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Question: I got something on my face (cheekbone) Its basically a smal bump (you can feel it -hard- under the skin if you touch it) Its 'redish' on the surface and it itches a lot (specially when exposed to heat - in the shower, using the AC, etc) If you touch it, it causes swelling of the area.
I've had for 50 days now (or so) First it was just a redish tiny spot. Then (like 2 days after that) it started to swell and itch.
A week later I started using "Macril" (betamethasone, Gentamicin, Miconazole) I used that for a week and you could still feel the bump, it was still red, but the inflammation surrounding the hard bump, was gone.
I figured it would just go away... A month later it was still there so I went to see the first doctor...
She gave me "Acifusin B" (Fusidic Acid and Betamethasone) to use it for 10 days... When I applied the cream everynight, I started to feel the bump was smaller (maybe...) Used it for 4/5 days.
I had another doctor appointment scheduled from before so, I took the chance... He told me to stop using Acifusin and sent me to a laboratory for a cream they should prepare for me (which was basically the same thing... Betamethasone, gentamicin and vitamin A)
My friend (who is a surgeon) told me this kind of creams are better because they don't have additives... So I started using that.
Used it for 2/3 days and nothing changed. It would even get worse cause the cream was much more thick and harder to scatter.
Went back to the Acifusin... this thing was still itching (still is) and getting inflammated, etc so I went to see the last doctor...
She said it could be "foreign body granuloma"
She gave me oral antibiotics (amoxixiline 750mg) which I took for 7 days. (Once I finished that, someone suggested Ciprofloxacin so I've been taking that for 3 days now)
She also said I should stop usin Acifusin and gave a "much stronger corticosteroid" (Clobetasol propionate cream)
After seeing her, and because of all the touching, it got worse than ever... Touching to apply the much thicker cream, would only make it worse so I quitted that too (after 2/3 days) and got back to Acifusin...
You would think Acifusin is the answer here but, it only gets better to a point. Like it wont go anywhere from there...
I started using Aloe Vera, right from the plant... Got just a bit better... But it still itches A LOT, its still red and swollen (it looks worse today, more inflammated)
I should add this happened while I was staying at this hotel for the weekend. I was going to take a nap and removed the hotel pillows to place my own... to find 3 dead bugs (didn't look like the "bed bugs" I could find online when I searched) I moved to the other bed, made sure it didn't have any bugs and took a nap for 2 hours... This was on the evening, that night, I found that red spot that looked like a sting on my face...
I complained and they changed both beds (not the linens, the bed!)
2 of the dermatologist I've seen, said it could be from a sting.
Note: It doesn't bleed. It's not open.
I've had for 50 days now (or so) First it was just a redish tiny spot. Then (like 2 days after that) it started to swell and itch.
A week later I started using "Macril" (betamethasone, Gentamicin, Miconazole) I used that for a week and you could still feel the bump, it was still red, but the inflammation surrounding the hard bump, was gone.
I figured it would just go away... A month later it was still there so I went to see the first doctor...
She gave me "Acifusin B" (Fusidic Acid and Betamethasone) to use it for 10 days... When I applied the cream everynight, I started to feel the bump was smaller (maybe...) Used it for 4/5 days.
I had another doctor appointment scheduled from before so, I took the chance... He told me to stop using Acifusin and sent me to a laboratory for a cream they should prepare for me (which was basically the same thing... Betamethasone, gentamicin and vitamin A)
My friend (who is a surgeon) told me this kind of creams are better because they don't have additives... So I started using that.
Used it for 2/3 days and nothing changed. It would even get worse cause the cream was much more thick and harder to scatter.
Went back to the Acifusin... this thing was still itching (still is) and getting inflammated, etc so I went to see the last doctor...
She said it could be "foreign body granuloma"
She gave me oral antibiotics (amoxixiline 750mg) which I took for 7 days. (Once I finished that, someone suggested Ciprofloxacin so I've been taking that for 3 days now)
She also said I should stop usin Acifusin and gave a "much stronger corticosteroid" (Clobetasol propionate cream)
After seeing her, and because of all the touching, it got worse than ever... Touching to apply the much thicker cream, would only make it worse so I quitted that too (after 2/3 days) and got back to Acifusin...
You would think Acifusin is the answer here but, it only gets better to a point. Like it wont go anywhere from there...
I started using Aloe Vera, right from the plant... Got just a bit better... But it still itches A LOT, its still red and swollen (it looks worse today, more inflammated)
I should add this happened while I was staying at this hotel for the weekend. I was going to take a nap and removed the hotel pillows to place my own... to find 3 dead bugs (didn't look like the "bed bugs" I could find online when I searched) I moved to the other bed, made sure it didn't have any bugs and took a nap for 2 hours... This was on the evening, that night, I found that red spot that looked like a sting on my face...
