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Suggest Treatment For Pus Filled Acne On Chin

Posted on Fri, 12 Aug 2016

Question: Sir,,
I am dealing with so called adult acne around my jaw line, chin area , around my nose and on chest too since 7-8 years and may be more than these years, yes I dealt with acne vulgories too in my twenties, when they stopped adult acne stared in my early thirties . My acne are not too much big in size they are small in size FILLED WITH PUS. I get around 5-6 small acne and 1-2 big acne every month on my face besides chest area. Please note, acne on chest area are very small in size and without pus. Around 2 years back my dermologist advised me use adaplance and glintra gel. Though, i am not using glintra anymore but applying adaplance without fail since then. To avoid these acne i mostly take antibiotic off and on like doxy 100 mg and Azitrymycin 500 mg thrice in a week ( Clindryicine crème/ gel/lotion too).Furthermore, I am also using benzyoil face wash twice a day too. Now, i am fed up with this skin condition and wish to use permanent cure of it. Please suggest other medication besides i mentioned above .I have thyroid and taking 100 mg thyorom daily. I don’t have any health problem besides this one. Right now, my skin by and large is clear as I am taking doxy 100 mg twice daily since XXXXXXX 2016. My god knows when I will stop Doxyline my so called adult acne will bounce back within 3-4 weeks of stopping antibiotics . Though, acne may not be big in size or large in number but they are permanent on my face (On above mentioned area of my face and chest) in the form of small red pus filled bumps . Please suggest if I can take accutane and get rid of this acne in my rest of life. Some personal health details for your reference of mine are hereunder:-

Height; 5.2
Weight 58kg
Health –Perfectly fine i.e. No BP , No sugar , No Cholesterol etc
Lifestyle: Healthy and active
Skin: Normal but turns oily in summer.
Allergy To any medicine so far:- No
Thyroid: Always in normal level as I don’t skip my dose even a single day without fail.

Regards
XXXXXXX XXXXXXX

Answered by Dr. Dr. Kakkar (15 hours later)

Brief Answer:
Need more information

Detailed Answer:
hello. thank you for writing to us

I have read your question and i have noted your concern

i would like to know about a few more specific details.

Is there any menstural cycle irregularity? any history of coarse facial hair?

i suggest you to undergo a few blood tests i.e Serum testosterone, Serum DHEAS levels, 17 OH progesterone levels, Serun FSH levels, Serum prolactin levels. These tests are to be done within the first 5 days of menstural cycle. In addition I also suggest a Pelvic ultrasound to look for polycystic ovaries.

regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. Kakkar (2 hours later)

Sir,

Throughout of my life i never have had any cycle irregularity and i dont have any history of coarse facial Hair. My cycle is of 22-23 days since i started my periods and lasts for 4-5 days .

Thanks

Answered by Dr. Dr. Kakkar (17 hours later)

Brief Answer:
Need to undergo lab tests

Detailed Answer:
Hi.

I would still suggest you to go ahead with the lab tests as advised, during the first 5 days of menstural cycle (preferably between 2nd and 5th day)
You may start on accutane but you may also need hormonal treatment in addition to it e.g spironolactone with or without OCPs (oral contraceptive pills) for better control of acne.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (6 hours later)

Sir,

I am attaching herewith some snapshots of my face ( affected area ) though, it may appear quite clear it is due to i am taking Doxyline for the last 6-7 weeks as mentioned by me in my earlier post. I will back to you after i am done with my lab tests as advised by you , it will take 8-10 days. Please let me know should i start hormonal treatment / accutane as advised by you once i am done with my lab test ?

Regards

CS XXXXXXX XXXXXXX

Answered by Dr. Dr. Kakkar (17 hours later)

Brief Answer:
Follow up after tests

Detailed Answer:
Hi. Thank you

I have reviewed the Images.

Yes. You may require either hormonal treatment or accutane or both depending on the severity of your acne and if their is some derangement in lab tests.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (11 days later)

Sir,

My lab reports are attached herewith for your consideration and further advise into the matter . Test are done on third day of mensuration cycle as advised by your good self .
Please advise accordingly.
Thanks
Regards.

Answered by Dr. Dr. Kakkar (21 hours later)

Brief Answer:
Remedy for acne.

Detailed Answer:
Hi. Thank you.

I have reviewed the reports. They seem fine to me except a slight elevation above normal of 17 OH progesterone levels (an adrenal hormone).
Based on these reports I would suggest starting you on Tablet Aldactone 100 mg once daily in evening. In addition to this I also suggest starting you on Tab. Diane 35 mg (to be started on the 1st of menstural cycle and continued for next 21 days, uninterupted and then a gap of 7 days. Restart again on the first day of the 2nd menstural cycle and so on. Continue diane for at least 6-12 months. It is a hormonal treatment and you cannot get pregnant while on this).
I suggest you to start Tab. Aldactone and Tab. Diane 35 together with the onset of next menstural cycle.
You can continue with doxycycline till then. Discontinue doxycycline thereafter.
Topically you may use Clindac A solution, for twice daily application on acne affected area.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (1 hour later)

Sir,
As per my understanding I can start treatment of Tab aldactone and Diane 35 mg from my next periods for a period of 6-12 months. Till then, I can continue my doxycycline. Doxycyline will be discontinue once I start my treatment. Besides this I can use Clindac A solution twice daily.
Sir, there are some questions are coming in mind so you are requested to answer them for clarification of my doubts and for my knowledge too:-
Queries Regarding Aldactone:-
What is Aldactone? Any reason for its prescription? How it will affect my body? How long should I continue with this tablet? Does Aldactone treat acne? Does it affect weight of body? Is it inter connected to other hormones of body?
Please guide me why I used to gain weight during my periods days by 2-3 kg? I am very health and weight conscious.

Queries Regarding Diane 35 mg:_

1 Does this hormonal treatment will rectify any hormonal unbalance in my body forever or till I am on this tablet?
2 As per my understanding it is prescription for acne.
3 I heard that it causes weight gain is it so?
4 How it affect skin condition. Does it make it dry? My skin is healthy and very shining. it will make skin dull?

Thanks with regards

Answered by Dr. Dr. Kakkar (23 hours later)

Brief Answer:
Answers to specific queries

Detailed Answer:
Hi.

Aldactone is spironolactone. It is a diuretic which also has antiandrogenic action and therefore benefits acne, specially in hormonal acne in females.
It can cause some minor side effects like irregular menstural cycle in females and breast tenderness, however not everyone has these side effects.
Combining with diane 35 takes care of the irregular menses in addition to addition beneficial effect on acne. Continue both of these for 6-12 months.
You don't have any serious hormonal abnormalities, just minor one which I guess would be corrected.
I would suggest that you pursue healthy life style habits like walking and cycling etc which would help keep your weight under check and benefit acne in addition. These medicines would not cause weight gain.
No. These medicines would not cause dryness and neither make your skin dull.

Regards

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Above answer was peer-reviewed by : Dr. Nagamani Ng