Hi!,

Thank you for the query,

Pimples are multi-factorial ,and therefore one has to find the exact cause of it.
It can be because of wrong use of soaps to moisturizers or any fairness creams which one is using , to hormonal disturbances if anybody has.So,a complete work up is necessary in all patients.Also one should remember that its not a short course treatment,but a matter of say 6 months or so if pimples are sever .

As you said that you have rosacea too and you have been using Diprovate -G for that.Now thats the biggest mistake you have done by using diprovate-g ,as it is a steroid cream and can flare up your pimples (in fact topical steroids is a reason for pimples in many cases).And a good dermatologist would never prescribe strong topical steroid for face in case of rosacea.So,I would advise you to please stop diprovate immediately.

The second reason for your pimples can probably be hormonal imbalance since you said acne flares up prior to periods .This can happen even though your hormonal reports are normal.The most important test is a ultrasound of lower abdomen to rule out PCOD(Polycistic ovary disease).If that comes normal then you need not worry about hormones.Also look for other features of hormonal imbalance in body like weight gain,irregular periods,facial hair & scalp hair loss.If you have any of these then get a complete hormonal profile done.In such cases conventional treatment for acne would not work,and one needs to take hormonal tablets to cure acne.

I can understand your urgency for the treatment,but then there is no immediate or fast treatment of acne ,but yes you can reduce it to a great extent.A complete treatment would take at-least couple of months.

Firstly I would advise you to stop all cosmetic creams if you are using on face(in your case especially diprovate).
This would be followed by a good anti acne soap to wash your face.You should also use any good antiacne creams like clindamycin or bezoyl peroxide or nadoxin gel.Since you have rosacea along with ,topical retinoids won't suit you good.Now this a difficult situation ,treating rosacea and acne both together(but not impossible).

Azithromycin is a good antibiotic to treat acne ,but needs to be repeated every 7 days.If you don't respond to this then you can even try clarithromycin tablets.This would be good to give you immediate result(but may not be permanent)

In case you don't have any hormonal imbalance & you don't respond to conventional treatment, then one can take oral retinoids(iso-tretinoin) .Retinoids is a wonderful medicine for acne & for rosacea both,provided one gets all the relevant blood investigations and takes care of all the precautions associated with it.According to the body weight one needs to take it for at-least 6-10 months .The most important precaution in this would be to avoid pregnancy during the course of medicine and 3 months after stopping retinoids.But this is a prescription based medicine and would require proper follow up by the dermatologist to look for any complications.Otherwise oral retinoids is considered as a wonder drug in treating acne.

Rosacea is a condition in which one sees redness of cheeks and nose associated with burning sensation.There can be a history of aggravation on sun exposure, spicy foods ,stress ,lack of sleep, tea ,coffee ,emotional disturbance,overuse of topical steroids(as in your case) etc.
Topical metronidazole cream is a good option in treating rosacea.But one of the latest, is use of tacrolimus cream or pimecrolimus cream topically . This needs to be applied for long.Along with this you should also use a non-oily sunscreen daily.
In my practice I've seen best results with tacrolimus cream.

Last but not the least , LASERS (esp IPL) also works good in resistant cases of rosacea. This works directly on the fine blood vessels and occludes it.It requires multiple session for good results at an interval of approx 1 month

I think that the culprit in your case is diprovate cream ,causing both rosacea and acne.As one uses diprovate cream, in the beginning patient feels that it is helping in rosacea ,but gradually one gets addicted to it and as you leave it actually aggravates both acne and rosacea.

I hope you would understand that there is no instant cure for acne ,but you can try clarithromycin tablet as a short course .Oral retinoids gives magical result in acne but would take at-least 1 month to show its good response. But since retinoid is a prescription based medicine ,I would suggest you to consult a good dermatologist who would investigate your case properly and treat you.

Please also take plenty of water and a good sleep in night ,this would help you re-leave all the stress.

As far as acne scars are concerned ,if you have any pits ,then I would suggest a fractional laser ,but only when you are completely free from your acne.A chemical peel would be a good alternative to begin with right away.

Hope I have answered your query. I will be available for follow up query if any.


Regards,
Dr.Bharat chawda

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Hi,

Thanks for writing back,

Azithromycin can be taken for long in a pulse form i.e. one can repeat the 3 days course after a gap of 7 days interval.This can be done 3-4 times .Clarithromycin is usually give for a short period of 7 days and is used only for acute conditions.

