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Suggest Treatment For Cystic Acne Pimples

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Posted on Wed, 28 Jan 2015
Question: Dermatology enquiry

Hi

Could you please tell me whether the spot in my pictures would be called a moderate /nodular or cystic acne pimple? Also (I'm bedbound with serious illness) should i call my GP out to prescribe oral medication? I live in the UK so we don't have easy access XXXXXXX to a dermatologist.

Currently I'm using clindamycin lotion or zindaclin gel - unfortunately my skin gets easily irritated by gels - & when i can tolerate, differin 0.1% gel. Also 5-10ml oral ibuprofen sometimes. I don't know whether this would warrent the use of oral antibiotics or something?
I've only just finished - a week ago - flucloxecillin 1wk course for a bigger skin pimple. I have not had a bad spot for 8 months but have very greasy skin & blackheads despite being 38 (female)

the area is prickly, tingly & a bit itchy but not painful unless I touch it. I don't know if the tingling is the infection or sensitivity to the treatments? Should i therfore stop them if its irritated? I'm worried if i stop that i effectively am doing no treatment. I never know whether this type of spot requires more than topical treatment? As its something which occurs only maybe 2-3 times/year & usually in the singular, rather than a face full of acne, I'm not under medical supervision but do have multiple places of scarring which has accumulated over the years unfortunately.

Do yoi thonk it will scar also? Can that be prevented?

I'd be grateful if you could advise.
Thanks very much for your help XXXX
doctor
Answered by Dr. Dr. Kakkar (17 minutes later)
Brief Answer:
Its a single inflammatory acne nodule; Oral+ topical antibacterial

Detailed Answer:
Hello. Welcome back to healthcaremagic

I have taken note of your query and I have also reviewed the Images.

In the Images I can see a single inflammatory acne lesion. It is a papule/nodule with a pustular center. It does not look like a cystic acne lesion.
Tingling is most likely due to it being an inflammatory acne lesion rather than due to irritation to topical's.

Normally, I wont recommend an Oral antibiotic for a single lesion such as this but sometimes I may, if it is getting bigger and patient insists on getting rid of it fast.

Topically, you may use clindamycin 1% lotion just over the lesion, once or twice daily during day time.
At night I would suggest you to use adapalene gel 0.1% just as a spot treatment as well.
Use topical's just as a thin film. Using too much would irritate.
An Oral antibiotic e.g Azithromycin once daily in adult doses for 3-5 days, is all that would be required for this particular acne lesion.
Oral antibiotics are prescription medications and I suggest you to talk to your general physician for the needful.

Don't squeeze it or manipulate it. No, it won't scar.

Regards
Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Kakkar (2 days later)
Hello

Thanks for your reply.

my GP wrote me a prescription for clarithromycin. Is that a good drug for this?.

Also you say use clindamycin lotion twice daily as well as differin - would that be along the lines of 9am, 4pm & 11pm application? I was always unsure about how to use clindamycin lotion with differin, as clindamycin lotions directed for twice daily which i'd usually do day & night but differin is for night use & mustn't be applied with clindamycin.

Do I stop topical antibiotics when taking orally as well?
Also finally if I use differin Would differin cream be less irritating to my sensitive skin do you think?

Thanks for your time. XXXX
doctor
Answered by Dr. Dr. Kakkar (3 hours later)
Brief Answer:
I suggest both Oral as well as Topical treatment.

Detailed Answer:
Hi.

You may either use Clindamycin Or Clarithromycin at 9am and 3 pm. Adapalene gel 0.1 % should be used at night i.e 9pm.

Oral antibiotics should be taken simultaneously with topical treatment

Adapalene is a mild irritant, therefore, you must use it as a thin film. However, it is a very effective topical antiacne treatment.
The redness that I see in this particular acne lesion is not due to irritation but because it is inflammatory.

I suggest you to go ahead with the above mentioned treatment schedule.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Kakkar (10 hours later)
Hi

Thankyou for your advice.
Just to clarify do you mean that oral antibiotics shouldn't be taken at night as they would react with differin? I hadn't realised oral antibiotics reacted with differin.

Thanks very much! XXXX,
doctor
Answered by Dr. Dr. Kakkar (30 minutes later)
Brief Answer:
I suggest both Oral as well as Topical treatment

Detailed Answer:
Hi.

No, I did'nt mean that. I meant treatment should be both Topical as well as Oral. I said "Oral antibiotics should be taken simultaneously with topical treatment".. that was an answer to your question "Do I stop topical antibiotics when taking orally as well?"
I should reformulate it "Oral treatment should be combined with topical treatment and you don't need to stop topical antibiotics"

No way Oral antibiotics would react with Adapalene.

Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

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

Dermatologist

Practicing since :2002

Answered : 9612 Questions

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Suggest Treatment For Cystic Acne Pimples

Brief Answer: Its a single inflammatory acne nodule; Oral+ topical antibacterial Detailed Answer: Hello. Welcome back to healthcaremagic I have taken note of your query and I have also reviewed the Images. In the Images I can see a single inflammatory acne lesion. It is a papule/nodule with a pustular center. It does not look like a cystic acne lesion. Tingling is most likely due to it being an inflammatory acne lesion rather than due to irritation to topical's. Normally, I wont recommend an Oral antibiotic for a single lesion such as this but sometimes I may, if it is getting bigger and patient insists on getting rid of it fast. Topically, you may use clindamycin 1% lotion just over the lesion, once or twice daily during day time. At night I would suggest you to use adapalene gel 0.1% just as a spot treatment as well. Use topical's just as a thin film. Using too much would irritate. An Oral antibiotic e.g Azithromycin once daily in adult doses for 3-5 days, is all that would be required for this particular acne lesion. Oral antibiotics are prescription medications and I suggest you to talk to your general physician for the needful. Don't squeeze it or manipulate it. No, it won't scar. Regards Take care