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Suggest Treatment For Yellowish Bumps On Face
Question: Hi
I am 32 yrs old male suffering with yellow pimples on my face, especially on and around nose area. i have been having this kind of acne for last 6-7 years. The attached pic is just example but on some days i get so many more than what you in pic. I never had this kind of acne issue in my teenage, i used to get like one or two small ones once in a month or so. Please help !!!!
I am 32 yrs old male suffering with yellow pimples on my face, especially on and around nose area. i have been having this kind of acne for last 6-7 years. The attached pic is just example but on some days i get so many more than what you in pic. I never had this kind of acne issue in my teenage, i used to get like one or two small ones once in a month or so. Please help !!!!
Brief Answer:
Folliculitis;Oral Penicillin gr of antibiotics+Isotretinoin;topical dapsone
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your query and I have also reviewed the Image.
Not all bumps on face are acne. This is actually folliculitis.
This type of pustular folliculitis around nose/ nasolabial folds may be seen in patients of acne who have had acne for years and those who have an Oily Or very Oily central T zone coupled with alteration/ resistance of cutaneous and nasal resident bacterial flora due to long term and repeated courses of broad spectrum Oral antibiotics for there chronic acne problem e.g Doxycycline.
If I was the treating doctor I would suggest an Oral antibiotic e.g either Amoxycillin (preferably augmentin i.e amoxycillin in combination with clavulanic acid) Or Cephalexin for a week or two, for folliculitis. These are not acne antibiotics.
I would also suggest that you be started on Oral Isotretinoin. Isotretinoin is sebostatic i.e decreases oil production by shrinking size of sebaceous glands by more than 90% within a month of its use. It also helps restore altered nasal and cutaneous bacterial flora that was altered due to long term or repeated courses of oral antibiotics for acne. Isotretinoin would need to be continued for months (6-9 months or more).
Topically you may use an anticane antibacterial e.g Dapsone 5% gel i.e Aczone Or nadifloxacin gel 1% over the affected area, twice daily.
Topical benzoyl perxide gel though effective in drying pustular lesions, it will prove counterproductive as it is overdrying and therefore would cause rebound oiliness and more pustular lesions.
Regards
Folliculitis;Oral Penicillin gr of antibiotics+Isotretinoin;topical dapsone
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your query and I have also reviewed the Image.
Not all bumps on face are acne. This is actually folliculitis.
This type of pustular folliculitis around nose/ nasolabial folds may be seen in patients of acne who have had acne for years and those who have an Oily Or very Oily central T zone coupled with alteration/ resistance of cutaneous and nasal resident bacterial flora due to long term and repeated courses of broad spectrum Oral antibiotics for there chronic acne problem e.g Doxycycline.
If I was the treating doctor I would suggest an Oral antibiotic e.g either Amoxycillin (preferably augmentin i.e amoxycillin in combination with clavulanic acid) Or Cephalexin for a week or two, for folliculitis. These are not acne antibiotics.
I would also suggest that you be started on Oral Isotretinoin. Isotretinoin is sebostatic i.e decreases oil production by shrinking size of sebaceous glands by more than 90% within a month of its use. It also helps restore altered nasal and cutaneous bacterial flora that was altered due to long term or repeated courses of oral antibiotics for acne. Isotretinoin would need to be continued for months (6-9 months or more).
Topically you may use an anticane antibacterial e.g Dapsone 5% gel i.e Aczone Or nadifloxacin gel 1% over the affected area, twice daily.
Topical benzoyl perxide gel though effective in drying pustular lesions, it will prove counterproductive as it is overdrying and therefore would cause rebound oiliness and more pustular lesions.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for replying Dr. Kakkar.
I kind of remember taking Amoxycillin about 10 years ago but not sure if it was really Amoxicillin or some other oral antibiotics.
I have uploaded some more pics, kindly please review them as well.
So are you suggesting me to go on Oral antibiotics - example: Amoxycillin or Cephalexin for a week or two - then stop taking this ?
And then start on Isotretinoin right after for 6-9 months ?
Would i still have to use topical gels after finishing the above course ?
I remember when i saw dermatologist the last time about 4-5 yrs ago, the oral antibiotics he gave me worked for few months and acne/folliculitis returned back after few months so i went back to see dermatologist. I remember he said that i would probably have to go on "Accutane" as the last resort as all other meds are failing. But he made me aware of some serious side effects and wanted me to sign some legal paper, that's why i didn't go for Accutane. I believe isotretinoin = accutane ?
Please advise further.
Thank you for your kind reply. XXXXXXX
I kind of remember taking Amoxycillin about 10 years ago but not sure if it was really Amoxicillin or some other oral antibiotics.
I have uploaded some more pics, kindly please review them as well.
