What is the recommended treatment for severe inflammatory acne that has not responded to topical treatments?

In cases of severe inflammatory acne that have not responded to topical treatments, oral isotretinoin is the recommended treatment. This medication is a powerful retinoid derived from vitamin A and has been shown to significantly reduce sebum production, normalize keratinization, and exhibit anti-inflammatory properties. It works by targeting several pathogenic factors involved in acne development, making it particularly effective in cases where other treatments have failed.

Oral isotretinoin is also beneficial in reducing the size and production of sebaceous glands, leading to long-lasting remission for many patients. Its use is typically reserved for moderate to severe acne due to its side effects and the need for close monitoring during treatment, including the risk of teratogenic effects in females.

Topical benzoyl peroxide is more suitable for mild to moderate acne and may serve as an adjunct treatment but is not sufficient for severe cases on its own. Oral erythromycin, an antibiotic, may help with acne, but its efficacy is limited, especially when bacteria begin to develop resistance. Intralesional corticosteroids can provide rapid relief for individual cystic lesions but do not address widespread severe inflammatory acne effectively. Hence, for severe inflammatory acne unresponsive to topical options, the best approach is to initiate oral isotretin