Ask a doctor on the topic of Dermatology

Acne papulopustulosa, what helps besides isotretinoin?

November 3, 2012 | 20,00 EUR | answered by Dr. med. Ralf Berg

Hello dear team!

A few months ago I wrote here about my then Acne comedonica (https://frag-einen.com/arzt/?page=question&action=detail&object=5814).

Meanwhile, the situation has developed into a condition known as Papulopustulosa according to the dermatologist. This means, many blackheads, clogged pores, and occasional inflammations. The main issue, however, are the clogged pores.

I want to describe this as clearly as possible so that I can receive better advice from you.

Since August, I have been using Zeniac cleansing gel and LP cream. It helped, albeit only to a certain extent, but it terribly dried out my skin. I don't really tolerate moisturizers well, as they always seem to cause new clogged pores, even though they are supposedly non-comedogenic. For example, I used Clean AC. Do you have any new recommendations?

Subsequently, I switched from Zeniac to Cordes 3% as recommended to me here when I wrote before. The first few times applying it was great (without moisturizer), but then I developed swelling and itchy eczema all over my face.

I treated the skin with cortisone, let it heal, and tried Cordes again, but this time with the Clean Ac moisturizer from Avene. The next morning, I woke up with a swollen, itchy spot. The attempt with Cordes failed. I don't know if it's an allergy. I applied it to my forearm as a test - no reaction.

So, I went back to Zeniac, but now I am slowly reacting to it. This means as soon as it gets too dry, eczema and itching return. Could the problem be that I'm not using moisturizer? Could that be the mistake?

And due to this irregular use of Zeniac, I obviously have new clogged pores and blackheads.

I have already tried self-made ointments and such (antibiotics).

My current skincare routine looks like this:

Zeniac cleansing gel (I find it great, I tolerate it well), Zeniac LP cream, and in some areas Aknemycin Plus. Currently no moisturizer, although I have developed very dry skin because so far, almost every moisturizer I have used (Avene Clean AC) has caused new pimples or blackheads.

1 x weekly to 2 x Brasivil fine peeling.

My doctor said unfortunately, if so much external treatment doesn't work, Isotretinoin is method number 1. But for that, I would have to take the pill or use hormonal contraception. 1. I have not tolerated any pill so far, 2. My gut feeling is against Iso. At the moment, I don't want to go down that route.

Do I have any other options, is my question? Would microdermabrasion from a cosmetologist help?

Dr. med. Ralf Berg

Hello dear inquirer,

Unfortunately, I don't have a "secret tip". And I suspect there is hardly any other "therapy concept" that you have not already tried. In light of your description, the duration (1.5 years), as well as the knowledge of most of the products you have already used and knowledge of the course of people who have developed a similar persistent "adult acne" with comedone formation seemingly out of nowhere, I trust my gut feeling over yours. Mine tells me (and the memory of patients) that probably at least a temporary use of isotretinoin will be the right choice. Contraception does not necessarily have to be hormonal. You just have to confirm to the provider that you accept the increased risk of conception, and in case of a possible pregnancy, take countermeasures (pregnancy test or morning-after pill).

So, I believe that at the moment there is probably no alternative in your situation that will effectively solve your problem. However, I have often seen that after isotretinoin treatment, the result could be maintained with regular skincare. Even though this is probably not the advice you were hoping for, it is simply my gut feeling and the sum of my experiences from practice. But you can still try something before doing this. (of course, with no guarantee and of course, not knowing if you have already tried this:)

If you are right and the lack of moisture/intolerance of creams is the cause of your recurrences, I would advise you to try the skincare lines from Weleda or Wala. These are deliberately hypoallergenic, without preservatives, and should also be tolerated by your skin. Even if you have probably already tried this: Some people tolerate lotions better than creams or ointments even with dry skin (even if this goes against the textbook). Just try it out. (And then maybe consider trying the isotretinoin after all.... then there might be a happy ending after all....

With many greetings, Dr. R. Berg