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Have skin colored bumps under skin on chin and nose. Prescribed roaccutane. Could it be fungal infection?

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Dermatologist
Practicing since : 2006
Answered : 2016 Questions
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Hi

I have skin coloured bumps under the skin on chin and around nose, it looks worse in certain lighting. they sometimes appear flat and sometimes raised. I have seen a dermatologist and been on roaccutane and finished the course, my acne is gone but the bumps are still there.
Could it be a fungal infection? or something? or would microdermabrasion help? I have tried everything nd don't know what will help. I have recently started taking vit a vit e and zinc.
really hope you can help.
Posted Thu, 17 Oct 2013 in Skin Hair and Nails
 
 
Answered by Dr. Kalpana Pathak 1 hour later
Brief Answer:
it could be closed comdones

Detailed Answer:
Hi
Thanks for writing to us.
From the description provided, it could be closed comedones or white heads. These simply appear as tiny bumps and become more apparent in stretching the skin.
Other possibility could be milia, molluscum,plane warts etc
The best treatment for these is electrocautery of lesions. Zinc and vit E wont help
I would like to see the lesions to confirm the diagnosis and discuss the treatment elaborately. For the same please attach an image depicting these lesions.
Waiting to hear from you soon
Take care
Above answer was peer-reviewed by
 
Follow-up: Have skin colored bumps under skin on chin and nose. Prescribed roaccutane. Could it be fungal infection? 13 minutes later
Hi

Thank you for your response. I have had them for about 4 years but do seem to getting more worse now...

I attached 2 images with previous email, shall I attach more images?

Doc has prescribed diffein gel should I use this? will it help?

 
 
Answered by Dr. Kalpana Pathak 22 hours later
Brief Answer:
these are closed comedones only

Detailed Answer:
Hi,
Thanks for writing back.
I have seen the images attached. These look like closed comedones only. The best and most definite treatment option would be to get the lesions cauterised by RF cautery. Cautery basically burns the lesion superficially, so after few days at the cauterised area scab formation will occur that will fall off spontaneously. Later on you may apply differin gel( adapalene gel) to prevent the lesions from occuring further.

Adapalene as such can be used for closed comedones but response is delayed and might not be as good as cautery. But yes you may definitely use it to see, how much response you get. Apply it atleast for two weeks. If respose is not good, then go with cautery

Hope this helped.
Take care
Above answer was peer-reviewed by
 
Follow-up: Have skin colored bumps under skin on chin and nose. Prescribed roaccutane. Could it be fungal infection? 7 minutes later
Thank you. When I went to see dermatologist they did a biopsy and said its submarine comedones and out me on roaccutane but they did not improve at all.
Will cautery leave scars? And how long does it take for the scabs to go?
And I could I get cautery done 2 months after roaccutane?
Also will differin make my skin red? Shall I apply little amount( is it like Benezol peroxide) or can I apply it liberally?
Many thanks

 
 
Answered by Dr. Kalpana Pathak 19 hours later
Brief Answer:
Submarine comedones are type of close comedones

Detailed Answer:
Hi,
Thanks for writing back.
Submarine comedones are type of closed comedones only.
Cautery would give definite results without any scarring or marks if done superficially
Scab formation usually lasts for a week and then falls off spontaneously
You can get cautery done after 2 months of stopping isotretinoin.
Adapalene gel has an irritant potential like benzoyl peroxide and can make skin red, itchy, flaky.So it should not be applied liberally. Apply a small minimal quantity once in night.

Hope this helped.
Take care
Above answer was peer-reviewed by
 
Follow-up: Have skin colored bumps under skin on chin and nose. Prescribed roaccutane. Could it be fungal infection? 5 hours later
Thank you for your response. So submarine comedones can go away?
Can you please explain what they are and how and why I hve them? Will microdermabrasion help or not?
Thanks
 
 
Answered by Dr. Kalpana Pathak 3 hours later
Brief Answer:
submarine comedones are treatable . MDA wont help

Detailed Answer:
Hi XXXXX,
I shall try to explain it in detail and simple language.
Comedones are formed when the pilosebaceous follicle( oil gland) is plugged by shedding of cells( keratinocytes). Sometimes the opening is big and these plugged material can be seen( open comedones/ blackheads) and when the opening is too small to show the retained plug it is known as closed comedone or whitehead.

Now submarine comedone is a type of closed comedone. It is a big( more than 5 mm therefore also known as macrocomedone) and deep closed comedone with high chances of getting inflammed and may lead to formation of recurrent pimples in that area. Isotretinoin therapy as such works in all stages of acne but closed comedones can lead to failure of isotretinoin therapy and may infact flare up.

As far as tendency to have comedones or acne is concerned it is mainly governed by seborrhea( oily skin), hormones( androgen) and increased tendency to have shedding of cells( ductal hyperproliferation). So in simpler terms, one might be having a tendency to get acne. External causes could be use of greasy cosmetics, topical steroid creams, diet esp dairy products, facial massages etc

Microdermabrasion wont work for comedones. Submarine comedone can only be treated by cautery.
Personally in my clinical practice, I cauterise the comedones first and drain any pustular lesions present on my patient's first visit. Later on I put the patients on antibiotics and isotretinoin as per patient's requirement. Believe me i have received wonderful response with this treatment protocol.

So my advise to you would be to get the lesions cauterised.

