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    Suggest treatment for pustules on face

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Posted on Mon, 14 Apr 2014 in Skin Hair and Nails
Question: I first noticed that I had some ringworm on my face that was inflamed. I got prescribed lotrisone by my GP. Within about 5 days the inflammation had completely subsided. It said that I was to treat for two weeks so I kept using it. I started to notice weird red lines at the corner of my nose and pustules on my face. I went back to the Dr. immediately and she said that it was just the ringworm and that it would take 6 weeks to get better. I asked if I could stop using the lotrisone since my inflammation had gone and switch to the lotrimin ultra, she said that would be fine. I noticed my skin had alot of pimples and was a little blotchy after doing my research online I realized that lotrisone is only meant to be used for 5 days on the face (at the point I stopped it had been 12-this makes sense as it looked better after 5 days and then I noticed the pustules and redness). In order to alleviate some of this I looked on line and saw that tumeric and honey could really help with acne and inflammation. I made a mask and left it on overnight. The next day when I washed it of my face was much redder than before, the pustules had spread. I don't know what to do, and think I look terrible right now. Is this just an allergic reaction and how long will it take to go away? What can I do?
doctor
Answered by Dr. Kakkar S. 4 hours later
Brief Answer: Acne/perioral dermatitis due to steroid Detailed Answer: Hello and welcome to healthcaremagic. Lortisone contains clotrimazole +betamethasone. Betamethasone is a potent steroid which should never be used on face because it can cause side effects like acne/perioral dermatitis. I think that is what has happened in your case. Besides acne betamethasone can also cause hirsutism, photosensitivity, and skin thinning and telangiectasias if used for long term. Lortisone ultra is fine because it contains a plain antifungal, butenafine and is therefore safe to be used on face unlike lortsone, which contains clotrimazole +betamethasone. I would suggest that you you use a topical clindamycin gel for twice daily application. You could also take oral doxycycline 100mg twice daily for faster improvement of acne/perioral dermatitis. Use a gentle cleanser for face wash e.g cetaplhil cleansing lotion. Remember, never use a potent steroid on face. Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Kakkar S. 30 minutes later
Hmm. Okay, thank you. I am allergic to clindamycin (benzoyl peroxide), is it okay if use a plain antibacterial soap, the cetaphil or Olay Age Defying (which contains some salicylic acid, sodium XXXXXXX sulfate etc). I usually use the Olay Age Defying but stopped it for about two weeks, I don't know if it is appropriate at this point (because my skin in hyper sensitive and it has small microbeads) but I have used it for years with no averse reactions. I notice that doxycycline is a prescription med. I can make an appt to see derm but that may take two weeks for them to see me. Is there some over the counter brand? Also, is there any thing I can put on my face now to atleast help a bit with the redness? I have hydrocortisone 1%. I know that it a steroid as well (though a mild one). Would this atleast help with the physical appearance of my face? Also, how long will it take for this to go away on average? Both in the un-treated and treated case.
doctor
Answered by Dr. Kakkar S. 39 minutes later
Brief Answer: Acne/perioral dermatitis Detailed Answer: Hi. Plain clindamycin 1% gel is a good option, benzoyl peroxide is NOT, because it would cause more irritation. OR you can use Nadifloxacin 1% gel twice daily. 1% hydrocortisone is the mildest steroid that can be used once daily to calm down the already supersensitive skin (due to betamethasone application). Some doctors do advice it because stopping a potent steroid like betamethasone causes lot of redness and flaring. Hydrocortisone is a mild steroid and it can be used to wean off the skin from a potent steroid. If desired you can use it for 7-10 days and then discontinue it. Or else you could just use a non-comedogenic moisturizer to calm down the skin. Cetphil cleansing lotion is neutral PH cleanser and is non-soap based, it is very mild. Olay Age Defying (which contains some salicylic acid, sodium XXXXXXX sulfate etc) is not advisable because salicylic acid might irritate the already sensitive skin Oral Erythromycin 500mg thrice daily if you can get it OTC, is an equally good option. Both Doxycycline as well as Erythromycin are good options. regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Kakkar S. 1 hour later
Thank you again! Approximately how long will this take to clear up? In treated and un-treated cases.
doctor
Answered by Dr. Kakkar S. 3 hours later
Brief Answer: Acne/Perioral dermatitis Detailed Answer: Hi. Treatment should show remarkable improvement in about 2 weeks in your case. Oral antibiotics bring about rapid improvement. Topical treatment alone is effective too, but take a little longer, may be 3-4 weeks. Protect yourself from sun till the skin gets back to normal, use an umbrella. Your skin would be sensitive to sun. Untreated cases might flare initially as the steroid is withdrawn. The flare may last for 3-4 weeks or longer, depending on how long the potent steroid was used but ultimately the flare settles down gradually in most of the cases. Home remedies are not recommended. regards regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Kakkar S.

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