BLOG

Doctors' Point

For those considering acne treatment at a cosmetic dermatology clinic. We’ll work with you to address your concerns about recurring acne, increasing redness, and scarring, and guide you on where to start.

 

The conclusion is simple: First, carefully build a solid foundation of “proper basics” through insurance-covered treatment. On that basis, for patients who continue to experience intractable or recurrent conditions, it is realistic to consider options such as isotretinoin (an oral vitamin A derivative) at a cosmetic dermatology clinic.

 

At our cosmetic dermatology clinic, we determine treatment priorities based on your lifestyle, skin type, and preferred frequency of visits.

The Basics of Acne from a Cosmetic Dermatology Perspective

Acne is a chronic skin condition caused by a combination of "sebum production," "clogged pores (keratinization)," and "inflammation."

 

At a cosmetic dermatology clinic, we take a comprehensive approach to evaluate not only your current skin conditions (such as whiteheads, red acne, and lumps) but also the risk of hyperpigmentation and uneven skin texture, seasonal factors, and your skincare routine.

 

Treatment isn't a one-step process; the key to success is adjusting the intensity in stages to determine what works and what doesn't.

An Overview of General Insurance-Covered Treatments

The foundation of this treatment is insurance-covered care. Topical medications are combined to “unclog pores” and “reduce inflammation,” while oral medications are used for a limited period when inflammation is severe.

 

We will reassess your treatment every 4 to 8 weeks and transition to maintenance therapy after confirming your response at 8 to 12 weeks. In the early stages of treatment, you may experience a stinging sensation, redness, or dryness; however, these symptoms can usually be alleviated by adjusting the amount applied, the frequency of application, and moisturizing. The effectiveness of the treatment and the duration of any downtime vary from person to person.

Commonly Used Medications and Key Points

• Benzoyl peroxide (BPO): Combines exfoliation with antibacterial properties. During the initial phase, when irritation is more likely to occur, adjust the amount applied and the frequency of use.

• Topical retinoids (e.g., adapalene): Help clear clogged pores and prevent recurrence. They are typically used primarily at night, as this makes it easier to combine them with moisturizers.

• Antibiotics (topical and oral): Used for short-term, intensive treatment of inflammatory acne. To prevent the development of resistance, it is recommended to use them in combination with BPO and avoid prolonged, drawn-out treatment.

• Comedone Extraction: An insurance-covered procedure that physically removes clogged pores. After the procedure, it is recommended to use gentle skincare products.

• Traditional Chinese medicine, etc.: These may be selected based on a person’s constitution, sensitivity to cold, swelling, and other self-reported symptoms.

The Role of Isotretinoin

This treatment is often considered for patients with moderate to severe acne or those with recurrent, treatment-resistant acne. It is expected to have multifaceted effects, including suppressing sebum production, regulating keratinization, and reducing inflammatory signals.

 

In Japan, this treatment is not covered by insurance, and even cosmetic dermatology clinics handle it with great caution. Because it is known to be highly teratogenic, it is essential to discuss treatment plans and ensure proper contraception if there is any possibility of pregnancy.

 

The medication is typically taken orally while adjusting the dosage every few months; temporary worsening of symptoms or dryness may occur initially. Since effectiveness, side effects, and duration of action vary from person to person, it is important to avoid both overestimating and underestimating the effects and to make judgments on a step-by-step basis.

Pre-Administration Checks and Monitoring

• Do not use this medication during pregnancy or while breastfeeding. Due to its strong teratogenic potential, contraception (preferably using two methods) is mandatory before, during, and after treatment. If you are planning to become pregnant, consult your doctor to determine the necessary contraception periods before, during, and after treatment, and create a schedule that works for you. Under U.S. prescribing guidelines, women of childbearing potential are required to use contraception for one month before starting treatment, during treatment, and for one month after stopping treatment. This will be confirmed through a verbal interview during treatment.

• We monitor liver function, lipid levels, and other factors through regular blood tests and adjust the dosage and frequency based on the results.

• Since there are medications that should not be taken in combination with this drug (e.g., certain antibiotics), you must disclose all medications, including supplements and over-the-counter drugs.

• Consideration must be given to blood donation restrictions, dry eyes, chapped lips, and sensitivity to light.

Common Side Effects and Self-Care

• Dryness and chapped lips: Apply petroleum jelly or a mild moisturizer frequently. Avoid overwashing.

• Skin irritation and redness: Use sunscreen during the day and apply extra moisturizer at night. If symptoms are severe, see a doctor promptly.

