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Suffer from acne. Tried Epiduro, periodic antibiotics and isotretinoin. Cure?

Dec 2013
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Practicing since : 2002
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Hi Doctor, I am a 22 year old who has suffered from mild to moderate acne which has cleared up now thanks to toners and moisturizers. For the past year and a half I have had closed comedones which form flesh coloured bumps but are under the surface of the skin. These exist on my cheek, and forehead and have not changed. This gives the skin highly uneven texture. I have tried everything doctors have suggested, including Epiduro, periodic antibiotics, isotretinoin, kojic acid, but nothing has changed. Will it ever go away? I'm told that laser is not the solution and wont affect this. I need an honest opionion. How do I get completely rid of them? i would urge you to be thorough since this is distressing. Is it curable? These would start with some inflamation under the skin, some were painful and inflamed- now the inflamation is gone but the bumps remain.

Once again, there is no puss or any kind of head on the surface. It is just an elevated surface slightly red due to fair complexion but otherwise not inflamed at the moment. These are not to be mistaken with skin coloured papules that a lot of people have.
Posted Wed, 3 Jul 2013 in Skin Hair and Nails
Answered by Dr. Sanjay Kumar Kanodia 58 minutes later
Hello XXXXX,

Welcome and thanks for posting your query to XXXXXXX

Myself Dr Sanjay Kumar Kanodia and will try to provide you the best of information regarding your query.

I can understand your concern for pimples and related problems.

Before explaining or suggesting anything else, let me explain you some thing in brief about acne/pimples.

Acne or pimples generally starts appearing at the age of 13-14 years (that means by the start of our teenage). In most of the cases it almost vanishes by the age of 25 years.

This is basically due to hormones (chemicals which are influencing one or other body functions) in addition to the influence of certain other factors causing its aggravation.

Amongst the "Hormones"- testosterone is the most important biochemical related to all our pimples activity. So as soon as the teenage is starting, this hormone starts its influence on all over body producing its effect by growth of body and appearance of secondary sexual characters such as beard and mustaches and other changes.

Regarding pimples especially, the hormone testosterone plays the most important role in high oil secretion and increase the size of oil glands. As the pores or ducts of the glands are blocked so it leads to formation of pimples in the from of black heads, white heads and bumps which later on heals with marks, pigmentation and scars.

There are certain other factors such as application of oily or creamy products, moisturizers, over exposure to sunlight, heat and humidity or due to pinching, popping and squeezing of the pimples also leads to further aggravation of pimples. Once these are healing they leave the most problematic thing which are either marks or scars.

Now coming to your problem directly. You are young man of 22 years. As I said earlier the hormonal effect plays it's most important role till 25 years. This means you would be having the tendency to develop pimples till 25 years. But this does not means to have problematic face till that age. This means that the very first and foremost thing you have to understand regarding your problem is that is not a serious disease but a youth related problem.

So probably you got some idea regarding your pimples, black heads and related problems.

I can get from your query that you have tried multiple types of treatment. Especially I can make out that you have had taken "isotretinoin" as a part of treatment. But in your query you haven't mentioned how long and what daily dose of isotretinoin you have taken.

I am asking the above fact because isotretinoin is the mainstay of treatment for long term relief from pimples. This is one therapy which has revolutionized the treatment part in pimples. Generally it is to be taken for 3-6 months of period with appropriate dose according to your body weight. I can not get from your query how much and how long the drug was prescribed to you.

So I would advise you to take "isotretinoin"- which is very good drug meant for long term benefit of acne. It is the only drug which acts on all modes of pimple formation without affecting the hormones. It should be taken only under dermatologist's guidance.

Regarding laser treatment- this actually works on the scars or at maximum some lasers works on the existing pimples but none of the laser can work on the genesis of pimples. This means the basic reason for pimples is because of hormones and we can not reduce or change the hormones, neither we should do the same. Therefore using laser is not the solution for your problem.

There are certain suggestions which you can follow:

1. Do not pinch, pop or squeeze any area on face.
2. Do not apply any creamy or oily stuff or moisturizers or any other cosmetics over face. As all these above mentioned things can actually block your pores leading to further pimple formation.
3. Try to avoid any home remedies suggested by your friends or family members or otherwise self implicated therapies also.
4. Try avoiding situations of direct continuous exposure to sunlight or heat and humidity for long hours.
5. Kindly do not use any antibiotic as self medication.

Lastly in my clinical experience I would prefer to give oral isotretinoin in best suited dose with topical treatment with certain creams and some procedures if required.

