Cystic acne is devastating. Fortunately, isotretinoin is literally a lifesaver. I realized this more acutely when my own son kept getting multiple disfiguring facial cysts. They did not respond to topical or oral antibiotics. Intralesional corticosteroids were of temporary benefit, but not always available when we were away visiting family in New York, New Jersey, or Florida.
I made him an appointment with my PA-C Jonathan Cyphers. Jonathan has a special touch with kids. We began at a low dose, considering it was summer and there would be a lot of sun exposure. The skin peels on this drug, especially the lips. As it turns out, after one week, the kids at camp and his cousins were commenting on his visibly peeling skin. He was quite embarrassed and wanted to quit the medication. I informed him that this was a typical response and to moisturize his skin with an over-the-counter emollient and any kind of ointment for his lips.
He did so. In addition, I had him take his pill every other day, thereby halving his dose. I felt it essential not to give up, to persist because this medication is curative.
So far he is clearing well and is sure to have spectacular results.
For acne that is scarring or manifests even with one cyst or “boil”, isotretinoin works the best. It prevents further scarring and boosts a child’s self-esteem at a critical time of life, the teenage years. I have treated adults even after age 40 with this medication successfully, so it is never too late. There is a list of common side effects, all manageable.
Elie Levy, MD, FAAD
Aesthetic and General
Dermatology of Seattle