So are you suggesting me to go on Oral antibiotics - example: Amoxycillin or Cephalexin for a week or two - then stop taking this ?
And then start on Isotretinoin right after for 6-9 months ?
Would i still have to use topical gels after finishing the above course ?
I remember when i saw dermatologist the last time about 4-5 yrs ago, the oral antibiotics he gave me worked for few months and acne/folliculitis returned back after few months so i went back to see dermatologist. I remember he said that i would probably have to go on "Accutane" as the last resort as all other meds are failing. But he made me aware of some serious side effects and wanted me to sign some legal paper, that's why i didn't go for Accutane. I believe isotretinoin = accutane ?
Please advise further.
Thank you for your kind reply. XXXXXXX
Brief Answer:
Isotretinoin;Oral Amoxicillin+clavulanic acid;Topical dapsone/nadifloxacin
Detailed Answer:
Hi. Thank you.
I have reviewed all the Images and this is not simple acne.
This is folliculitis and I would like to keep a possibility of gram -ve folliculitis which is a side effect of long and repeated courses of Oral broad spectrum antiacne antibiotics e.g doxycycline for acne. In my view you should certainly be started on Isotretinoin which is same as accutane.
If I was the treating doctor I would have started you on both tablet. augmentin (amoxicillin+clavulanic acid) as well as isotretinoin along with topical antibacterials like dapsone 5% gel (Aczone gel) Or nadifloxacin 1% gel. The antibiotic can be stopped after 1-2 weeks and thereafter you may use topical antibacterial. Isotretinoin would require 6-9 months of treatment.
Isotretinoin is safe and is commonly prescribed by dermatologists around the world for various indications.
Side effects are mainly skin related i.e dryness of lips and skin.
Its main risk is its effect on pregnancy in females therefore it should eb avoided in pregnant or would be pregnant females. Serious side effects like pancreatitis, hypersensitivity, hepatotoxicity are rare.
Its may cause psychiatric side effects like depression and rare cases of suicides have been reported in past in patients who were on isotretinoin but these are unsubstantiated reports and Isotretinoin has never been directly linked to these psychiatric side effects. Moreover, patients with severe chronic/ treatment resistant acne are already depressed about there never ending skin problems and isotretinoin benefits rather than worsens psychology of these patients. Therefore in my view it is an entirely safe drug.
Regards
Isotretinoin;Oral Amoxicillin+clavulanic acid;Topical dapsone/nadifloxacin
Detailed Answer:
Hi. Thank you.
I have reviewed all the Images and this is not simple acne.
This is folliculitis and I would like to keep a possibility of gram -ve folliculitis which is a side effect of long and repeated courses of Oral broad spectrum antiacne antibiotics e.g doxycycline for acne. In my view you should certainly be started on Isotretinoin which is same as accutane.
If I was the treating doctor I would have started you on both tablet. augmentin (amoxicillin+clavulanic acid) as well as isotretinoin along with topical antibacterials like dapsone 5% gel (Aczone gel) Or nadifloxacin 1% gel. The antibiotic can be stopped after 1-2 weeks and thereafter you may use topical antibacterial. Isotretinoin would require 6-9 months of treatment.
Isotretinoin is safe and is commonly prescribed by dermatologists around the world for various indications.
Side effects are mainly skin related i.e dryness of lips and skin.
Its main risk is its effect on pregnancy in females therefore it should eb avoided in pregnant or would be pregnant females. Serious side effects like pancreatitis, hypersensitivity, hepatotoxicity are rare.
Its may cause psychiatric side effects like depression and rare cases of suicides have been reported in past in patients who were on isotretinoin but these are unsubstantiated reports and Isotretinoin has never been directly linked to these psychiatric side effects. Moreover, patients with severe chronic/ treatment resistant acne are already depressed about there never ending skin problems and isotretinoin benefits rather than worsens psychology of these patients. Therefore in my view it is an entirely safe drug.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. Kakkar,
So i went to see my Dr yesterday and asked him to cure me as folliculitis and i asked him to prescribe me what you suggested. He said folliculitis is a
He did prescribe me Amoxicillin / Clavulanic Acid 500mg / 125 mg - 3 times a day for 14 days.
And clindamycin, as phosphate, 1% and benzoyl peroxide 5 % when mixed - apply two times a day. However, i didn't know he was prescribing me BP until i got it from pharmacy. So i am not going to use BP as it makes my skin extremely dry.
But i do have dapsone gel 5% which i am going to apply twice a day for two weeks.
I also have Clindamycin phosphate 1.2% and tretinoin 0.025% - should i use this or dapsone 5 % ?