• Fluctuations in blood test results: Adjust the dose based on the results. Do not continue treatment on your own.

• Rare mood changes, headaches, etc.: While a causal relationship cannot be definitively established in all cases, please don't hesitate to consult us if you experience any discomfort.

Combined and Complementary Care at a Cosmetic Dermatology Clinic

Self-paid exfoliation treatments and light- or energy-based procedures serve different purposes during the inflammatory phase and the skin-improvement phase. We combine these treatments with insurance-covered treatments based on criteria such as the frequency of visits, work or school schedules, budget, and whether it’s a time when redness would not be a problem.

 

Choosing based on “compatibility” rather than “effectiveness” leads to sustainable, stress-free care. At our cosmetic dermatology clinic, we provide skincare guidance and lifestyle recommendations to prevent recurrence, and we consider alternative approaches during the acne scarring phase.

How to Interpret "Before & After" Images

The impression conveyed by a photo can vary depending on lighting, angle, whether makeup is worn, when the photo was taken (how many months later), and any changes in skincare routines made at the same time. When viewing “Before & After” photos, please check the time period and whether multiple treatments were combined, and use them only as examples for reference.

 

It's important to think about this in terms of your own skin type and lifestyle.

Frequently Asked Questions

Q. How long does it take to notice the effects of insurance-covered treatment?

Changes are typically evaluated after a few weeks at the earliest, and generally after 8 to 12 weeks. Irritation and dryness can often be managed, so the key is to find ways to continue the treatment comfortably without straining yourself.

Q. Is a single dose of isotretinoin enough?

As a general rule, treatment is temporarily discontinued once the cumulative dose per body weight (approximately 120–150 mg/kg) has been reached. However, if the disease persists or there is a high risk of relapse, an additional course of treatment may be necessary after a break in therapy.

 

Most treatment plans are designed as courses lasting several months, and since individual differences in treatment persistence and recurrence exist, it is also important to incorporate maintenance care (such as topical treatments and lifestyle adjustments) into the treatment plan. In particular, if you are planning to become pregnant, consult with your doctor to confirm the necessary period of contraception before, during, and after taking the medication, and create a schedule that works for you.

 

Under U.S. prescribing guidelines, women of childbearing potential are required to use contraception for one month prior to starting the medication, during treatment, and for one month after discontinuing it.

Q. Do I need to take time off from work or school?

Generally, there’s no need to take a break. Even if you experience stinging, redness, or dryness early on, you can usually manage these symptoms by adjusting the amount and frequency of application, as well as by using moisturizers and sun protection. If you’re concerned about how your skin looks, wait to start the treatment until after any important events, or begin by using it only at night.

 

Although isotretinoin can cause dryness and redness, these symptoms can be managed with moisturizers and sunscreen.

Q. Can I combine insurance-covered treatment with out-of-pocket treatment?

While it is possible to combine these treatments, you’ll need to adjust the order and timing to avoid overstimulation. Consult with a cosmetic dermatologist to develop a comprehensive treatment plan.

When to Consult a Cosmetic Dermatologist

If you’re experiencing recurring flare-ups, an increase in painful lumps, concerns about pigmentation or uneven skin texture, or discomfort from medication—in these cases, please consult a cosmetic dermatologist.

 

From reviewing insurance-covered treatments to evaluating the appropriateness of isotretinoin and making minor adjustments to your lifestyle and skincare routine, we can work together to explore options that best suit your current situation. We’ll proceed without high-pressure sales tactics, prioritizing your peace of mind.

Summary

The first step in treating acne is to carefully build a foundation using standard insurance-covered treatments. For cases that are difficult to treat or prone to recurrence, it is worth carefully considering treatment options—including isotretinoin—at a cosmetic dermatology clinic.

 

Because effects, side effects, and downtime vary from person to person, it’s important to create a plan that fits your lifestyle and goals. Especially if you’re hoping to become pregnant, be sure to discuss with your doctor the necessary period of contraception before, during, and after taking the medication, and plan your schedule accordingly without putting undue strain on yourself.

 

In the U.S., prescription guidelines require women of childbearing age to use contraception for one month before starting the medication, during treatment, and for one month after stopping it. If you’d like to know if this medication is right for you, please consult with your healthcare provider.

 

If your acne is difficult to treat, keeps coming back, or you’ve noticed an increase in acne scars, it’s time to reassess your treatment. Don’t stop or change your treatment on your own—consult a doctor as soon as possible.

 

▷ Acne and Acne Scar Treatments Page

▷ Counseling Appointment Page