Acne treatment in Kochi,
on the IADVL-IAA protocol.

For adult acne, the IADVL-Indian Acne Alliance protocol DermaVue follows starts with topical adapalene 0.1% + benzoyl peroxide 2.5%, plus azelaic acid 15-20% for any post-inflammatory hyperpigmentation (the standard residual concern in Fitzpatrick IV-VI skin). For moderate or severe cases, oral doxycycline (4-12 weeks) is added; for nodulocystic acne or any case with scarring risk, oral isotretinoin to a cumulative 120 mg/kg target. Procedural peels and laser scar revision are added as required. Consultation ₹300.

Most patients on the IADVL-protocol topical + oral combination see meaningful clearance at 8-12 weeks, with full clearance typically by week 16. Patients on isotretinoin reach the 120 mg/kg cumulative target over 5-8 months depending on weight and starting dose (≤0.5 mg/kg/day initiating). Post-inflammatory hyperpigmentation continues fading for 3-6 months after acne clears, often with continued topical adapalene + azelaic acid maintenance.

Atrophic acne scars (ice-pick, boxcar, rolling) do not flatten with peels alone, they need fractional CO₂ laser resurfacing or MNRF microneedling with radiofrequency for collagen remodelling, typically 4-6 sessions. Peels (glycolic 35-70%, salicylic 20-30%, TCA at lower concentrations) are excellent for post-inflammatory hyperpigmentation, the dark marks, but not for the depressed scar contour itself. A combined protocol, peel for PIH + laser for scar, gives the best result.

Isotretinoin is the only treatment that addresses all four pathogenic factors of acne and reaches lasting remission in most severe cases. At DermaVue's conservative ≤0.5 mg/kg/day initiation, side effects are predictably manageable: dry lips and skin (universal, treated with bland emollient), transient photosensitivity (mandatory daily SPF 50), elevated LFTs and lipids (monitored monthly, adjusted if abnormal). Pregnancy is an absolute contraindication; female patients use contraception throughout and one month after. The cumulative 120 mg/kg target is achieved over 5-8 months.

Recurrence usually points to one of three causes: hormonal (PCOS, adrenal androgen excess, the workup includes a hormonal panel and PCOS screening for female patients with adult-onset acne), inadequate maintenance (stopping topical retinoid + azelaic acid immediately after clearance lets the original biology return), or contact / cosmetic acne (comedogenic skincare or hair-product residue). The IADVL recommendation is structured maintenance for 6-12 months after clearance, not just acute-phase treatment.

The peer-reviewed evidence supports two dietary associations: high-glycaemic-index diets (white rice, refined sugar, processed flour) and high dairy intake (especially skim milk) modestly worsen acne severity in adolescents and young adults. Other foods (chocolate, fried food, nuts) do not have meaningful evidence. DermaVue dermatologists discuss this individually, but diet alone is not a substitute for medical treatment in established acne.

For very mild acne with only a few comedones, OTC adapalene 0.1% (now available without prescription) plus benzoyl peroxide 2.5% is reasonable to try for 8 weeks. For anything beyond mild, papules, pustules, nodules, scarring, dermatologist care is the rational decision because the IADVL protocol requires titration and misdiagnosis is common: many acne cases are actually rosacea, folliculitis, perioral dermatitis, or seborrhoeic dermatitis, each requiring different treatment.

₹300 consultation. Standard medication (topical + oral combination) is ₹1,500-5,000 per month, varying by drug brand. A chemical peel course (4-6 sessions, 2-week intervals) is ₹10,000-39,000 total. Fractional CO₂ laser scar revision is ₹5,000-20,000 per session, typically 4-6 sessions. Isotretinoin (if indicated) is ₹400-1,200 per month brand-dependent. Pricing is transparent and shared before treatment commitment.

Yes, adult female patients with new-onset acne, jawline-pattern acne, or acne with menstrual irregularity get a hormonal workup (testosterone, DHEAS, free androgen index, LH/FSH ratio, fasting insulin) at the first consultation. PCOS-related acne typically responds best to combined oral contraceptives with anti-androgen activity (where indicated), spironolactone, and the standard topical regimen. DermaVue's Dr. Rejeesh Menon (MD Internal Medicine) consults on the metabolic component when PCOS is confirmed.

Yes, post-inflammatory hyperpigmentation (PIH) fades, but in Fitzpatrick IV-VI skin it can take 6-18 months without active treatment. With azelaic acid 15-20% topical + daily SPF 50 + a chemical peel course, the timeline compresses to 8-16 weeks for most. Stubborn dermal pigment may benefit from low-fluence Q-switched Nd:YAG laser (1064 nm at 0.5-1 J/cm², multiple passes, 2-week intervals), the same parameters that work for melasma.