Question: Hello

I%E2%80%99d like assistance with my skin, acne issues

Background

I%E2%80%99m 42 years old female,
very poor general health bedridden with ME/CFS.
Have has acne since 14
Have very oily, congested t zone that isn%E2%80%99t lessenin* with age, open pores black heads and am prone to nasty inflammatory acne.
Acne Used to be hormonal, associated with period but is now constant.
I have very sensitive skin also

I wash with micellar water and cotton pad in morning and cleanser and moisturise in the evening.
I also use red blue light treatment


Past treatment has been differin gel alone which stopped being effective
Clindamycin gel for active acne which stopped working
Zineryt lotion which has limited effect
Salicylic acid and benzoyl peroxide which has stopped working





Current issue
I%E2%80%99d been acne clear for a year through using salicylic acid every day and BP on small outbreaks. About two months ago I started getting nasty big spots again, I rarely get small pimples just big deep inflamed ones or nothing. My BP/ salicylic acid routine didn%E2%80%99t stop them coming up one after the other every week or two. Initially I thought it was sweating in the heat of the summer but it%E2%80%99s still happening. I think I irritated it with too harsh over the counter acne management.

I%E2%80%99ve been put into a cottage hospital for a year because I had my care cut and lost my accommodation. I%E2%80%99m very run down generally with my health and under constant stress because I don%E2%80%99t cope well in an inpatient setting. So I think this is impacting my skin but I can do nothing about that

I saw the GP here who put me on zineryt lotion which is a bit helpful but the alcohol is harsh and my skin looks congested, still some spots forming. I was wondering if I should add in different gel or BP too and if there%E2%80%99s any other things I could do. I don%E2%80%99t really trust GPs with my acne from past experience and can%E2%80%99t get to see a dermatologist as too poorly with my underlying health issue.
The problem is being generally poorly I need an easy acne regime so washing and treating three times a day for a zineryt/differin separate routine would be too much.
I tried duac as combination therapy ( BP/ clindamycin) Last year but couldn%E2%80%99t manage it%E2%80%99s harshness/drying effect as I do not moisturise in the morning, only in the evening.

Doctors in UK won%E2%80%99t prescribe spironolactone despite it being the only hormonal treatment I could take due to being bedridden which rules out other hormonal options like the pill.
I could ask for oral antibiotics but they%E2%80%99re always reluctant.

I%E2%80%99m part tube fed and I%E2%80%99m also vegetarian so wonder if the dairy I consume and lack of meat could be an issue.

My face feels like an irritated inflamed mess. I have inflammatory/neurological underlying condition and have skin pallor and tingling etc as normal.

Really I would very much value your professional opinion as to how bad my skin is and what I should do to keep it clear it long term as its wearing me down and depressing me. Please see photographs.

Thanks for your help. XXXXXXX Newnham

hello dr kakka

Thanks for your reply

you might remember working with me a few times in the past.

I don't actually think i have rosacea, i do have sensitive skin but it is not red, when i wrote it was inflamed i meant i had irritted it with the skin care and treatments. Was that diagnosis because of what I wrote or due to the photos?

I saw my GP and had a very disappointing consultantion, her one solution seems to be zineryt, she couldn't remember the name of an alternative and she couldn't not remember what differin gel was supposed to do. I raised the possibility of combination therapy as i struggle with different products and also raised in adding in an exfoliant to my anti bacterial treatment and she said she would have to look it up and then without further discussion has just re prescribed differin gel to add to the zineryt i presume. She would not prescribe oral antibiotics.

Basically, as i am currently reliant on topical only treatment could you please advise how i should use to best effect the zineryt, benzoyl peroxide 5%25, and differin gel i have in possession. Some of the spots on the photos have subside since i added in benzoyl peroxide to the zineryt As you advised previous occasion but one lesion has got steadily worse and is now quite nasty and big and red.

I had started to tell the doctor that the gel consistency of differin gel was an issue as too thick and heavy on my excessively oily areas and i would have asked for the liquid form. Could you please advise if the liquid form might be better. ?? I have also read of some%22 combination therapies%22 with benzoyl peroxide and antibiotics as one product or retinoid and antibiotics combined and do you think it would be worth trying to get them and are they available without prescription? i would find a once per day management treatment much easier

Is 5%25 benzoyl peroxide too strong to apply at the same time as differin gel and can i apply differin gel on top of zinery? . Would i be better just using two of the products or all three for the time being.? I also own some salicylic acid if you think that better.

Thanks for your'help. With regards, XXXXXXX Newnham

Thanks for your reply

i didnt understand that regarding the metronidazole gel. i will ask gp if i can try that next time.

In the meantime id be grateful if you could possibly reply to the questions in my previous post regarding how to make use of the three treatments i currently possess.
i also asked if liquid differin instead of gel and 2.5%25 BP might be better (things i can probably get easily without GP prescription here in uk).
And do you think for acne prevention once this current inflammatory outbreak has passed, as differin stopped working in past a combination management treatment like epiduo is a good idea?

Thanks for your time XXXXXXX Newnham