I complained and they changed both beds (not the linens, the bed!)
2 of the dermatologist I've seen, said it could be from a sting.
Note: It doesn't bleed. It's not open.
Brief Answer:
Acne cyst; Intralesional Triamcinolone Or Oral doxycycline Or Isotretinoin
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your query in detail and I have also reviewed the Images. I don't think that it is due to a sting or bed bugs.
I really doubt that it is a foreign body granuloma unless this place was injected with something e.g a filler.
I would think that it is most likely was an acne lesion to begin with and then it turned into an 'Acne Cyst'. Itching is a subjective symptom and it can be associated with acne cyst.
Acne cyst won't resolve with topical steroids, though steroids would reduce the inflammation/ swelling of an acne cyst thus providing partial benefit.
If I was the treating doctor I would have suggested, Oral Doxycycline Or Minocycline for 2 weeks.
Topically I would normally suggest an antiacne, antibiotic/ antiinflammatory gel e.g Nadifloxacin 1% gel, twice daily for a few days.
Another option that I would have considered ( in fact my first option) is to inject the cyst with intralesional steroid e.g Triamcinolone acetonide in a diluted concentration e.g 0.05 to 0.1 ml of triamcinilone acetonide in a concentration of 2.5 mg/ ml. That would reslve an acne cyst within 36-48 hours.
Third option that I would consider is to start you on Oral Isotretinoin (Accutane) for a 2-4 week period even though it is just a single cystic acne lesion.
Regards
Acne cyst; Intralesional Triamcinolone Or Oral doxycycline Or Isotretinoin
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your query in detail and I have also reviewed the Images. I don't think that it is due to a sting or bed bugs.
I really doubt that it is a foreign body granuloma unless this place was injected with something e.g a filler.
I would think that it is most likely was an acne lesion to begin with and then it turned into an 'Acne Cyst'. Itching is a subjective symptom and it can be associated with acne cyst.
Acne cyst won't resolve with topical steroids, though steroids would reduce the inflammation/ swelling of an acne cyst thus providing partial benefit.
If I was the treating doctor I would have suggested, Oral Doxycycline Or Minocycline for 2 weeks.
Topically I would normally suggest an antiacne, antibiotic/ antiinflammatory gel e.g Nadifloxacin 1% gel, twice daily for a few days.
Another option that I would have considered ( in fact my first option) is to inject the cyst with intralesional steroid e.g Triamcinolone acetonide in a diluted concentration e.g 0.05 to 0.1 ml of triamcinilone acetonide in a concentration of 2.5 mg/ ml. That would reslve an acne cyst within 36-48 hours.
Third option that I would consider is to start you on Oral Isotretinoin (Accutane) for a 2-4 week period even though it is just a single cystic acne lesion.
Regards
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you for your answer.
I did not have any kind of "filling" injected on that area (or anywhere at all)
Itching and burning sensation are real and very annoying.
About the treatments you are suggesting... I got some keloids and hypertrophic scars (nothing on my face but still) I was wondering if it would be safe to get that intralesional steroid injection you mentioned?
Also, would you please tell me the doses and indications for the oral medicine (Doxycycline Or Minocycline) you suggested? Is that the name of the drugs? (I live in Argentina) Are those 'over the counter' medicines?
Should I stop taking the ciprofloxacin if I were to start Doxycycline Or Minocycline?
Should I wait a few days before starting the new antibiotics?
I'm also on Dorixin relax (for another condition) every 8 hours, would that cause any interaction with the medicine you suggested?
Can you suggest any other gel in case I'm not able to get the one you mentioned?
Anything else I can do to reduce the redness? Is ice good for this or should I stop that too? Anything else to speed up the process?
I'm getting married in 4 weeks... Please, help me :/
Best regards
I did not have any kind of "filling" injected on that area (or anywhere at all)
Itching and burning sensation are real and very annoying.
About the treatments you are suggesting... I got some keloids and hypertrophic scars (nothing on my face but still) I was wondering if it would be safe to get that intralesional steroid injection you mentioned?
Also, would you please tell me the doses and indications for the oral medicine (Doxycycline Or Minocycline) you suggested? Is that the name of the drugs? (I live in Argentina) Are those 'over the counter' medicines?
Should I stop taking the ciprofloxacin if I were to start Doxycycline Or Minocycline?
Should I wait a few days before starting the new antibiotics?
I'm also on Dorixin relax (for another condition) every 8 hours, would that cause any interaction with the medicine you suggested?
Can you suggest any other gel in case I'm not able to get the one you mentioned?
Anything else I can do to reduce the redness? Is ice good for this or should I stop that too? Anything else to speed up the process?
