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Suggest Treatment For Acne Spot Under Chin And Big Red Lump In Skin
Question: Dear Dr
My question is regarding another hormonal single acne spot under my chin. It has been there 4 weeks now & whilst less angry than at the start its very stubborn & is not very responsive to the treatments I have tried so far.
WEEK 1
At the beginning it came up quite a big, red, lump in skin, very tender to touch or wash and topicals didn't feel like they were doing enough - so after 3 days wait (it was weekend so no ability to get meds IN the UK) I asked my GP for a prescription of oral antibiotics. She gave me 5 days clarithromycin but this time it really didn't do anything (I have had it twice before - 5 days each - in the past few months for acne lesions) During that time i just applied differin every other day also.
WEEK 2
When Antibiotics ended It hadn't responded much & I foolishly, rather than contacting my GP, went back to topicals thinking that they'd seemed to be more effective, so that was daily use of both zindaclin gel & differin cream
WEEK 3
It was still tender to wash it etc & not cleared up much at all (I guess if it was tender it was likely a deeper infection so topicals weren't going to touCh it) . So after week 2 of topical, I asked my GP for more oral Antibiotics as i was worried about scarring.
Dr said that she had only given me 250 mg clarithromycin before which might not have been enough because of my size, & therefore prescribed 500 mg clarithromycin which I took 6 days. It once again Seemed to be doing not much until the 6 the day when it really seemed to lessen in anger, size and tenderness. On this day my Gp visited & told me the spot was too small to justify taking more Antibiotics for and that I should stop. I wasn't keen on stopping as it had only just started to subside much and for me, as soon as treatment subsides they tend to reflare. But I stopped and went back to topicals.
WEEK 4
Unfortunately, a week on Topicals alone, it still feels a tender red lump in the skin and feels like its swelling up again a bit and I do not know how to beat it. My skin became sensitive to differin so I have mainly been using benzoyl peroxide or zindaclin gel daily.
I wouldn't care about its persistance except I know long term inflammation is bad for the skin and I have a history of acne damage/scarring.
Could you please advise - should I ask for a different oral antibiotic(maybe clarithromycin wasn't able to work this time?) Should I take the other 2 bottles of high strength clarithromycin I have in my fridge still? (Maybe if I'd continued beyond 6 days it would have defeated it?) Or should I just use twice daily topicals again / nothing i'm applying seems to be doing much.
Thanks very much for your time.
XXXXXXX Newnham
Other info - 4th large spot in 3 months. Often hormonal/period.
Preventative treatments I now use are BP & differin alternate days & ibuprofen premenstrual, but this spot is possibly in an area sometimes missed by by sloppy topical applications
I have very severe CFS so am bedbound. I am therefore not on any hormonal therapy such as dianette to control my skin because of the thrombosis risk. I do not take any hormonal treatment or use oral contraceptives.
For previous spots my Dr prescribed clarithromycin 5 day only prescriptions also. GP doesn't take much skin maintenance interest.
My question is regarding another hormonal single acne spot under my chin. It has been there 4 weeks now & whilst less angry than at the start its very stubborn & is not very responsive to the treatments I have tried so far.
WEEK 1
At the beginning it came up quite a big, red, lump in skin, very tender to touch or wash and topicals didn't feel like they were doing enough - so after 3 days wait (it was weekend so no ability to get meds IN the UK) I asked my GP for a prescription of oral antibiotics. She gave me 5 days clarithromycin but this time it really didn't do anything (I have had it twice before - 5 days each - in the past few months for acne lesions) During that time i just applied differin every other day also.
WEEK 2
When Antibiotics ended It hadn't responded much & I foolishly, rather than contacting my GP, went back to topicals thinking that they'd seemed to be more effective, so that was daily use of both zindaclin gel & differin cream
WEEK 3
It was still tender to wash it etc & not cleared up much at all (I guess if it was tender it was likely a deeper infection so topicals weren't going to touCh it) . So after week 2 of topical, I asked my GP for more oral Antibiotics as i was worried about scarring.
Dr said that she had only given me 250 mg clarithromycin before which might not have been enough because of my size, & therefore prescribed 500 mg clarithromycin which I took 6 days. It once again Seemed to be doing not much until the 6 the day when it really seemed to lessen in anger, size and tenderness. On this day my Gp visited & told me the spot was too small to justify taking more Antibiotics for and that I should stop. I wasn't keen on stopping as it had only just started to subside much and for me, as soon as treatment subsides they tend to reflare. But I stopped and went back to topicals.
WEEK 4
Unfortunately, a week on Topicals alone, it still feels a tender red lump in the skin and feels like its swelling up again a bit and I do not know how to beat it. My skin became sensitive to differin so I have mainly been using benzoyl peroxide or zindaclin gel daily.
I wouldn't care about its persistance except I know long term inflammation is bad for the skin and I have a history of acne damage/scarring.
Could you please advise - should I ask for a different oral antibiotic(maybe clarithromycin wasn't able to work this time?) Should I take the other 2 bottles of high strength clarithromycin I have in my fridge still? (Maybe if I'd continued beyond 6 days it would have defeated it?) Or should I just use twice daily topicals again / nothing i'm applying seems to be doing much.
Thanks very much for your time.
XXXXXXX Newnham
Other info - 4th large spot in 3 months. Often hormonal/period.
Preventative treatments I now use are BP & differin alternate days & ibuprofen premenstrual, but this spot is possibly in an area sometimes missed by by sloppy topical applications
I have very severe CFS so am bedbound. I am therefore not on any hormonal therapy such as dianette to control my skin because of the thrombosis risk. I do not take any hormonal treatment or use oral contraceptives.
