Review of Current Treatment and Compliance

• Ensure correct usage of Tretiva-20 and adherence to prescribed regimen.
• Persistent acne may result from incorrect application or insufficient treatment duration.

Evaluation of Acne and Hyperpigmentation

• Consult a dermatologist for a detailed skin assessment to determine acne type and severity.
• Hyperpigmentation often follows inflammation; treatment can be challenging.

Adjunctive and Alternative Treatments

• Consider additional topicals like azelaic acid or hydroquinone for pigmentation.
• Explore oral medications such as antibiotics or hormonal therapy if acne persists.

Lifestyle and Skincare Recommendations

• Adopt a gentle skincare routine, use sun protection, and avoid irritants.

Follow-up and Specialist Consultation

• Regular follow-ups with a dermatologist are crucial for monitoring and adjusting treatment.
• Referral to a specialist in pigmentary disorders may be beneficial.

Safety and Monitoring

• Be aware of potential side effects of tretinoin and report any concerns to your doctor.