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Suggest Remedy For Acne Lesions On Face
Question: Acne Skin Queery for dermatologist please
Hi
I recently had 2 large acne lesions on my face (consecutively not at the same time). In both cases I treated them with oral antibiotics (flucloxecillin & clarithromycin) and topical differin. They both seemed to go down, although they had come up rather angry/ big initially despite immediately applying topical antibiotics.
(See photos1 & 4)
Anyway neither have ended successfully - the first spot appeared mid december & initially just left a reddish mark but now it has developed 2 new white/ flesh coloured lumps as well. The 2nd does not seem to have gone properly flat & has remained a small red, raised bump of about 1-2mm diameter. (See photos)
Can you please tell me what has happened to the first lesion - is it scarring & will the 2 lumps decline or be treatable? & also with the 2nd lesion (started early January) should i ask for more oral antibiotics- I only had 5 days prescription- to fully kill it? (I'm currently still treating with topical clindamycin lotion & differin cream) Is it still active or is that too some type of scar? I was expecting a red mark but not a residual raised bump.
I've read Salicylic acid is a good exfoliant , would that help if if its a blockage problem? & I also have 2.5% benzoyl peroxide cream I could put on. I don't know how to use/or which products best, to treat it topically now - if thats the best approach.
Photos are as follows -
1st lesion at worst
Scarring from 1st lesion
Other bumps in skin
2nd lesion at worst
& the rest are of residual blemish from 2nd lesion which i don't think is a white head so i'm not sure why its a raised bump.
Many thanks for your help XXXX
Hi
I recently had 2 large acne lesions on my face (consecutively not at the same time). In both cases I treated them with oral antibiotics (flucloxecillin & clarithromycin) and topical differin. They both seemed to go down, although they had come up rather angry/ big initially despite immediately applying topical antibiotics.
(See photos1 & 4)
Anyway neither have ended successfully - the first spot appeared mid december & initially just left a reddish mark but now it has developed 2 new white/ flesh coloured lumps as well. The 2nd does not seem to have gone properly flat & has remained a small red, raised bump of about 1-2mm diameter. (See photos)
Can you please tell me what has happened to the first lesion - is it scarring & will the 2 lumps decline or be treatable? & also with the 2nd lesion (started early January) should i ask for more oral antibiotics- I only had 5 days prescription- to fully kill it? (I'm currently still treating with topical clindamycin lotion & differin cream) Is it still active or is that too some type of scar? I was expecting a red mark but not a residual raised bump.
I've read Salicylic acid is a good exfoliant , would that help if if its a blockage problem? & I also have 2.5% benzoyl peroxide cream I could put on. I don't know how to use/or which products best, to treat it topically now - if thats the best approach.
Photos are as follows -
1st lesion at worst
Scarring from 1st lesion
Other bumps in skin
2nd lesion at worst
& the rest are of residual blemish from 2nd lesion which i don't think is a white head so i'm not sure why its a raised bump.
Many thanks for your help XXXX
Brief Answer:
Topical clindamycin/ benzoyl peroxide+ Topical adapalene+Oral Antibiotics
Detailed Answer:
Hello. Welcome again and thank you for writing to us at healthcaremagic
I have answered one of your previous queries too so Hello again!! I remember last time you consulted your concern was the 2nd acne lesion you are referring to in this query (on right side).
To recapitulate:
At that time I had suggested you to use clindamycin lotion during day time (once or twice) and adapalene gel at night.
I also asked you to take an Oral antibiotic e.g Azithromycin for 5 days.
Recent images show that the 2nd lesion on right side has gone down considerably but still is a small, raised red lesion on right side. This is because it is not completely resolved as yet.
Therefore I suggest you to continue with adapalene gel during night and clindamycin lotion during day. It would gradually go away.
Regarding the new lesions which have developed besides the first lesion, I will suggest you to treat these similarly as well i.e topical clindamycin lotion and topical adapalene gel.
You may definitely use benzoyl peroxide instead of clindamycin lotion. Use it as a thin film only as a spot treatment for acne.
Benzoyl peroxide would be more effective but certainly it will be more irritating as compared to clindamycin.
