Question: Hello this is a dermatology enquiry. Ideally id be grateful if Dr S Kakkar could respknd but any detmatologist is fine. Thankyou.

I an writing about the management of my facial acne

Background
I am 39, female & severely unwell with chronic fatigue syndrome and bedbound and tube fed. I don't get exercise and due to my care situation suffer a lot of stress, especislly recent which i think has caused flare up.

I have had acne since my teens and still get very oily t - zone and blackheads but my acne was essentially under control with regular (every other day) use of differen (adapalene gel). If I didn't use differin I would get about 3 major nasty hormonal nodular type spots which would scar plus the odd minor zit or two.

However this past 6-8 weeks I seem to have had a new large tender spot come up every week, my pictures show the current and most Recent. I'm finding this distressing and Also difficult to manage. Clearly my current prevention is not enough and i don't know what to do now. I'm treating the areas with zindaclin but only when there around spots, not as preventative. I also struggle with zindaclin gel as I've very sensitive skin and I have caused irritation through using it. I find it difficult to apply enough but thinly.

I don't think my GP would allow me oral antibiotics for this and I don't know what regime I should put in place to prevent new acne. I wash with water in the morning and with a proper cleanser on the evening.

Should I treat the entire chin and jaw daily with zindaclin or clindamycin lotion whovh i could get from my GP?how long for? as I know antibiotics aren't for long use. I've also purchased some benzoyl peroxide which I could switch to along with differin - is it antibacterials that my skin needs now on top of differin to sto
p this ?

I don't know whether my differin has gone off if I've not screwed the lid down 100% each time?

Is topicals going to be enough for my skin now which hasn't been this bad for years? I'm very prone to irritation from topicals. And scarring from acne.

Thanks for your time. XXXXXXX Newnham

Dear S Kakkar

Thanks very much for your reply

Are you then of the opinion that topical antibiotics or BP along with differin is not enough to control my acne anymore?

Thanks for your oral medications recommendations

Can I just ask a couple of questions regarding them in relation to my underlying health problem.

Basically my concern re spironolactone is that it can reduce BP and I often , especially in the mornings can have quite low BP and that's meant in the past when I was for eg put on propanelol for anxiety I had to stop it in hospital as my BP went too low on it. Also does spironolactone cause irregular gynae bleeding?

Secondly the other hormonal treatments you mentioned , do they come with increased risk of thrombosis because again, being totally bed ridden I have been told that drugs such as the estrogen contraceptive pill aren't allowed for me because I'm too ta risk of blood clot.

Thanks for your time. XXXXXXX Newnham