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Suggest Treatment For Adult Onset Acne And Premenstrual Flares
Question: Dermatology queery.
Hi
Im female and I've always had very greasy skin and am bedbound with an illness which means i cant take any drugs (I don't think?) to reduce this as I'm immobile with low BP. I'm also very weak so a thorough skin care regime isn't possible. Despite being now age 38 about every 3 or 4 mths , coinciding with either stress or my period, I get a flare of a deep lesion. Because i've not be able to consult drs very often i don't know what type of acne it is, it's often just one area feeling very swollen& sore with a red 1-2cm area. At worst Sometimes a 3-4cm area can feel tender look puffy due to the one "spot". I might have one/two other mild spots and always have blackheads.
In the past my GP has always said strong oral meds can't be given for just one spot so I was left with topicals, recently zindaclin and adapalene but I haven't always found these effective & have been left with white damage & scarring. She recently then said oral Antibiotics would be better for deep scarring lesions which can't be be reached topically.
my GP is also not keen on home visit except for emergencies so I'm often lost as to what to do with an "eruption". And i now have one which felt like it could turn very big like before. Large area felt tender. I called the surgery and rather than return call was just sent a script for flucloxecillin which i have been taking 3 days. However looking on the web it isn't mentioned as an common acne drug but for infected so im concerned its not right and all else i've been using is adapalene. A big area before felt numb and very tender & it is less puffy/tender now but the visible red lesion not much different and I'm still feeling discomfort and tingling and depth to it. I was wondering whether to go back to topicals as i dont know if my acne is "infected"? Can you please advise on correct action for this.
1st 6 pics - current problem
Last 4, old bad scarring, skin sores.
Thanks for your time. XXXX - in the UK
Hi
Im female and I've always had very greasy skin and am bedbound with an illness which means i cant take any drugs (I don't think?) to reduce this as I'm immobile with low BP. I'm also very weak so a thorough skin care regime isn't possible. Despite being now age 38 about every 3 or 4 mths , coinciding with either stress or my period, I get a flare of a deep lesion. Because i've not be able to consult drs very often i don't know what type of acne it is, it's often just one area feeling very swollen& sore with a red 1-2cm area. At worst Sometimes a 3-4cm area can feel tender look puffy due to the one "spot". I might have one/two other mild spots and always have blackheads.
In the past my GP has always said strong oral meds can't be given for just one spot so I was left with topicals, recently zindaclin and adapalene but I haven't always found these effective & have been left with white damage & scarring. She recently then said oral Antibiotics would be better for deep scarring lesions which can't be be reached topically.
my GP is also not keen on home visit except for emergencies so I'm often lost as to what to do with an "eruption". And i now have one which felt like it could turn very big like before. Large area felt tender. I called the surgery and rather than return call was just sent a script for flucloxecillin which i have been taking 3 days. However looking on the web it isn't mentioned as an common acne drug but for infected so im concerned its not right and all else i've been using is adapalene. A big area before felt numb and very tender & it is less puffy/tender now but the visible red lesion not much different and I'm still feeling discomfort and tingling and depth to it. I was wondering whether to go back to topicals as i dont know if my acne is "infected"? Can you please advise on correct action for this.
1st 6 pics - current problem
Last 4, old bad scarring, skin sores.
Thanks for your time. XXXX - in the UK
Brief Answer:
Kindly elaborate certain points about the query.
Detailed Answer:
Hello XXXXXXX ,
Welcome and thanks for posting your query to the forum.
I can understand your concern for the current problem of eruption on face and I am quite empathetic for the same.
After analyzing the picture I can make out that you have "Adult onset acne" with "Premenstrual flares". For a female it is really distressing if there is presence of pimples on face.
Before I proceed to your issue let me explain you elaborately regarding pimples- Acne or pimples generally appears at the age of 13-14 years and then almost vanishes by the age of 25 years.