Acne is recurrent and chronic, therefore new lesions may crop up while old ones are healing.
Therefore, it is desirable to use a topical treatment that not only cures existing lesions but also prevents new eruptions.
This is exactly the role of adapalene gel, a topical retinoid.
Adapalene is comedolytic and therefore not only treats existing lesions but also prevents new lesions due to its comedolytic properties.
The point I want to stress here is that rather than using adapalene just over the acne lesions you should use adapalene over the whole affected area i.e area which is prone to develop acne so that it prevents new lesions from forming e.g all of cheeks.
Since you have a history of inflammatory acne lesions i.e red, painful and pustular, as can be seen from the Images and also referring from your previous query answered by me, therefore I would also suggest a course of an Oral antibiotics e.g one of either doxycycline, azithromycin Or clarithromycin for a longer duration e.g 4-6 weeks, rather than just 5 days.
To summarize:
-Either Clindamycin lotion or benzoyl peroxide, only as a spot treatment over active acne lesions.
-Adapalene gel over all of acne affected area i.e both cheeks.
-Oral antibiotics for 4-6 weeks.
Regards
Topical clindamycin/ benzoyl peroxide+ Topical adapalene+Oral Antibiotics
Detailed Answer:
Hello. Welcome again and thank you for writing to us at healthcaremagic
I have answered one of your previous queries too so Hello again!! I remember last time you consulted your concern was the 2nd acne lesion you are referring to in this query (on right side).
To recapitulate:
At that time I had suggested you to use clindamycin lotion during day time (once or twice) and adapalene gel at night.
I also asked you to take an Oral antibiotic e.g Azithromycin for 5 days.
Recent images show that the 2nd lesion on right side has gone down considerably but still is a small, raised red lesion on right side. This is because it is not completely resolved as yet.
Therefore I suggest you to continue with adapalene gel during night and clindamycin lotion during day. It would gradually go away.
Regarding the new lesions which have developed besides the first lesion, I will suggest you to treat these similarly as well i.e topical clindamycin lotion and topical adapalene gel.
You may definitely use benzoyl peroxide instead of clindamycin lotion. Use it as a thin film only as a spot treatment for acne.
Benzoyl peroxide would be more effective but certainly it will be more irritating as compared to clindamycin.
Acne is recurrent and chronic, therefore new lesions may crop up while old ones are healing.
Therefore, it is desirable to use a topical treatment that not only cures existing lesions but also prevents new eruptions.
This is exactly the role of adapalene gel, a topical retinoid.
Adapalene is comedolytic and therefore not only treats existing lesions but also prevents new lesions due to its comedolytic properties.
The point I want to stress here is that rather than using adapalene just over the acne lesions you should use adapalene over the whole affected area i.e area which is prone to develop acne so that it prevents new lesions from forming e.g all of cheeks.
Since you have a history of inflammatory acne lesions i.e red, painful and pustular, as can be seen from the Images and also referring from your previous query answered by me, therefore I would also suggest a course of an Oral antibiotics e.g one of either doxycycline, azithromycin Or clarithromycin for a longer duration e.g 4-6 weeks, rather than just 5 days.
To summarize:
-Either Clindamycin lotion or benzoyl peroxide, only as a spot treatment over active acne lesions.
-Adapalene gel over all of acne affected area i.e both cheeks.
-Oral antibiotics for 4-6 weeks.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello again. Thanks for your reply & nice to talk with you again.
Thanks very much for your information & detailed usage advice.
Could you just add comment on whether adding an exfoliant Eg Salicylic acid into the mix would be a good idea or is that not necessary if using adapalene? I know you've very kindly advised a regime but I had recently read online regarding the benefit & importance of exfoliating which is why I bought some BHA prior to writing to you & was trying a routine of -
day 1 - Salicylic acid morn, Benzoyle peroxide night.
Day 2 clindamycin lotion day, adapalene night.
& Cycled that.
Is that too bitty and I should just not bother with Salicylic acid? Is it important to take adapalene every day? I have only been using adapalene every other night as I felt it quite strong, even in a cream - I guess adapalene & Salicylic acid all on one day would be too much of one type of thing & not a good idea if trying to get an anti bacterial in as well.
