Oracea is low-dose doxycycline.  This can be used for both acne and rosacea.

The risk of bowel disease with Accutane is very low.  If you decide to consider that drug, you should check with your gastroenterologist.

I doubt that stress or hormones had any meaningful effect on your acne.  It isn't uncommon at all for acne to start after age 20.

Overall, I'm not sure you should consider Accutane now, because your acne doesn't sound serious enough to warrant it.  There are other choices--full-dose doxycycline, minocycline, may topical therapies--that you haven't tried.  Also, one month of an antibiotic (or anything else) isn't nearly long enough--acne treatments take 8-12 weeks to work.

Best.

Dr. Rockoff