These erupts basically due to hormones (chemicals which are influencing one or other body functions including growth, puberty and development of body in adults) in addition to the influence of certain other factors causing its aggravation.
The hormone testosterone and its bye-products plays the most important role in high oil secretion and increase the size of oil glands especially in males. As the pores or ducts of the glands are blocked so it leads to formation of pimples.
In females there is not a direct presence of testosterone is there but the female hormones turns into the testosterone and other of related chemicals.
There are certain other factors such as application of oily or creamy products, over exposure to sunlight, heat and humidity, premenstrual flare or due to pinching, popping and squeezing of the eriptions also leads to formation of pimples.
Once these are healing they leave the most problematic thing which are either marks or scars. Therefore any of the above factors along with hormones can cause appearance of pimples at the age of 38 years also.In view to help you best kindly elaborate about the problem so that I can help you better.
It would be best if you can elaborate certain points about:
- Since exactly how many days you have this eruption.
- Do you feel pain over it in terms of - mild/ moderate or deep intense pain.
- Do you feel any throbbing sensation over it.
- Do you feel an intense urge to scratch the area.
- Date of your last menstrual periods.
Hope to hear soon from your side.
Regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
Kindly elaborate certain points about the query.
Detailed Answer:
Hello XXXXXXX ,
Welcome and thanks for posting your query to the forum.
I can understand your concern for the current problem of eruption on face and I am quite empathetic for the same.
After analyzing the picture I can make out that you have "Adult onset acne" with "Premenstrual flares". For a female it is really distressing if there is presence of pimples on face.
Before I proceed to your issue let me explain you elaborately regarding pimples- Acne or pimples generally appears at the age of 13-14 years and then almost vanishes by the age of 25 years.
These erupts basically due to hormones (chemicals which are influencing one or other body functions including growth, puberty and development of body in adults) in addition to the influence of certain other factors causing its aggravation.
The hormone testosterone and its bye-products plays the most important role in high oil secretion and increase the size of oil glands especially in males. As the pores or ducts of the glands are blocked so it leads to formation of pimples.
In females there is not a direct presence of testosterone is there but the female hormones turns into the testosterone and other of related chemicals.
There are certain other factors such as application of oily or creamy products, over exposure to sunlight, heat and humidity, premenstrual flare or due to pinching, popping and squeezing of the eriptions also leads to formation of pimples.
Once these are healing they leave the most problematic thing which are either marks or scars. Therefore any of the above factors along with hormones can cause appearance of pimples at the age of 38 years also.In view to help you best kindly elaborate about the problem so that I can help you better.
It would be best if you can elaborate certain points about:
- Since exactly how many days you have this eruption.
- Do you feel pain over it in terms of - mild/ moderate or deep intense pain.
- Do you feel any throbbing sensation over it.
- Do you feel an intense urge to scratch the area.
- Date of your last menstrual periods.
Hope to hear soon from your side.
Regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi
Thanks for your reply.
It came up suddenly Wednesday afternoon - so 3 &1/2 days.
It feels like if you maybe have a tooth infection, quite mild, possibly moderate but a niggling ,constant sensation in the area & face feels as if its swollen or after dental jab. And fairly tender to wash etc.
It was first day or two, not throbbing now just repeated sensation and also numbness. Nerves very affected day 1-2 not so much now.
Not itchy now. I can't remember if it was. Sometimes spots can be i know.
Period began 10th december.
Wrewith regards XXXX
Thanks for your reply.
It came up suddenly Wednesday afternoon - so 3 &1/2 days.
It feels like if you maybe have a tooth infection, quite mild, possibly moderate but a niggling ,constant sensation in the area & face feels as if its swollen or after dental jab. And fairly tender to wash etc.
It was first day or two, not throbbing now just repeated sensation and also numbness. Nerves very affected day 1-2 not so much now.
Not itchy now. I can't remember if it was. Sometimes spots can be i know.
Period began 10th december.
