Hello. Thanks for writing to us at healthcaremagic Most likely she has developed Gram Negative Folliculitis , as also revealed in the culture report. Acne patients while on treatment with doxycycline may develop a sudden pustular flare or worsening of acne on upper lip, chin and cheek area, because the normal resident flora of nose is replaced by gram negative bacteria. Treatment of gram negative folliculitis is with different oral antibiotics, that also have a gram negative coverage e.g Trimethoprim sulphamethoxazole, Ampicillin antibiotics may be started. Oral retinoids e.g Isotretinoin, are also an option in gram negative folliculitis and can be started, if oral antibiotics prove ineffective in eradication gram negative flora from nose. Regards