Is 2.5% benzoyl peroxide an adequate dose? I found it interesting its more effective than clindamycin so i will definitely try that as its not felt irritating so far.
You recommended a longer course of Antibiotics - I admit I found 5 days short- was that to have now, or how to proceed with antibiotic therapy if i get a breakout another time? I just wanted to say a couple of points relevant to that (the 2nd one also include unrelated questions) & then ask my question on that ...
1) I don't often get big pus, inflamed spots - I had a lingering one September & 2 in April, so With the most recent of last year, that's the sum the year.
I am now applying topicals as treatment & preventatively.
Before , i'm chronically severely ill & bedbound, I never followed proper acne prevention as felt it too arduous, so maybe that explains the recurrent clusters.
2) regarding the new 2 small bumps on the first lesion area, *I thought that that might be some type of skin damage rather than fresh acne? - They are not sore or red or pus filled & from my experience in the past, lumps seem to be permanent. *I was reading about keratosis or perifollicular elastolysis & wondered if it might be that or hypertrophic scarring?
Back to the requiring of a longer oral anbiotics course now, do you still think, with what i've added above it is necessary? I'm happy to ask for that, i just wanted to make sure with all their background known it still was. Is that to get things thoroughly & long lastingly cleared?
*I hope that i can now stay clearer, but If in 6 months I got another serious lesion which warranted oral Antibiotics would it be wise to take that course longer than 5 days, even if at the time it was one spot?
Thanks so much for your time & help. XXXX
Thanks very much for your information & detailed usage advice.
Could you just add comment on whether adding an exfoliant Eg Salicylic acid into the mix would be a good idea or is that not necessary if using adapalene? I know you've very kindly advised a regime but I had recently read online regarding the benefit & importance of exfoliating which is why I bought some BHA prior to writing to you & was trying a routine of -
day 1 - Salicylic acid morn, Benzoyle peroxide night.
Day 2 clindamycin lotion day, adapalene night.
& Cycled that.
Is that too bitty and I should just not bother with Salicylic acid? Is it important to take adapalene every day? I have only been using adapalene every other night as I felt it quite strong, even in a cream - I guess adapalene & Salicylic acid all on one day would be too much of one type of thing & not a good idea if trying to get an anti bacterial in as well.
Is 2.5% benzoyl peroxide an adequate dose? I found it interesting its more effective than clindamycin so i will definitely try that as its not felt irritating so far.
You recommended a longer course of Antibiotics - I admit I found 5 days short- was that to have now, or how to proceed with antibiotic therapy if i get a breakout another time? I just wanted to say a couple of points relevant to that (the 2nd one also include unrelated questions) & then ask my question on that ...
1) I don't often get big pus, inflamed spots - I had a lingering one September & 2 in April, so With the most recent of last year, that's the sum the year.
I am now applying topicals as treatment & preventatively.
Before , i'm chronically severely ill & bedbound, I never followed proper acne prevention as felt it too arduous, so maybe that explains the recurrent clusters.
2) regarding the new 2 small bumps on the first lesion area, *I thought that that might be some type of skin damage rather than fresh acne? - They are not sore or red or pus filled & from my experience in the past, lumps seem to be permanent. *I was reading about keratosis or perifollicular elastolysis & wondered if it might be that or hypertrophic scarring?
Back to the requiring of a longer oral anbiotics course now, do you still think, with what i've added above it is necessary? I'm happy to ask for that, i just wanted to make sure with all their background known it still was. Is that to get things thoroughly & long lastingly cleared?
*I hope that i can now stay clearer, but If in 6 months I got another serious lesion which warranted oral Antibiotics would it be wise to take that course longer than 5 days, even if at the time it was one spot?
Thanks so much for your time & help. XXXX
Brief Answer:
I suggest you to continue with adapalene along with clinda/benzoyl peroxide
Detailed Answer:
Hi.
It would not be such a good idea to add salicylic acid while you are using adapalene because adapalene would make the skin sensitive and using salicylic acid would be too harsh and might cause irritation.