Above and all the best thing would be to XXXXXXX a proper dermatologist at Mumbai who can analyze your condition and then give treatment accordingly which is best suited for you. I would advise you to have a long term follow is required with patience to see best results.

Hope these informations will help you. If you have any further query I will be happy to help.

Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by
Follow-up: Suffer from acne. Tried Epiduro, periodic antibiotics and isotretinoin. Cure? 13 minutes later
Dear Doctor,

Thank you for your detailed explanation. My Isotretenoin treatment was purely topical in the form of Sotret. I also use Brevoxyl facewash regularly and I have found that toner and moisturizers have helped me control acne to agreat extent.

Now, I have a fairly good idea of the causes of acne and how to prevent it and protect the skin. I maintain good hygeine, do not use any kind of make up,and use sunscreen whenever exposed to the sunlight. My only concern at this point is the bumps and if they would go away. Please note that I am coming to you after visiting several dermatologists and using their prescribed creams and dosages of anti biotics. I was told that a periodic use of Azee500 followed much later by a lower dosage and then Doxycyclin would help get rid of these bumps.
my main queries are

1. Are they enlarged oil glands? There is no major discolouration on the surface and it remains skin coloured. However it is a visible bump and there are others which havent left despite more than a year of good hygiene and skin care.

2. What would it take to get rid of them? Would I ever get rid of them? As I said they have existed longer than any other pimple or hyperpigmented scar and so I am beggining to think they are permanent.

Answered by Dr. Sanjay Kumar Kanodia 47 minutes later

Thanks for your prompt and detailed reply.

The things are bright and clear now to provide you further guidance.

Now as per your description of present status of the problem it appears to be closest possibility of “cyst formation” in acne. This is a commonly observed phenomenon in acne where due to continuous blockage of the oil glands, the skin is formed over the areas. These blocked oil glands then enlarges slowly under the skin leading to the bump like feeling.

These cysts can remain for years together without any problem. At the maximum these can enlarge in size or can get infected or can get reduced by itself without any treatment. None of the oral or topical treatment is actually effective in this condition.

The good news for this problem is that this is completely treatable without many efforts. This can be done by simple injections in the cyst which resolves the cyst from inside in few weeks of period.

Generally, it resolves in single injection in most of the cases. Otherwise if any of the cyst is deep or not resolving by simple injection then can be taken out by small incision under expert hand of dermatologist. We are doing this procedure in multiple numbers everyday taking only few minutes of time. So you can get it now that this problem is not a life long problem and is very well treatable.

Now regarding the rest of the things- I can now get that you were prescribed with topical sotret. Topical treatments of any kind do help in reducing the problem but not to great extent.

As I said previously, Isotretinoin by mouth is the best available treatment for preventing further progression of pimples. Using antibiotics in my own experience is not the way to take out this problem. Antibiotics are effective for very short period of time and then become ineffective because of resistance.

As you have met multiple of dermatologists before ( I think in private setup), it would be better to consult in Skin department at Medical College near you. In Mumbai there are very good skin specialist at Medical College level who can guide you best for the problem.

I hope that the informations will help you. If you have any further query I will be happy to help.

"With healthy skin wishes"

Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by
Follow-up: Suffer from acne. Tried Epiduro, periodic antibiotics and isotretinoin. Cure? 5 minutes later
Thank you doctor. That was very helpful.

My only question remains
1. Would these injections/incisions cause any kind of permanent scarring?

2. What are the chances that these things would go away on their own? I was told by a dermatologist in Bangalore after he prescribed Epiduro to me that any surgical attempt to remove or dissolve these things would result in permanent scarring.
3. Is there any scar free surgery/injection that can be used ? I am really tired of having them on my face. They are aesthetically very unappealing.

3. Can anything realistically be done to bring them to a head? I also use magnesium sulphate but even that has failed to do anything.

Please advise me.

Also I have never had cystic acne. My acne levels are moderate and most my face has completely cleared up with almost no permanent scarring. I have never gotten large sebaceous cysts so Im not sure what this growth is. It is probably a cyst but it ruins othrwise acne free skin. There is no pain of any sort at this point and it doesnt feel inflamed . I just want to know it will go away completely without any scars-
Answered by Dr. Sanjay Kumar Kanodia 1 hour later
Welcome again young man.

Now the answers related to your query:

1.The injections and incisions, if done under expert hands is totally safe. As with any other procedures, it needs skilled and professional approach. So I believe at an institute level your things would definitely be taken care of properly.

