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Hello, thank you for having this platform for our queries to be answered. I have suffered with moderate acne for about 6 years and I’ve always visited this GP that focuses on skin (they’re pretty popular and have their own line of skin care products, and why a GP you may ask? I guess cause it is cheaper and more convenient) for many years and have had success with topicals (differin, clindoxyl, clindamycin solution, tretinoin cream etc.) + a single round of doxycycline. During my army, I thought I would maintain my skin with Changi General Hospital since it is subsidised (about a year back they’ve prescribed me another round of doxycycline + topicals). In the past 5 months, my acne has spiralled out of control and I think it would be considered moderately severe now. In the past visit to CGH (which was about 4 weeks back, and I have since come out of the army), I asked the consultant for accutane but he refused saying that their records are being audited and cannot simply just prescribe accutane without trying ALL the possible antibiotics. He then prescribed me with erythromycin and another round of clindoxyl and of course till now, I think my condition has worsened instead of getting better.
I would like to ask if I insist on accutane + tell them about my long history with antibiotics and topicals they would be more likely to put me on accutane. The doctor said himself that my condition is moderately severe and I’m puzzled why he wouldn’t want to prescribe me with accutane. Is accutane even available in CGH? Or will they refer me back to NSC which would take a whole round of waiting and time wasted again?
Thank you for your time
Thanks for the detailed summary. There’s no problem at all with seeing a GP to treat your acne – the treatment algorithm for acne is pretty standard.
My pet peeve is only with clinics who overcharge based on having some sort of special super secret ingredient “miracle acne creams”, because the reality is that all effective topical creams contain well-known ingredients, and packaging it under their own brand shouldn’t give them the right to charge more, or “lock-in” patients to only using their creams.
Personally, I find your preference for a trial of Accutane reasonable, although I cannot comment on why it wasn’t offered at CGH if you acne is as severe as you’ve described, and given that you’ve already had a trial of various antibiotics treatment.
I guess it’s unlucky that you went to CGH at an “audit time”, which are sometimes carried out to make sure treatment paths follow the right algorithm, and medications are properly prescribed. In these situations, all treatment records are scrutinised, which may be a reason why they were reluctant to give you a trial of Accutane without first following through with the typical “treatment protocol”.
As explained in the post above, different doctors have a different threshold for giving Accutane to treat acne.
I’d like to add that it’s unlikely your doctor meant for you to use Clindoxyl (an antibiotic cream) and erythromycin at the same time. It’s a contraindication to use both an oral and topical antibiotic at the same time, as their effects are not cumulative, and it breeds quicker antibiotic resistance. There are quite a number of studies on this. Do clarify this at your next visit (I can’t comment if prescribing an oral and topical antibiotic may be just down to your doctor’s anecdotal experience and preference once again). I prefer Epiduo as a topical myself, which is a combination of Differin and Benzoyl Peroxide.
“Is accutane even available in CGH?” – yes, and it is highly unlikely that they will refer you back to the NSC.
“I would like to ask if I insist on accutane + tell them about my long history with antibiotics and topicals they would be more likely to put me on Accutane.” – yes.
Don’t quote me on this, but you could try telling them you are particularly worried about antibiotic resistance as well, with your multiple courses of antibiotics. Also, if you are experiencing any side effects from the antibiotics as well, such a tummy upsets, do also inform the doctor as gastrointestinal disturbances can be quite a common side effect, and would give the doctor a valid reason to stop antibiotics trials.
Finally, if you are adamant on having a trial of Accutane (as I probably would be too), and have no luck with CGH still, the best way would be to just visit a private dermatologist in Singapore.
Alternatively, you could try other special interest GPs that deal with acne – you could easily call up the clinic beforehand to check if they have Accutane. Be prepared to recap your whole story and treatment history with multiple failed courses of antibiotics again.
Naturally this will be the more expensive option, but prevention is better than cure – acne scars will be way more expensive and challenging to have to deal with later on in life.
Hope you get your acne under control soon!