Brief Answer: Isotretinoin is drug of choice for pimples Detailed Answer: Hello XXXX, Welcome and thanks for posting your query to the forum. I can understand your concern for pimples. It is really distressing for a young female of your age if there is presence of pimples on face. Before I guide you best regarding your condition 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 play 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 or due to pinching, popping and squeezing of the pimples 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 28 years also. So probably you got some idea regarding your acne. After analyzing your history as well as your picture, I can make out that these are basically due to hormonal cause. This finding is supported by two facts- one is the presence of pimple on lower face and chin area and subsidence of pimple after using hormonal therapy. 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). Now coming on the treatment part: The best medication for the same is isotretinoin- it is drug of choice which acts on all aspect of pimple formation BUT UNDER STRICT DERMATOLOGICAL SUPERVISION ONLY. If you are not planning for baby (at least for now) then you are the ideal candidate for isotretinoin. It is one of the most preferred choices for your kind of condition. A full 3-6 months course under strict dermatological supervision is required to get best relief. There are different doses of the isotretinoin to be given at different aspect of time according to the grade of improvement. We always first go for certain basic investigation of blood before we start this medicine. The other of the way is to go for hormonal therapy in low dose along with anti-androgen tablets can be taken for 3 months. For married females who do not wish to conceive in near future can be given this part of treatment for few months. As I notice that you have already taken hormonal tablet for 4 months, so now this part of therapy can not be given again for some time. Accordingly you dermatologist has taken the best decision of giving isotretinoin to you. I favor his clinical judgment as it is one of the best and long lasting therapies. For the part of side effects- these are seen only in little percentage of patients and in most of my patients I see only chapping of lips only. Other of side effects are rarely seen. There is continuous monitoring which is done in case of this therapy and we dermatologists are very particular for same. As you want to have your baby next year so there is almost a period of 8 months in next year. The isotretinoin therapy is given for a period of maximum 6 months. On safer side we take 1-2 months of gap between your conception and stopping the therapy. On more of the safer side you can prolong the gap before conceiving. I generally prefer a gap of 2 months and have never seen any side effects in pregnancy and then in baby. Reduce your stress level too as high stress leads to hormonal up surge and thereby more eruption of pimples. Hope these informations will help you. If you have any further query I will be happy to help. Regards, Dr Sanjay Kumar Kanodia MD (Dermatology)

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