Salicylic acid is a good antiacne product, though. It is exfoliant as well as comedolytic. However, it is usually recommended to leave a gap of at least 7 days between stopping adapalene and starting salicylic acid.
Adapalene is an excellent comedolytic and you may choose between either adapalene or salicylic acid but never together.
Moreover, even salicylic acid and benzoyl peroxide can be too irritating.
I would suggest you to maintain it simple.
You may use either adapalene along with clindamycin/ benzoyl peroxide Or you may use saliyclic acid along with clindamycin lotion.
In both these regimes, there is a comedolytic agent (either salicylic acid or adapalene and an antiacne antibacterial i.e either clindamycin Or benzoyl peroxide).
Oral antibiotics are only advisable only if you keep having inflammatory eruptions, not otherwise.
It is better to take oral antibiotics for a longer period in acne, say e.g 4-6 weeks rather than for a short period of 5 days because the mechanism of action of Oral antibiotics in acne is anti-inflammatory rather than as an antibacterial/ antibiotic.
It may be necessary to take repeat course of Oral antibiotics because acne is recurrent.
Though maintaining the improvement with alternate day topical adapalene may prevent new acne lesions because of comedolytic action.
Since you have just one or two red lesions that linger on, therefore, it would be worth take an oral antibiotic for these type of lesions for better control of acne activity along with topical antiacne remedies.
Just 1 or 2 inflammatory lesions may not be too much of an indication for Oral antibiotics Or something which cannot be argued against but the option can be weighed, if these acne lesions are affecting patient psychologically and because inflammatory lesions/ bigger lesions, are certainly prone to atrophic scaring (depressed below skin surface).
Adapalene can even reverse mild scaring because of collagen remodelling property.
Regarding the bumps that you noticed around the first lesion, they are most likely to be deep comedones/ white heads rather than elastolysis or hypertrophic scar.
I suggest you to continue using adapalene over here.
Regards
I suggest you to continue with adapalene along with clinda/benzoyl peroxide
Detailed Answer:
Hi.
It would not be such a good idea to add salicylic acid while you are using adapalene because adapalene would make the skin sensitive and using salicylic acid would be too harsh and might cause irritation.
Salicylic acid is a good antiacne product, though. It is exfoliant as well as comedolytic. However, it is usually recommended to leave a gap of at least 7 days between stopping adapalene and starting salicylic acid.
Adapalene is an excellent comedolytic and you may choose between either adapalene or salicylic acid but never together.
Moreover, even salicylic acid and benzoyl peroxide can be too irritating.
I would suggest you to maintain it simple.
You may use either adapalene along with clindamycin/ benzoyl peroxide Or you may use saliyclic acid along with clindamycin lotion.
In both these regimes, there is a comedolytic agent (either salicylic acid or adapalene and an antiacne antibacterial i.e either clindamycin Or benzoyl peroxide).
Oral antibiotics are only advisable only if you keep having inflammatory eruptions, not otherwise.
It is better to take oral antibiotics for a longer period in acne, say e.g 4-6 weeks rather than for a short period of 5 days because the mechanism of action of Oral antibiotics in acne is anti-inflammatory rather than as an antibacterial/ antibiotic.
It may be necessary to take repeat course of Oral antibiotics because acne is recurrent.
Though maintaining the improvement with alternate day topical adapalene may prevent new acne lesions because of comedolytic action.
Since you have just one or two red lesions that linger on, therefore, it would be worth take an oral antibiotic for these type of lesions for better control of acne activity along with topical antiacne remedies.
Just 1 or 2 inflammatory lesions may not be too much of an indication for Oral antibiotics Or something which cannot be argued against but the option can be weighed, if these acne lesions are affecting patient psychologically and because inflammatory lesions/ bigger lesions, are certainly prone to atrophic scaring (depressed below skin surface).
Adapalene can even reverse mild scaring because of collagen remodelling property.
Regarding the bumps that you noticed around the first lesion, they are most likely to be deep comedones/ white heads rather than elastolysis or hypertrophic scar.
I suggest you to continue using adapalene over here.
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
Answered by
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