I am afraid I may not be able to treat you or suggest a dose , as it would be unethical and inappropriate to prescribe you any scheduled drugs without doing a proper clinical examination(which can be done only in person).

Under medical laws we doctors are not supposed to suggest any medicine of any kind in the net.We can give only our expert opinions and guide you in course of your treatment.Its just like giving a second opinion.Apart form this, these medicines are prescription based medicines ,so they won't be available as OTC(over the counter).

Nadikam and minoz can be used ,but they are not going to help you much in roasacea and also needs to be taken for long to see the response.

Oral retinoids (isotretinoin) would be best in cases where patient has both rosacea and acne .And as i told you earlier retinoids is a drug which needs lot of precautions and investigations before one takes it.The most important being not to conceive .

If you are married ,then contraceptive devices or use of condom is a must so as not become pregnant during the course of the medicine.Oral retinoids would give you pretty good result in 20 days time ,but needs to be taken long to prevent any recurrence.

Also please consider use of tacrolimus cream for rosacea as I had discussed earlier.

Evion and antioxidants don't have much role to play in your case,so I would rather avoid it.

Since you are already consulting a doctor ,I would suggest you to discuss with him the possibility of retinoids in your case,since that can give you a complete and permanent recovery.And also discuss the hormonal aspect of pimples and get your self diagnosed for that.

My most basic advise would be not to use any moisturizers on face and always prefer using a anti acne soap.A non oily sunscreen is also a must since you have rosacea.

I hope this would help you understand your line of treatment .In case you have any further query ,please write back to us.I'll be happy to answer them.

wish you good health.

Regards,
Dr.Bharat chawda

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Hi,

Thanks again.

Diprovate-g should not be used in any case as its going to aggravate not only pimples but also rosacea.

Tacrolimus is considered as a non-steroidal anti-inflammatory cream. So its going to help you with your rosacea attacks. But you have to use it for long (may be 6 months or so) to have a complete relief. As you said all other creams doesn't suit you (and thats because of use of diprovate cream), you need to apply tacrolimus very gradually i.e. to begin with use it as a short contact therapy, for may be an hour and then wash it off if you get any burning sensation. Gradually increase the time duration. You can use it any time of the day. Also please use a good non-oily sunscreen daily on face. At times rosacea patient complain of aggravation of symptoms on taking tea ,coffee or spicy foods. If you feel so then kindly avoid it.

For acne, you can take azithromycin as a pulse therapy for 4-5 cycles(giving a gap of 7 days every time).

For you superficial scars there are lot of options. Creams might not suit you because of roscaea. One can apply tretinoin cream(0.025%) at night only on the spots. But you have to be very careful using it especially if you are using it for the first time. This cream should be only used on pigmented lesions at night and if one develops any irritation then should be washed off immediately. This cream causes gradual peeling of skin and thus lightens the pigmented spots. It again becomes mandatory to use a good sunscreen in the day time, if one is using tretinoin cream at night.

Chemical peeling is a second good option for spots and improving the complexion, but again there is a risk of aggravation of rosacea. If at all you go for a chemical peel then kindly get it done from a dermatologist only and do discuss your rosacea part with him.

There are no tablets or supplements to improve the complexion, but oral retinoids would have helped in all your condition.

I encourage you to discuss these treatment options with your dermatologist and get them done under their expert guidance.

I hope this would help you in understanding your skin and managing your problem.

Wish you good health.

Regards,

Dr.Bharat chawda

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Hi!,

Thanks for writing back,

Tacrolimus should be used daily whether you have rosacea or not,as its a slow acting cream would take few weeks to act.Its a safe cream and can be used for long.You can apply it over the cheeks where you actually get symptoms. Also use a non-oily sunscreen along with daily.

As far as oral retinoids is concerned ,the following are the important precautions:
1) one should not conceive during the course of medicine and till 3 moths after stopping the drug.
2)No contact lenses till you are on the medicine.
3)If you get headache following the medicine ,the you should stop the medicine .This would mean that it doesn't suit you.
4) No blood donation till you are on the medicine.
5) You should not combine oral retinoids with certain medicines like tetracycline & minocyclin (which are also used in treating acne or rosacea).
6) Oral retinoids are taken after meal,or best with milk .

Since its a medicine which is not only prescription based ,but also a medicine which should be taken under dermatologist supervision .I would advise you to consult a dermatologist before taking it.

Hope I've answered your query and that you recover soon.Should you have additional concerns regarding this issue I would be happy to address them.

Regards,
Dr.Bharat chawda

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