I'm getting married in 4 weeks... Please, help me :/
Best regards
Brief Answer:
Kindly revisit your dermatologist for the needful
Detailed Answer:
Hi.
Yes, intralesional steroid injections are preferred choice for nodulocystic acne lesions such as this. They produce the most rapid response.
However they should only be injected by an experienced dermatologist and no more than 0.05 - 0.1 ml of 2.5mg/ ml of triamcinolone acetonide. Overenthusiastic injections and injecting to large amounts may cause a temprary atrophy.
Injection at this site would have no effect on hypertrophic/ keloidal scaring elsewhere. In fact, Hypertrophic scars and keloids are also treated with intralesional triamcinolone acetonide injections but in much higher concentrations i.e 40 mg/ ml.
Doxycycline and Minocycline are generic names. They are prescription medications and should always be taken under supervision of a dermatologist. Dose of Minocycline for acne is 1 mg/kg/ day whereas doxycycline is usually prescribed in a dose of 100 mg, once or twice daily. Duration of treatment with oral antibiotics may be 2-4 weeks.
Can take these medications with your other medication.
Ciprofloxacin won't do much in an acne cyst, therefore I suggest you to stop it and kindly revist your doctor for another follow up. You may share my discussion with you.
Oral Retinoids (Accutane) is also an effective option. Caution: One should avoid Oral Retinoids if one is planing to get pregnant. Pregnancy should be avoided during treatment with retinoids and for 1 month after discontinuing treatment.
Apart from madifloxacin gel you may try a benzoyl peroxide gel (but it may cause some irritation and redness) Or clindamycin gel.
Redness would resolve once the inflammatory process subsides. Ice has no role in reducing redness.
Can take a tablet of cetrizine 10 mg, once daily for symptomatic relief from itching.
Congratulations for getting married soon. Wish you the very best of a happy married life :-)
Regards
Kindly revisit your dermatologist for the needful
Detailed Answer:
Hi.
Yes, intralesional steroid injections are preferred choice for nodulocystic acne lesions such as this. They produce the most rapid response.
However they should only be injected by an experienced dermatologist and no more than 0.05 - 0.1 ml of 2.5mg/ ml of triamcinolone acetonide. Overenthusiastic injections and injecting to large amounts may cause a temprary atrophy.
Injection at this site would have no effect on hypertrophic/ keloidal scaring elsewhere. In fact, Hypertrophic scars and keloids are also treated with intralesional triamcinolone acetonide injections but in much higher concentrations i.e 40 mg/ ml.
Doxycycline and Minocycline are generic names. They are prescription medications and should always be taken under supervision of a dermatologist. Dose of Minocycline for acne is 1 mg/kg/ day whereas doxycycline is usually prescribed in a dose of 100 mg, once or twice daily. Duration of treatment with oral antibiotics may be 2-4 weeks.
Can take these medications with your other medication.
Ciprofloxacin won't do much in an acne cyst, therefore I suggest you to stop it and kindly revist your doctor for another follow up. You may share my discussion with you.
Oral Retinoids (Accutane) is also an effective option. Caution: One should avoid Oral Retinoids if one is planing to get pregnant. Pregnancy should be avoided during treatment with retinoids and for 1 month after discontinuing treatment.
Apart from madifloxacin gel you may try a benzoyl peroxide gel (but it may cause some irritation and redness) Or clindamycin gel.
Redness would resolve once the inflammatory process subsides. Ice has no role in reducing redness.
Can take a tablet of cetrizine 10 mg, once daily for symptomatic relief from itching.
Congratulations for getting married soon. Wish you the very best of a happy married life :-)
Regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Sorry to bother you again. I've tried to get the nadifloxacin gel, but nadifloxacin is not commercialized in my country. Can you please suggest something else (as good as the noadifloxacin)?
I did get the oral Doxycycline 100mg which I assume I could start using since the appointment with my doctor is in one week... Would that be ok?
Thank you for your good wishes :)
I did get the oral Doxycycline 100mg which I assume I could start using since the appointment with my doctor is in one week... Would that be ok?
Thank you for your good wishes :)
Brief Answer:
Clindamycin gel can be used instead of nadifloxacin gel
Detailed Answer:
Hi.
You may use Clindamycin 1% gel, twice daily.
You may start with Doxycycline but make sure you follow up with your dermatologist as soon as possible and also share my discussion with you and if your dermatologist is experienced in intralesional steroid injections for acne cysts, you may go ahead with it.
Regards
Take care
Clindamycin gel can be used instead of nadifloxacin gel
Detailed Answer:
Hi.
You may use Clindamycin 1% gel, twice daily.
You may start with Doxycycline but make sure you follow up with your dermatologist as soon as possible and also share my discussion with you and if your dermatologist is experienced in intralesional steroid injections for acne cysts, you may go ahead with it.
Regards
Take care
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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