Hope this helped.
Take care
Above answer was peer-reviewed by
 
Follow-up: Have skin colored bumps under skin on chin and nose. Prescribed roaccutane. Could it be fungal infection? 8 minutes later
Hi

Thank you sooo much for your response so would you I advise I go back to my dermatologist and get them cauterised. Pr can I get them cauterised elsewhere?
After the cauterisation can they reoccur?
What skin products would you recommend for me I currently use cetaphil facewash and simple moisturiser are they ok?

Many thanks
 
 
Answered by Dr. Kalpana Pathak 19 hours later
Brief Answer:
get it cauterised from dermatologist

Detailed Answer:
Hi XXXXX,
Thanks for writing back.
I would always advise that you should get the lesions cauterised from dermatologist as we have been trained for the same. Getting it done from a doctor would also prevent its further recurrence and any untoward side effect like scarring, pigmentation etc.
As such after cautery, these would not recur. But sometimes few sessions of cautery might be required to treat it. But generally, a single session of cautery is enough to treat these lesions.
Also to prevent recurrence, please use adapalene gel once in night over your comedone as well as acne prone areas for a month or two.


Cetaphil face wash is a good face wash. So you may continue using the same. Use any mild water based moisturiser. Neutrogena and clinique has wonderful moisturisers for acne prone skin.

Hope this helped.
Take care
Above answer was peer-reviewed by
 
Follow-up: Have skin colored bumps under skin on chin and nose. Prescribed roaccutane. Could it be fungal infection? 2 days later
Thank you for your help if I use differin will it make me break out? Will the closed comedones become inflamed or will they just go away?
Also to get cautery I will have to be referred to the dematologist by my gp which can be long winded as was the last I was referred.
So if differin will improve my condition I would like to start using it bit don't want to make my skin worse.
What would you advise?
Many thanks
 
 
Answered by Dr. Kalpana Pathak 17 hours later
Brief Answer:
Apply adapalene/ differin

Detailed Answer:
Hi,
Thanks for writing to us.
Differin won't flare up acne or make it inflammed. Such flare ups are more common with oral isotretinoin. If you can't get cautery done, apply Differin gel over affected area in night. It might help but response would be slow and delayed. But as getting cautery done from a dermatologist might take time due to appointment hassles, so it is better to use adapalene gel in night. After all something is better than nothing.
Hope this helped.
Take care
Above answer was peer-reviewed by
 
Follow-up: Have skin colored bumps under skin on chin and nose. Prescribed roaccutane. Could it be fungal infection? 11 minutes later
Thank you so much for all of your help I will start using differin and will go and see my gp on mon and he will hopefully refer me to a dermatologist.

Are you 100% sure it is closed comedones? Is it possible to get a second opinion from another dermatologist please.

Many thanks

 
 
Answered by Dr. Kalpana Pathak 2 hours later
Brief Answer:
apply adapalene till the lesions are cauterised

Detailed Answer:
Hi XXXXX,
As advised start applying adapalene gel.
I am quite sure these are closed comedones and moreover you have got the lesions biopsied confirming my diagnosis.
See these are benign lesions, so do not worry about them. Whenever you get an appointment with your dermatologist, get these cauterised.
I do not think you need a second opinion. Your previous doctor had diagnosed it correctly, so please remain under his/her consultation.

Hope this helped.
Take care
Above answer was peer-reviewed by
 
Follow-up: Have skin colored bumps under skin on chin and nose. Prescribed roaccutane. Could it be fungal infection? 8 hours later
Thanks I will start that today. Can they cauterise a lot of them at the same time and after the procedure will I have to wear a bandage or dressing?
Also do you advise I take the vit c vit a zinc and vit e tablets or not?
Many thanks
 
 
Answered by Dr. Kalpana Pathak 30 hours later
Brief Answer:
It can be done in single session

Detailed Answer:
Hi,
Thanks for writing back.
Cautery can be done in single session. But the decision to do it in single or multiple session depends upon the doctor and patient
No bandaging of area is required after cautery. The lesions are superficially burnt which later on scab and shed off.

Taking vitamin c, E and zinc won't provide any added benefit, so not required.
Hope this helped.
Take care
Above answer was peer-reviewed by
 
Follow-up: Have skin colored bumps under skin on chin and nose. Prescribed roaccutane. Could it be fungal infection? 4 hours later
Thank you. I have started differin and will see my doctor hopefully get this all resolved.
So my skin will be red XXXXXXX cautery ad then scabs will form?
Apologies for asking so many questions but as you can appreciate this is my face not another part of body so want to be really certain it won't scar and the process involved.
Can you please let me know which moisturizer I should use I know you said a few brands but I would like to know exactly what is good so I use that il continue with cetaphil wash

Many thanks

XXXXX
 
 
Answered by Dr. Kalpana Pathak 27 hours later
Brief Answer:
Cautery won't leave scars

Detailed Answer:
Hi,
Thanks for writing to us.
One the lesion is cauterised, it is slightly burnt. For few hours surrounding area might look mildly red but the redness subsides on the same day. The burnt lesions then scab and heal in a week without scarring, we do cautery over face very commonly. a dermatologist has the expertise to do it with precision without causing any scars.
For your face you may use cetaphil, neutrogena, Clinique or sebamed moisturiser. You can buy any of these depending on availability in your area of residence.
Hope this helped.
Take care
Above answer was peer-reviewed by
 
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