Wrewith regards XXXX
Brief Answer:
"Adult onset acne" with "Premenstrual flares": Suggestions and guidance.
Detailed Answer:
Hello XXXXXXX
Welcome again to the forum and thanks a lot for your swift follow up.
After analyzing the complete situation let me reassure you first that you do not require surgery and the Flucloxacillin antibiotics are correctly prescribed for for the area. So you can continue the same. Though these are not the mainly prescribed medication for acne but are useful in case there is flareup or in larger possibly infected lesions.
Presently as you do not have throbbing sensation or deep pain therefore no active intervention is required for the same. You can continue with the antibiotics as prescribed in the script.
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 any other cosmetics over face.
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. Make your room properly ventilated it will improve the status of pimples.
5. Kindly do not use any antibiotic as self medication.
6. Do not apply any hair oil on scalp or apply in very less amount. Wash your scalp daily with some good shampoo and let there be no dandruff in your scalp ( because dandruff itself causes blockage of pores of oil glands and then pimples).
You can continue to apply Zindaclin over it. Apply in thinnest possible amount so that it shod not be visible by naked eye.
If I were your treating doctor then would have additionally suggested you a tablet containing Paracetamol or Ibuprofen or any good anti-inflammatory drug to reduce the inflammation. It should be taken after meals.
An important information to reduce the Premenstrual flare of eruptions: In may patients I use Paracetamol or Ibuprofen or any good anti-inflammatory drug three days prior to the due date of menstrual cycle. It is well documented that use of Paracetamol or Ibuprofen or any good anti-inflammatory drug helps in reducing the inflammatory response and therefore the Premenstrual flare of eruptions.
Hope the above information will help you. If you have any further query I will be happy to help.
With regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
"Adult onset acne" with "Premenstrual flares": Suggestions and guidance.
Detailed Answer:
Hello XXXXXXX
Welcome again to the forum and thanks a lot for your swift follow up.
After analyzing the complete situation let me reassure you first that you do not require surgery and the Flucloxacillin antibiotics are correctly prescribed for for the area. So you can continue the same. Though these are not the mainly prescribed medication for acne but are useful in case there is flareup or in larger possibly infected lesions.
Presently as you do not have throbbing sensation or deep pain therefore no active intervention is required for the same. You can continue with the antibiotics as prescribed in the script.
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 any other cosmetics over face.
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. Make your room properly ventilated it will improve the status of pimples.
5. Kindly do not use any antibiotic as self medication.
6. Do not apply any hair oil on scalp or apply in very less amount. Wash your scalp daily with some good shampoo and let there be no dandruff in your scalp ( because dandruff itself causes blockage of pores of oil glands and then pimples).
You can continue to apply Zindaclin over it. Apply in thinnest possible amount so that it shod not be visible by naked eye.
If I were your treating doctor then would have additionally suggested you a tablet containing Paracetamol or Ibuprofen or any good anti-inflammatory drug to reduce the inflammation. It should be taken after meals.
An important information to reduce the Premenstrual flare of eruptions: In may patients I use Paracetamol or Ibuprofen or any good anti-inflammatory drug three days prior to the due date of menstrual cycle. It is well documented that use of Paracetamol or Ibuprofen or any good anti-inflammatory drug helps in reducing the inflammatory response and therefore the Premenstrual flare of eruptions.
Hope the above information will help you. If you have any further query I will be happy to help.
With regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi
Thanks for your reply. it was very helpful. If I had a large inflamed area in the future Do you think I should i request a dr visit each time?
If I had a drug written as repeat prescription Antibiotic is that a good idea or does each time need to be individually assessed?