2.     The chances of the cyst by self resolution are unpredictable. I have seen these cysts persisting for years together and then resolving by itself. As I can make out that you are quite anxious with this problem so I would not suggest for wait and watch approach.
“Epiduro” gel contains Adapalene and benzoyl peroxide in it. It may have little but not the mainstay of help. This is applicable to all sorts of topical treatment whether it is magnesium sulphate or anything else. As per your previous dermatologist advise of permanent scarring- with due respect it depends on personal experience of doing so. In my series of patients with such problem I never encountered any scarring problem.

3.     Regarding your third and fourth query of scar free surgery or realistic approach- my suggestions are as above. Doing intralesional injection or with small incision of few millimeters would not at all be a problem to anyone including yourself. Especially this incision is so small that it is generally not visible after few days of surgery. But again as I mentioned- skilled and professional approach by a cosmetic dermatologist (exclusively trained in these procedures).

Lastly I reassure you on the part that during youth period even I suffered from the same set of problems when the things were not so advanced. Now in today’s advanced world of Medical Science, we would not leave you with any such problem.

You visit any good skin institute in Mumbai- talk to the treating “cosmetic dermatologist” regarding your problem and clear all the doubts in your mind before proceeding for anything. I hope with sound professional approach you would be relieved of your problem.

Hope I have answered your query. If you have any further questions, I will be happy to help or if you do not have any clarifications, you can close the discussion and rate the answer.

Wish you good health.

Dr Sanjay Kumar Kanodia
(MD- Dermatology & STD)
Above answer was peer-reviewed by
Follow-up: Suffer from acne. Tried Epiduro, periodic antibiotics and isotretinoin. Cure? 17 hours later
Thankyou so much Doctor! Before I close this page I have one last query.

I have never had any permanent scarring of any sort barring perhaps in one or two spots. Now, whenever a pimple inevitably drains, after the scab has healed I have noticed some shallow pit scars in its place. Are those likely to heal and go back to their normal stage. These pimples werent very big. They were just infected and needed that white bit to come out.

Is there irreparable tissue damage. Or will there be sufficient collagen build-up over a period of time to restore it to its normal condition. They are shallow. But up close they are visible.
Answered by Dr. Sanjay Kumar Kanodia 14 hours later
Welcome again to the forum young fellow.

I can make out that the problem you are asking is for the scars after acne which we commonly designate as “Post acne Scar”.

As I said previously “Acne or pimples” are not that problematic thing but once these are healing they leave the most problematic sequel which are either marks or scars or both.

In yourself also I can make out by the query that shallow post acne scars are present. “Post acne Scar” per say have two problematic things: one is pigmentation and the other is atrophy or depth of the scar. The former is due to action and oer activity of color giving cells (called melanocytes) and the latter due to damage to collagen (the tissue which gives plumpness and texture to our skin).

Therefore the treatment advised is also related to both the things. Actually speaking, most of the topical creams have good effect in pigmentation but have slow effect in reducing the depth of scars. You are lucky enough o have shallow scars!! This is because by reducing slight pigmentation over the scars can also make the out look of scars on better side. With this, the slow but steady effect of the topical creams also helpful in rebuilding of collagen tissue.

For both slight pigmentation and shallow scarring, topical cream applications such as “retinoic acid” and or “glycolic acid” and or “azelaic acid” in different combinations and different concentrations will also be quite helpful under best dermatological guidance.

Other than this medical therapy there are certain procedures such as chemical peeling (chemical agents for controlled peeling of skin to reduce pigmentation and rebuilding collagen), scar reversion (method to lift up scar) and laser treatment (for deep scars by “Fraxel laser” only) is also quite helpful in different stages of treatment.

In my experience with a combination of various of the treatment modalities enumerated above, we can see visible results in 3-4 months and best results in next couple of months. I recommend you to follow one good "Cosmetic Dermatologist" with long term follow up and patience to see best results. So now you probably got some idea regarding the complete series of simple problem you are facing.

In between I would also recommend you to eat a lot of fruits in daily routine. I would especially recommend all seasonal fruits with special emphasis on citrus fruits (contains Vitamin C which is very essential for collagen rebuilding). Fruits contains good amount of vitamins, minerals and other essential nutrients which are quite essential for rebuilding collagen. As you are young man of 22 years only so in my experience the collagen rebuilding and remodeling with various above enumerated treatments would be very good in yourself making the things better and best faster.

Hope I have answered your query. If you have any further questions, I will be happy to help or if you do not have any clarifications, you can close the discussion and rate the answer.

Wish you good health and glowing skin.


Dr Sanjay Kumar Kanodia
(MD- Dermatology & STD)
Above answer was peer-reviewed by
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