For previous spots my Dr prescribed clarithromycin 5 day only prescriptions also. GP doesn't take much skin maintenance interest.
Brief Answer:
Oral antibiotics for 2 weeks along with topical antibiotics
Detailed Answer:
Hello. Welcome back and thank you for writing to us.
Most likely it is a deeper acne nodule or cyst. This type of acne lesion can persist for weeks.
The best way to treat a single acne nodule or cyst is by Intralesional injection of Triamcinolone acetonide.
It comes as an injection of 10 mg/ ml. I usually dilute it (1:4) with sterile water and inject a small amount of it (0.05 to 0.1 ml) directly into the acne nodule or cyst.
This usually flattens an acne cyst or nodule within 36-48 hours.
This procedure would however be done only by a dermatologist at his office and therefore might not be an option.
Another option to deal with it is to restart with Oral antibiotics.
Oral antibiotics in acne may be required for longer duration instead of usual 5-7 day course of an oral antibiotic.
They can be continued for 4- 12 weeks! if required.
Therefore, you may restart with clarithromycin once a day, and take it for another 2 weeks along with topical clindamycin and/ or topical benzoyl peroxide gel.
Regards
Oral antibiotics for 2 weeks along with topical antibiotics
Detailed Answer:
Hello. Welcome back and thank you for writing to us.
Most likely it is a deeper acne nodule or cyst. This type of acne lesion can persist for weeks.
The best way to treat a single acne nodule or cyst is by Intralesional injection of Triamcinolone acetonide.
It comes as an injection of 10 mg/ ml. I usually dilute it (1:4) with sterile water and inject a small amount of it (0.05 to 0.1 ml) directly into the acne nodule or cyst.
This usually flattens an acne cyst or nodule within 36-48 hours.
This procedure would however be done only by a dermatologist at his office and therefore might not be an option.
Another option to deal with it is to restart with Oral antibiotics.
Oral antibiotics in acne may be required for longer duration instead of usual 5-7 day course of an oral antibiotic.
They can be continued for 4- 12 weeks! if required.
Therefore, you may restart with clarithromycin once a day, and take it for another 2 weeks along with topical clindamycin and/ or topical benzoyl peroxide gel.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello agajn,
Thanks very much for your reply. I used the web for my 1st post so i couldnt see how to attach pictures but back on the app i can, so i have just posted some so you can see what the spot looked like and how its progressed. Hope thats ok. It does feel a deeper spot but its surface size isnt that big now, but persistant. Perhaps you could kindly tell me then, on seeing the pictures, if the above still applies exactly the same. Sorry for not doing it at the beginning.
with regards XXXXXXX
Thanks very much for your reply. I used the web for my 1st post so i couldnt see how to attach pictures but back on the app i can, so i have just posted some so you can see what the spot looked like and how its progressed. Hope thats ok. It does feel a deeper spot but its surface size isnt that big now, but persistant. Perhaps you could kindly tell me then, on seeing the pictures, if the above still applies exactly the same. Sorry for not doing it at the beginning.
with regards XXXXXXX
Brief Answer:
Oral and topical antibiotics
Detailed Answer:
Hi XXXXXXX
I have reviewed the Images.
It is an acne nodule/ cyst. Though the lesion seems to have gone down considerably in the later pictures as compared to what it seemed in the earlier ones.
I would still suggest oral antibiotics and topical benzoyl peroxide gel twice daily for a 2 week period.
Though looking at what it appears now I would'nt have injected it with intralesional triamcinolone acetonide.
Regards
Oral and topical antibiotics
Detailed Answer:
Hi XXXXXXX
I have reviewed the Images.
It is an acne nodule/ cyst. Though the lesion seems to have gone down considerably in the later pictures as compared to what it seemed in the earlier ones.
I would still suggest oral antibiotics and topical benzoyl peroxide gel twice daily for a 2 week period.
Though looking at what it appears now I would'nt have injected it with intralesional triamcinolone acetonide.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Mant thanks for your time. Thats really helpful.
Could i just clarify, ith regards to your recommendation regarding resuming clarithromycin Antibiotics. Originally I had 250 mg twice per day , the 2nd time it was upped to 500 mg twice/day. Which dosage should I take & should I take them once or twice /day
. Many thanksw
Could i just clarify, ith regards to your recommendation regarding resuming clarithromycin Antibiotics. Originally I had 250 mg twice per day , the 2nd time it was upped to 500 mg twice/day. Which dosage should I take & should I take them once or twice /day
. Many thanksw
Brief Answer:
Oral and topical antibiotics
Detailed Answer:
Hi
As this is a resolving acne lesion, I would suggest you to take a lower strength of oral antibiotic just once daily for 2 weeks and that would be enough along with topical benzoyl peroxide gel, twice daily.
Oral antibiotics at lower doses are as effective as higher doses in acne because even at submicrobial doses oral antibiotics exert antiinflammatory effect and that is there main mechanism of action in acne.
The goal of treatment in acne is to maintain this antiinflammatory action for a longer duration i.e 2 weeks or even more.
Regards
Oral and topical antibiotics
Detailed Answer:
Hi
As this is a resolving acne lesion, I would suggest you to take a lower strength of oral antibiotic just once daily for 2 weeks and that would be enough along with topical benzoyl peroxide gel, twice daily.
Oral antibiotics at lower doses are as effective as higher doses in acne because even at submicrobial doses oral antibiotics exert antiinflammatory effect and that is there main mechanism of action in acne.
The goal of treatment in acne is to maintain this antiinflammatory action for a longer duration i.e 2 weeks or even more.
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
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