question-icon

Suggest remedies for acne

default
Posted on Tue, 17 May 2016
Question: This is a dermatolgy enquiry. Ideally i would prefer drs kakka or sawhney to answer as i have worked with them recently but anyone as soon as possible woukd be great. Thank you.


Dear dr,

I am writing to you about how to manage the use of differin on my face. I currently am not sure whether to use the gel or the cream or even at all - ie switch to something gentler. I need some type of exfoliant as I'm prone to Occassionall hormonal cystic acne & scarring as well As having black heads & excess oil /thickening. I have tried Salicylic acid before and don't know if it's a better option?

Anyway, I'm 39, female, bedbound with cfs & My skin type is difficult, with it being combination & drier sides/ cheeks but the oily central areas very oily and congested with marked thickening & open pores. It's also very sensitive which means that a lot of products irritate it. I can't take the contraceptive pill to regulate my skin, although it seems to be hormonally driven, as I'm too immobile

I think firstly I'm doing something wrong as The other day I put differin cream on my cheeks and they, after about an hour started to go increasingly red to the extent it felt burning & I decided I had better wash it off. I don't know how I can avoid this reaction? Could you give me some advice? Also with my skin type am I better to use gel or cream -issue is that the cream feels too heavy for oily areas but the gel to drying/ harsh on cheeks etc. On my very oily areas i don't know if the cream is adding to the congestion and worse pore enlargement. Both the cream & gel strength is 0.1% differin.

Maybe I was putting too much on... I thought that i had read that we were supposed to cover area with a very thin film, then rub it in if its the cream or leave on if it's the gel. Maybe applying the cream like that meant I'm applying more than the bare minimum??

I find differin drying sometimes too, which is a problem as, due to severe ill health, I only manage to wash and moisturise my face 1x/day so it can go for 10 hours feeling parched which i dont feel is good for skin. I have however found the cream less drying, & Also wearing a light moisturiser underneath has helped a bit but not fully

Finally I also have been using differin as part of the treatment of a single nodular acne lesion in combination with fucudin cream. This seemed fairly successful but whilst it has now subsided to just a small, slightly tender red lump on my face it is not improving beyond that. I'm not sure if differin cream is too heavy for that, especially with fucudin cream on top and gel instead would help penetration etc but as I can not put fucudin cream on top of the gel, I don't think, I don't know how to do it. Should I switch to zindaclin gel again with the differin or do I need to continue with fucudin &. Differin as I was originally prescribed? I just want to resolve the lesion fully whereas it seems to be stubbornly refusing to fully subside. I realise I've probably been using fucudin too little - just 2x/ day for a fortnight, so Maybe that's part of the problem.


So to summarise my questions are
General differin advice so it doesn't cause the strong red irritation I've experienced past usage (btw I've used the gel ok without irritation but found harsh etc). In past I tried differin for few months but gave up with issues.
More specifically should I use gel or cream or even both on the corresponding dry or oily areas?
As differin and its high strength , textures /drying effects can be problematic am I better to switch to Salicylic acid? & can the drying effect be reduced in any way? I felt putting moisturiser on afterwards seemed to increase penetration & irritation so just use a light oil free lotion before .
How should I apply /combine, & in what forms, fucudin & differin to the stubborn, former nodular lesion? I think they need to go on together as I wash and apply fucudin morning, will start applying fucudin afternoon & then In Evening I will wash and apply them both.


Many thanks for your time & help
XXXXXXX XXXXX
doctor
Answered by Dr. Kakkar S. (2 hours later)
Brief Answer:
Advice regarding acne and yse of topical medications

Detailed Answer:
Hello XXXXXXX Thank you for writing to us

I have read your question and I wish to provide you with a suitable solution.

The treatment of acne is individualised, depending on the severity of acne, response to treatment and its side effects. The products that you mention i.e differin, fucidin, salicylic acid, fucidin etc and in addition to these benzoyl peroxide gel are all useful for acne but the trick is how to use them so as to be effective yet avoiding side effects.
As you say the central part is oily and sensitive and the cheeks are drier; this combination skin type if the most common skin type in patients of acne.
I would suggest you to use differin every alternate night rather than every night, because differin does make the skin sensitive/ red as compared to other topical medications and because it removes the comedones/ blockages of pores therefore oil flows freely and the skin consequently gets more oily on differin; differin has no effect on oil production by sebaceous glands. The only thing that helps regulate oil is oral isotretinoin.

Using a light moisturiser before differin is also less likely to irritate than using it alone.

You may use either gel or cream formulation Or you may try both togther (gel on nose and neighbouring area and cream on cheeks) but I usually prefer gel in my patients. Some patients do use it overenthusiastically, in those i specifcally ask them to apply a just a pea-sized amount to the whole face and that helps.

So, using every alternate days, using a moisturiser prior to differin and using a pea - sized aount for the whole face would help reduce irritation.

Differin is a better antiacne product than salicylic acid and moreover salicylic acid is also drying and using these together can cause additive irritation/ dryness so I would suggest you to stick with just differin.

Regarding the single nodular lesion you can add Zindaclin for day time application and fucidin cream for night time application. Continue with differein gel once daily at night or alternate night. Apply fucidin after differin had dried.

