Brief Answer: Kindly see the suggestions below Detailed Answer: Hi XXXXXXX Welcome and thanks for posting your query to Healthcare magic. I have gone through the pictures sent by you and after thoroughly analyzing the pictures I can make out that you have pimples with pigmentation and marks. I can understand your concern for pimples. It is really bothersome to have something unwanted present on our face. Before I proceed to your issue let me explain you elaborately regarding pimples- Acne or pimples in most of teenage people starts appearing at the age of 13-14 years and then reduces by the age of 25-30 years. The main cause of pimple formation is basically due to hormones (chemicals which are influencing one or other body functions) in addition to the influence of certain other factors causing its aggravation. The hormone plays the most important role in high oil secretion and increase the size of oil glands. As the pores or ducts of the glands are blocked so it leads to formation of pimples. There are certain other factors such as application of oily or creamy products, over exposure to sunlight, heat and humidity or due to pinching, popping and squeezing of the pimples also leads to formation of pimples. Once these are healing they leave the most problematic thing which are either marks or scars. Therefore any of the above factors along with hormones can cause appearance of pimples before the age of 25-30 years. After the age of 25 years there is less upsurge in the hormones and these gets stabilized and therefore less appearance of pimples after 25 years. So probably you got some idea regarding your acne. I can see you are young man of 26 years, so in yours these can be outburst due to change of place and overdoing the efforts. The weather in southern side of India is one very important contributing factor because of high humidity. I can make out that you have done a lot of efforts for getting a clean skin but all gone in waste. If you want to make your skin better kindly do not do over of anything because rather than making better it will make the things worsened. There are certain best of suggestions which you can follow: 1. Do not pinch, pop or squeeze any area on face. 2. Do not apply any creamy or oily stuff or any other cosmetics over face. 3. Try to avoid any home remedies suggested by your friends or family members or otherwise self implicated therapies also. Most of he times any of the home remedies blocks more of the pores and results in more aggravation of pimples. 4. Do not take steam or steam bath or massage on your face as these also aggravates the pimples. 5. Try avoiding situations of direct continuous exposure to sunlight or heat and humidity for long hours. 6. Kindly do not use any antibiotic as self medication. 7. Do not apply any hair oil on scalp or apply in very less amount. Wash your scalp daily with some good shampoo and let there be no dandruff in your scalp (because dandruff itself causes blockage of pores of oil glands and then pimples). For the Acne treatment part - if I were your treating doctor then would prescribed you a combination of Clindamycin with adapalene along with the most important and latest therapy of isotretinoin by mouth for the long term remission. Isotretinoin is though a wonder drug but always to be used under dermatological guidance. For the marks -Skin lightening creams are quite helpful. I general prescribe Kojic acid cream (like Clearz ultra ) or Azelaic acid cream at night time only over the affected area. Apply it in such a thin layer that it should not be visible by naked eye. Do not try to rub it. It is generally diluted with some bland cream to reduce the irritation. So these creams are to be used under dermatological guidance only. Both acne and its marks need proper management as guided above. The acne and marks treatment application can be used on alternate day basis according to dermatological guidance. I suggest you to meet a proper dermatologist rather than consulting one or the other doctor and discuss all the points as suggested above. Hope these informations will help you. If you have any further query I will be happy to help. Regards. Dr Sanjay Kumar Kanodia MD (Dermatology)

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Brief Answer: Kindly see the suggestions below Detailed Answer: Hi XXXXXXX Welcome to the forum again and thanks for your follow up. I really appreciate your feeling and understand your part of problem. Our web site is basically meant to help you out and finding a right track for the problem. I have gone through all the prescriptions sent by you. I understand that till now you have not been able to get the best of treatment. If I were your treating doctor then would have started with Clindamycin with adapalene gel at night time very thinly applied on the pimples only so that it should not be visible to the naked eye. The dose of isotretinoin I would have started with simple 10 mg on daily basis. I would have observed the findings for next 7 days. If the things goes in right direction then would have continued for next 7 days and after that I would liked to start with the other of the lightening agents accordingly. I would have waited for minimum of 4-8 weeks for the proper results. Rest of the suggestions along with do's and don't are as previously. Hope these informations will help you. If you have any further query I will be happy to help. Regards. Dr Sanjay Kumar Kanodia MD (Dermatology) You can discuss these points with your treating doctor to get best relief.

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Brief Answer: First control pimples then pigmentation Detailed Answer: Hello young fellow, Thanks for your follow up. The most important of the aspect of your treatment is to have patience and not jumping over to something. If you can see my part of suggestions then can observe that I basically concerned for acne first rather than pigmentation. Doing so many things together will mess up your condition. So you first start with acne treatment as suggested before. DO not try to use any lightening agent till your acne are controlled. Don't be hasty, try to simplify the the things. You can not receive overnight changes my dear fellow. I know you have used Isotretinoin before but 20 days usage is not adequate. It has to be used for multiple of months under supervision. The effect is observed after 4 weeks of period and then a good maintenance is required. I again suggest you to get control of pimples first and then take the treatment of marks. For the term of marks too- only pea size amount of cream is sufficient to apply on palm size area of skin. SO if you are taking over and above this then will again cause problem of eruptions. Also if you are using all over face then will definitely lead to more eruptions. I always guide my patients to apply any cream on affected areas only and not all over face. Taking oil treatment with steam to hair should be stopped immediately. As it may lead to more eruptions. Hope these informations will help you. If you have any further query I will be happy to help or if you do not then can close the query and rate the answer. Regards. Dr Sanjay Kumar Kanodia MD (Dermatology)

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