Really frustrated with oil and acne in Toronto!

I want to know how to make my skin better, I'm so tired and frustrated. 3 dermatologists and nothing has changed. I'm in Toronto and am in total despair over how to find a competent dermatologist. 22 male, had moderate acne oily t zone, was on accutane 20mg/day for 12 weeks and it PERFECTLY re-balanced my oil production in my hair and face which I believe resulted in gradually reducing all my acne (except the black heads they never fully went away). I finished that in January and now the oil is back (not quite as bad) and acne is returning too. Little tiny whiteheads on my nose and all over my forehead. Skin is rough and bumpy on forehead nose area again where as during accutane treatment my skin was smooth and the complexion was actually pretty nice. Please Dr. Irwin I'm begging you here! I know that with acne an ounce of prevention is worth a pound of cure and that's why I am SCARED because the acne is slowly getting worse again and it feels like there is nothing I can do to stop it. I don't know who to talk to and what products to try because they're are millions! What do you think of Renee Rouleau's products? Other than being ridiculously overpriced Kind Regards, Al

Ok – let’s really talk about this.  I’m totally hearing your frustration.

Let’s think about your body though first. From puberty to late 20s, male and female hormones are the most intense. There’s a very gradual decrease after that. If you are genetically prone, oil and acne will be at their worst then. I know this doesn’t help when you’re frustrated so let’s go over these one by one.

Accutane and It’s Generics

The indications for this medication are for severe pustular or cystic acne that often scars. These types of acne often cause permanent scars, not just temporary brown or red spots. In the U.S., it is strictly regulated through a federal program. This is NOT the case in Canada or other countries.

Here are some things to think about:

  • IF you meet the criteria above, the recommended dosing is 1-2 mg/kg per day. If you are an 80 kg male, the correct dose for cystic acne would be 80-120 mg per day normally, or even higher. A dose of 20mg per day, is not a therapeutic dose for your size. It won’t cause the more permanent control of your acne. That dose (20mg/day) would be more an “oil control” dose, and you would expect the oil and acne to come back rather quickly.
  • If you don’t meet the criteria for the more severe acne, sometimes it is possible in Canada (not the U.S.), to be treated with the higher dose for the chronicity of the acne.
  • Please go to your excellent university derm clinic in Toronto and inquire about this for you!

Topical Acne Medications (prescription)

  • There are literally at least a dozen excellent prescription gels and lotions that can help control the plugs (comedones) and the bumps (papular acne). Your primary care doctor should be able to prescribe you one for the morning and a different one for the evening, to help control your acne.
  • Remember that it takes about 8-10 weeks for these medications to work. Don’t give up.
  • Stop them only if they are irritating you or causing an allergic reaction, and call  your doctor.
  • We also have excellent acne topicals on this site to help you, if it’s a wait to get in to your doctor.

Oral Prescription Medication

  • Oral antibiotics may be used for months or even a few years for acne. There are currently dosages (low dose) and ways to do this that don’t affect your gut biome as much.
  • If on oral antibiotics, take a probiotic capsule at a different time of day than your dose.
  • Spironolactone is not a option for men, because it affects testosterone.

Hope this helps,  Dr. I





Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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