Is the flucloxecillin an Antibiotic that would treat additional infection but not necessarily the acne lesion itself so thats why zindaclin is needed aswell, or is it for everything? In the past ive had erithromycin - is that a useful drug for the deep inflammation or flucloxecillin better? Now it's less swollen but still affecting the nerves with constant tinglin should i ask for a different oral Antibiotic or just stick to zindaclin topical when flucloxecillin runs out?( I'm halfway through course)
Do you think it's likely to leave permanent damage and is there anything oral I could take to reduce oily skin? - I've been told years ago that combined pill not suitable for bedbound people.
Thanks so much! XXXX
g
Thanks for your reply. it was very helpful. If I had a large inflamed area in the future Do you think I should i request a dr visit each time?
If I had a drug written as repeat prescription Antibiotic is that a good idea or does each time need to be individually assessed?
Is the flucloxecillin an Antibiotic that would treat additional infection but not necessarily the acne lesion itself so thats why zindaclin is needed aswell, or is it for everything? In the past ive had erithromycin - is that a useful drug for the deep inflammation or flucloxecillin better? Now it's less swollen but still affecting the nerves with constant tinglin should i ask for a different oral Antibiotic or just stick to zindaclin topical when flucloxecillin runs out?( I'm halfway through course)
Do you think it's likely to leave permanent damage and is there anything oral I could take to reduce oily skin? - I've been told years ago that combined pill not suitable for bedbound people.
Thanks so much! XXXX
g
Brief Answer:
"Adult onset acne" with "Premenstrual flares": Suggestions and guidance.
Detailed Answer:
Hello XXXXXXX
Welcome again to the forum and thanks for your prompt follow up.
Antibiotics as self medications is not at all advisable as can harm you in long term. Flucloxacillin antibiotics are measure for just this time being periods and are not at all the mainstay of therapy for recurrent lesions, so do not at all take these as self medication.
In my patients I also go for "Intralesional therapy" with "trimacinolone" injection at the big cystic site. You can ask your doctor if the doctor can do that. It is a simple steroid injection which is given to reduce the inflammation. It is the mainstay for the cystic kind of lesions and is not at all harmful in expertize hands. An additional advantage is that there is no need of any antibiotics in this therapy.
For the time being I suggest you to complete the course of the antibiotic. As there is tingling sensation only so it shows good healing. If at all you feel that there is increase in pain or the size of swelling then you can go for intralesional injection as suggested above.
As I can get from your query that most of the time you have large inflamed area before menses ( which I told you is known as premenstrual flare). You can take an anti- inflammatory tablet 3 days prior to reduce the tendency.
Follow other of the suggestions and instructions which will definitely help you in taking care of the problem better.
Hope the above information will help you. If you have any further query I will be happy to help.
"My best wishes for early and complete recovery from the problem"
With regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
"Adult onset acne" with "Premenstrual flares": Suggestions and guidance.
Detailed Answer:
Hello XXXXXXX
Welcome again to the forum and thanks for your prompt follow up.
Antibiotics as self medications is not at all advisable as can harm you in long term. Flucloxacillin antibiotics are measure for just this time being periods and are not at all the mainstay of therapy for recurrent lesions, so do not at all take these as self medication.
In my patients I also go for "Intralesional therapy" with "trimacinolone" injection at the big cystic site. You can ask your doctor if the doctor can do that. It is a simple steroid injection which is given to reduce the inflammation. It is the mainstay for the cystic kind of lesions and is not at all harmful in expertize hands. An additional advantage is that there is no need of any antibiotics in this therapy.
For the time being I suggest you to complete the course of the antibiotic. As there is tingling sensation only so it shows good healing. If at all you feel that there is increase in pain or the size of swelling then you can go for intralesional injection as suggested above.
As I can get from your query that most of the time you have large inflamed area before menses ( which I told you is known as premenstrual flare). You can take an anti- inflammatory tablet 3 days prior to reduce the tendency.
Follow other of the suggestions and instructions which will definitely help you in taking care of the problem better.
Hope the above information will help you. If you have any further query I will be happy to help.
"My best wishes for early and complete recovery from the problem"
With regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
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. Vinay Bhardwaj
Answered by
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