Brief Answer:
it could be closed comdones

Detailed Answer:
Hi
Thanks for writing to us.
From the description provided, it could be closed comedones or white heads. These simply appear as tiny bumps and become more apparent in stretching the skin.
Other possibility could be milia, molluscum,plane warts etc
The best treatment for these is electrocautery of lesions. Zinc and vit E wont help
I would like to see the lesions to confirm the diagnosis and discuss the treatment elaborately. For the same please attach an image depicting these lesions.
Waiting to hear from you soon
Take care

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Brief Answer:
these are closed comedones only

Detailed Answer:
Hi,
Thanks for writing back.
I have seen the images attached. These look like closed comedones only. The best and most definite treatment option would be to get the lesions cauterised by RF cautery. Cautery basically burns the lesion superficially, so after few days at the cauterised area scab formation will occur that will fall off spontaneously. Later on you may apply differin gel( adapalene gel) to prevent the lesions from occuring further.

Adapalene as such can be used for closed comedones but response is delayed and might not be as good as cautery. But yes you may definitely use it to see, how much response you get. Apply it atleast for two weeks. If respose is not good, then go with cautery

Hope this helped.
Take care

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Brief Answer:
Submarine comedones are type of close comedones

Detailed Answer:
Hi,
Thanks for writing back.
Submarine comedones are type of closed comedones only.
Cautery would give definite results without any scarring or marks if done superficially
Scab formation usually lasts for a week and then falls off spontaneously
You can get cautery done after 2 months of stopping isotretinoin.
Adapalene gel has an irritant potential like benzoyl peroxide and can make skin red, itchy, flaky.So it should not be applied liberally. Apply a small minimal quantity once in night.

Hope this helped.
Take care

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Brief Answer:
submarine comedones are treatable . MDA wont help

Detailed Answer:
Hi XXXXX,
I shall try to explain it in detail and simple language.
Comedones are formed when the pilosebaceous follicle( oil gland) is plugged by shedding of cells( keratinocytes). Sometimes the opening is big and these plugged material can be seen( open comedones/ blackheads) and when the opening is too small to show the retained plug it is known as closed comedone or whitehead.

Now submarine comedone is a type of closed comedone. It is a big( more than 5 mm therefore also known as macrocomedone) and deep closed comedone with high chances of getting inflammed and may lead to formation of recurrent pimples in that area. Isotretinoin therapy as such works in all stages of acne but closed comedones can lead to failure of isotretinoin therapy and may infact flare up.

As far as tendency to have comedones or acne is concerned it is mainly governed by seborrhea( oily skin), hormones( androgen) and increased tendency to have shedding of cells( ductal hyperproliferation). So in simpler terms, one might be having a tendency to get acne. External causes could be use of greasy cosmetics, topical steroid creams, diet esp dairy products, facial massages etc

Microdermabrasion wont work for comedones. Submarine comedone can only be treated by cautery.
Personally in my clinical practice, I cauterise the comedones first and drain any pustular lesions present on my patient's first visit. Later on I put the patients on antibiotics and isotretinoin as per patient's requirement. Believe me i have received wonderful response with this treatment protocol.

So my advise to you would be to get the lesions cauterised.

Hope this helped.
Take care

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Brief Answer:
get it cauterised from dermatologist

Detailed Answer:
Hi XXXXX,
Thanks for writing back.
I would always advise that you should get the lesions cauterised from dermatologist as we have been trained for the same. Getting it done from a doctor would also prevent its further recurrence and any untoward side effect like scarring, pigmentation etc.
As such after cautery, these would not recur. But sometimes few sessions of cautery might be required to treat it. But generally, a single session of cautery is enough to treat these lesions.
Also to prevent recurrence, please use adapalene gel once in night over your comedone as well as acne prone areas for a month or two.


Cetaphil face wash is a good face wash. So you may continue using the same. Use any mild water based moisturiser. Neutrogena and clinique has wonderful moisturisers for acne prone skin.

Hope this helped.
Take care

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Brief Answer:
Apply adapalene/ differin

Detailed Answer:
Hi,
Thanks for writing to us.
Differin won't flare up acne or make it inflammed. Such flare ups are more common with oral isotretinoin. If you can't get cautery done, apply Differin gel over affected area in night. It might help but response would be slow and delayed. But as getting cautery done from a dermatologist might take time due to appointment hassles, so it is better to use adapalene gel in night. After all something is better than nothing.
Hope this helped.
Take care

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Brief Answer:
apply adapalene till the lesions are cauterised

Detailed Answer:
Hi XXXXX,
As advised start applying adapalene gel.
I am quite sure these are closed comedones and moreover you have got the lesions biopsied confirming my diagnosis.
See these are benign lesions, so do not worry about them. Whenever you get an appointment with your dermatologist, get these cauterised.
I do not think you need a second opinion. Your previous doctor had diagnosed it correctly, so please remain under his/her consultation.

Hope this helped.
Take care

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Brief Answer:
It can be done in single session

Detailed Answer:
Hi,
Thanks for writing back.
Cautery can be done in single session. But the decision to do it in single or multiple session depends upon the doctor and patient
No bandaging of area is required after cautery. The lesions are superficially burnt which later on scab and shed off.

Taking vitamin c, E and zinc won't provide any added benefit, so not required.
Hope this helped.
Take care

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Brief Answer:
Cautery won't leave scars

Detailed Answer:
Hi,
Thanks for writing to us.
One the lesion is cauterised, it is slightly burnt. For few hours surrounding area might look mildly red but the redness subsides on the same day. The burnt lesions then scab and heal in a week without scarring, we do cautery over face very commonly. a dermatologist has the expertise to do it with precision without causing any scars.
For your face you may use cetaphil, neutrogena, Clinique or sebamed moisturiser. You can buy any of these depending on availability in your area of residence.
Hope this helped.
Take care

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