Ohh - and he did not prescribe me Isotretinoin as he thinks it's too harsh. He said that because my foundation is not good (being low on Vitamin D), no medicine will work. So he emphasized to wait for 2 more months until my Vitamin D is upto expected level only then he will do something i guess.
I told him that amoxicilin will certainly work as other meds did work, but only for a month or so. I told him that when i will stop taking amoxicilin, pimples are going to come back so why not give me isotretinoin ? And he gave me a cause of being low on Vitamin D.
since i have to take amoxicilin 3 times a day - i was wondering if i could go to sleep right after taking this antibiotic.
Here is what i am trying to ask - i have to take this med 3 times a day, so i would take it 8 hours apart. If i take first one at 8 AM, then 4 PM then 12 AM. If i take med at 12 AM then i would want to go to sleep as i have work next day :)
So can i take this med and go to sleep right after ?
Also another question - do i have to take this med with food ? or without food is okay ? for the reason as above - i can't be eating at midnight :)
Kindly please provide your suggestion.
So i went to see my Dr yesterday and asked him to cure me as folliculitis and i asked him to prescribe me what you suggested. He said folliculitis is a
He did prescribe me Amoxicillin / Clavulanic Acid 500mg / 125 mg - 3 times a day for 14 days.
And clindamycin, as phosphate, 1% and benzoyl peroxide 5 % when mixed - apply two times a day. However, i didn't know he was prescribing me BP until i got it from pharmacy. So i am not going to use BP as it makes my skin extremely dry.
But i do have dapsone gel 5% which i am going to apply twice a day for two weeks.
I also have Clindamycin phosphate 1.2% and tretinoin 0.025% - should i use this or dapsone 5 % ?
Ohh - and he did not prescribe me Isotretinoin as he thinks it's too harsh. He said that because my foundation is not good (being low on Vitamin D), no medicine will work. So he emphasized to wait for 2 more months until my Vitamin D is upto expected level only then he will do something i guess.
I told him that amoxicilin will certainly work as other meds did work, but only for a month or so. I told him that when i will stop taking amoxicilin, pimples are going to come back so why not give me isotretinoin ? And he gave me a cause of being low on Vitamin D.
since i have to take amoxicilin 3 times a day - i was wondering if i could go to sleep right after taking this antibiotic.
Here is what i am trying to ask - i have to take this med 3 times a day, so i would take it 8 hours apart. If i take first one at 8 AM, then 4 PM then 12 AM. If i take med at 12 AM then i would want to go to sleep as i have work next day :)
So can i take this med and go to sleep right after ?
Also another question - do i have to take this med with food ? or without food is okay ? for the reason as above - i can't be eating at midnight :)
Kindly please provide your suggestion.
Brief Answer:
Possibility of gram -ve folliculitis;amoxicillin+clavulanate is good choice
Detailed Answer:
Hi.
Yes, topical dapsone 5% gel would be good choice as compared to tretinoin+clindamycin combination.
Amoxicillin+clavulanic acid is a good choice for your folliculitis (probably a gram -ve folliculitis) and I suggest you to continue with it as advised i.e thrice daily for 2 weeks.
I would have also started you on Isotretinoin right away Irrespective of Vitamin D levels but if your doctor wants to wait till your Vitamin D levels are normal, that his individual discretion. I suggest you to go according to your doctor.
Yes, you can go to sleep right after the last dose of antibiotic. You should take it after a meal, may be something lighter at night, but not on empty stomach.
Regards
Take care
Possibility of gram -ve folliculitis;amoxicillin+clavulanate is good choice
Detailed Answer:
Hi.
Yes, topical dapsone 5% gel would be good choice as compared to tretinoin+clindamycin combination.
Amoxicillin+clavulanic acid is a good choice for your folliculitis (probably a gram -ve folliculitis) and I suggest you to continue with it as advised i.e thrice daily for 2 weeks.
I would have also started you on Isotretinoin right away Irrespective of Vitamin D levels but if your doctor wants to wait till your Vitamin D levels are normal, that his individual discretion. I suggest you to go according to your doctor.
Yes, you can go to sleep right after the last dose of antibiotic. You should take it after a meal, may be something lighter at night, but not on empty stomach.
Regards
Take care
Above answer was peer-reviewed by :
Dr. Yogesh D
Great advise Sir..
I truly appreciate your answers and feedback to my all questions.
Thank you for all your suggestions and help.
Best regards,
XXXXX XXXXXXX
I truly appreciate your answers and feedback to my all questions.
Thank you for all your suggestions and help.
Best regards,
XXXXX XXXXXXX
Brief Answer:
You are Welcome
Detailed Answer:
Thank you for your appreciation. Thanks for writing to us
Regards
You are Welcome
Detailed Answer:
Thank you for your appreciation. Thanks for writing to us
Regards
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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