Regards
Hope this helps
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Kakkar S. (2 days later)
Hello again Dr Kakka, thanks very much for your reply

I appreciate that acne treatment is very individual. My issues are quite different to the average person due to the constraints of & difficulty of fitting it in with, debilitating illness. As i only wash and treat & moisturise my face once per day in the evening (if i have to spot treat in the morning i literally just wash and treat the local area) & if acne prevention treatment is by nature often very dehydrating to the skin, am i possibly harming my skin by leaving it dehydrated during the day until the evening face care? People always talk about the risks with harsh acne products & also ive often seen it written that dehdrated skin is more susceptible to aging/damage so i have that concern. If salicylic acid has similar down side with less good, would azaeliac acid be better? I know we have discussed this briefly before but i i mean this time in the context of choosing a product that will help a bit with congestion and prevention ofoccasional cysts but with no risk of harm.
I'm personally keen to continue differin but can only do so if i know that not washing and moisturing in the morning will not lead to harm.

And secondly, i saw your recommendation of differin gel over the cream but if i decided to use the cream on the oily aeas of skin, is it likely to increase congestion and enlarge the pores around my nose or counteract the positive unblocking, refining action that differin itself is for? If it would, despite the drawbacks for me, i Would use gel.

Thanks so much for your time dr Kakka
With regards XXXXXXX XXXX
doctor
Answered by Dr. Kakkar S. (17 hours later)
Brief Answer:
Advice related to acne

Detailed Answer:
Hi.

Oilier skin is acne prone and usually there is no need to use any moisturiser from outside. This is because oil glands hydrate the skin from within. Even differin causes only superficial dryness without actually affecting/ decreasing sebaceous gland secretion. Infact, patients who use differin notice that though the face feels drier immediately after wash but it becomes oily after 30 minutes or so. This is because differin itself has no effect on sebaceous gland activity. Hence, you may use a light moisturiser only once a day immediately after facewash in evening and before you apply differin and there is no need to use a moisturiser more often than that because oil glands would compensate for any dryness.
Oily skin ages slow as compared to dry skin and therefore you have an advantage over those who have dry skin and not using a moisturiser in morning while on differin is not going to do any harm.
Salicylic acid is drying but none of these products alter the underlying genetic makeup of skin i.e an oily skin remains oily. These products only produce a temporary dryness which is compensated by sebaceous gland secretion.
Azaleic acid is also an antiacne product which is quite similar to differin. It is however less drying and also more suitable for sensitive skin as it does'nt irritate much. You can try this. It also has a refining action on skin pores. I have discussed this before.
Generally speaking, gels are preferred on oily skin and creams on dry skin because creams have a part of oil in them whereas gels are totally water based. However, you may use cream if you feel that it suits your skin more than a gel. Differin cream does'nt cause pores to enlarge though differin which is adapalene does cause a slight erythema/ redness and gives a rosy glow to skin. Azaleic acid is worth trying if congestion/ redness is a problem.

Regards
Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
default
Follow up: Dr. Kakkar S. (2 days later)
Hi dr Kakka, thats really helpful thankyou.
Finally i was reading on acne forums people saying that differin made the skin very fragile and that you had to be very gentle with it. I always try to use a gentle skin cleanser with it but read that you should not use wash cloths. I find that impossible most days as i don't wash over a sink or use my bare hands - i use the softest cloth i can find which is a bamboo fibre muslin cloth. Do you think that would be ok as a means of removing the cleanser?
Many thanks
doctor
Answered by Dr. Kakkar S. (17 hours later)
Brief Answer:
Can use a soft towel or cloth

Detailed Answer:
Hi.

Differin is adapalene, which has an antiageing action on skin apart from being an antiacne product.
Differin can make skin a bit sensitive but it would Ok if you use a soft towel or a soft cloth, gently.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 9244 Questions

premium_optimized

The User accepted the expert's answer

Share on
Suggest remedies for acne

Brief Answer: Advice regarding acne and yse of topical medications Detailed Answer: Hello XXXXXXX Thank you for writing to us I have read your question and I wish to provide you with a suitable solution. The treatment of acne is individualised, depending on the severity of acne, response to treatment and its side effects. The products that you mention i.e differin, fucidin, salicylic acid, fucidin etc and in addition to these benzoyl peroxide gel are all useful for acne but the trick is how to use them so as to be effective yet avoiding side effects. As you say the central part is oily and sensitive and the cheeks are drier; this combination skin type if the most common skin type in patients of acne. I would suggest you to use differin every alternate night rather than every night, because differin does make the skin sensitive/ red as compared to other topical medications and because it removes the comedones/ blockages of pores therefore oil flows freely and the skin consequently gets more oily on differin; differin has no effect on oil production by sebaceous glands. The only thing that helps regulate oil is oral isotretinoin. Using a light moisturiser before differin is also less likely to irritate than using it alone. You may use either gel or cream formulation Or you may try both togther (gel on nose and neighbouring area and cream on cheeks) but I usually prefer gel in my patients. Some patients do use it overenthusiastically, in those i specifcally ask them to apply a just a pea-sized amount to the whole face and that helps. So, using every alternate days, using a moisturiser prior to differin and using a pea - sized aount for the whole face would help reduce irritation. Differin is a better antiacne product than salicylic acid and moreover salicylic acid is also drying and using these together can cause additive irritation/ dryness so I would suggest you to stick with just differin. Regarding the single nodular lesion you can add Zindaclin for day time application and fucidin cream for night time application. Continue with differein gel once daily at night or alternate night. Apply fucidin after differin had dried. Regards Hope this helps