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Suggest Treatment For Cystic Acne

Posted on Wed, 19 Feb 2014

Question: Respected sir/ma'am I am a 29 year old woman, staying in bangalore. Weather here is moderate throughout the year. Of late i am suffering from cystic acne.....they appear one by one on my face and are hard ,red, painful and without a face. By the time one heals the other starts appearing. At a time i have maximun 3 cystic acne on my face and their fav spot is my nose,chin and cheeks. they leave scars after they are gone. When they develop they are hard , painful, below the skin surface but as they progress they sometimes form puss in them and if i accidentally rub my face with towel too hard they bleed. The ones on my nose take about a month to disappear. I have been having and ignoring them for past one year or so.I always had a pimple prone skin but cystic pimples are new to me....earlier i used to have normal ...on the surface pimples that go away easily. I donot suffer from dandruff and eat oily food only once in a while and i'm about 5'4" tall and weigh 67 kgs. I exercise moderately like walking. I have a zero stress job and life in general and i get a good 8 hour sleep everynight. I dont get exposed to dust/sun much during the weekdays. I go out shopping etc only on weekends that too for not very long. My water intake is not very good though....just about 4-5 glasses a day. SKIN CONDITION AND PRODUCTS I USE : My skin is more on the normal side but tends to get a little oily. I use Ponds face wash,neutrogena moisturizer during the day and ponds anti ageing night cream and Lotus herbals spf 40 pa+++ sunblock only when i go out in the sun. The only Medication I'm using for these pimples is Retino A. 0.025%. spot application each night which i feel is not helping at all. I am trying to get pregnant And i have a normal menstrual cycle. i am a little apprehensive about using just any product and need advice on safe products. The medication I'm having : My tsh levels are a little high and i take 25mcg thyronorm and Folic acid 5mg daily. My questions are 1. What are the topical treatments i can use safely since I'm trying to conceive. 2. Any oral medication that you recommend? 3. Is tea tree oil beneficial for cystic acne? Do u recommend using sking toner? if yes which one? 4. Any life style changes that i need to make? 5. Any skin moisturiser for acne control that you recommend? 6. What is best sun block for my skin type.? 7. What causes cystic acne? 8. What should be an ideal skin care regime for my skin condition? 9. What can i do to break this cycle forever.....as by the time one pimple heals up the other appears. Please help ..... These cystic acne are troubling me a lot. Thank you doctor.

Answered by Dr. Johny Chacko (1 hour later)

Brief Answer: Cystic acne Detailed Answer: Hello, Welcome to healthcare magic, 1. You can use clindamycin gel in the morning and a combination of Adapalene and benzoyl peroxide (epiduo gel ) in the evening for two hours. Epiduo can be stopped once you get pregnant that is when you miss a period and urine pregnancy test is positive. 2. You can take azithromycin 500 mg once a day on three consecutive days a week safely. 3. Yes, tea tree oil is beneficial. You may use body shop's tea tree oil toner once a day after washing your face. 4. Drink plenty of water, 2 to 3 litres per day.Diet is important. Avoid milk and milk products like cheese, chocolates, sweets, sugary foods and drinks. Eat a lot of fruits rich in vitamin A 5.Avoid moisturisers as much as possible, a gel based is better for acne prone skin eg: L'oreal hydrafresh aqua essence. Moisturisers won't control acne. 6. Gel based sun block will be better for acne prone skin type. Eg: Suncote gel or Suncros aquagel. 7. Acne is a disorder of sebaceous gland and is influenced by androgens. Cystic acne is a severe type and we cannot predict who develops it. 8. Ideal skin care regime is to follow the above. 9. We can only control the pimples. After a particular age it stops by itself. Till then keep it under check by the above measures. Hope this helped, Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Johny Chacko (24 minutes later)

respected doctor 1. azithromycin should be taken for how many weeks? is 3 tablet course for only one week sufficient? By consecutive, do u mean three days straight? like M,T,W. 2. do you recommend any face wash /soap for cystic acne? 3. can clindamycin and adapalene still be continued in case i test positive for pregnancy? 4. what strengh of each shoud be used in my case Clindamycin adapelene benzoyl peroxide 5. Is retino A harmful if one is pregnant? is it of any use at all in my case? 6. What anti ageing night cream do you suggest in my condition? 7. Neutrogena products claim to be non comedogenic . Are they good enough? 8. I read about salicylic acid benefits . Is there any medicinal face cream/gel that has salicylic acid? 9. Is fullers earth pack helpful? 10. How many times a day should i wash my face? 11. What SPF factor is ideal for bangalore weather? Considering i'm kashmir origin with a very light skin. 12. Is application of vit a and e helpful? if yes in what forms are they available? Can you recommend the specific products? 13. Can vit a and vit e if taken orally be any help in controlling cystic acne? If yes....what is the recommended dose? 14. What measures should one take for avoiding wrinkles? only the use of anti aging creams enough? Thanks a lot doctor. Your reply has been helpful.

Answered by Dr. Johny Chacko (5 hours later)

Brief Answer: Clarifications Detailed Answer: Hello XXXXXXX Welcome back. 1. Tablet Azithromycin 500 mg should be taken half an hour before food, once in a day on three consecutive days like Monday, Tuesday and Wednesday. This should be continued till the cystic acne improves. Atleast for 1 to 2 months. 2. You can use a salicylic acid containing face wash twice a day(Eg: Speelac face wash). Soaps are alkaline and better avoided. 3. Adapalene should be stopped if you get pregnant. Clindamycin gel can be continued. 4. Clindamycin 1 % gel. Epiduo gel is a combination of adapalene 0.1 % and benzoyl peroxide 2.5%. Apply it in the evening over pimple prone areas and wash it off with plain water after 2 hours. 5. Retino A is harmful if one is pregnant and is contraindicated in pregnancy. It is a treatment for acne but in certain people certain products do not work so well. 6. I will recommend you not to use any creams on your face. Creams will clog pores and will make acne worse. You may use vitamin C serum at night before going to sleep (Eg: Antox Vitamin C serum- XXXXXXX product). Serums and gels are better. 7. Water based moisturisers are better than cream even if it is Neutrogena's. 8. Salicylic acid is beneficial and the face wash I recommended will suffice. 9. Fuller's earth pack will absorb excess oiliness and is beneficial. My personal opinion is not to go for too many products. Go slow. 10. Twice a day Morning and Night with the the face wash. You may wash with plain water another two times a day. 11. Spf 26 is good enough, but a gel based one. Not lotus as it is thick and creamy. Higher the spf usually thicker the sunscreen. 12. Vitamin E is usually available as cream and avoid them. Adapalene is a vitamin A erivative and that is enough. Eat a lot of fruits rich in vitamin A . That is better. 13. Vitamin A derivative Isotretinoin is the best medicine for severe pimples but as it is harmful for growing baby you cannot take it. Oral Vitamin E is not that helpful. 14. Use a sunscreen daily. Use vitamin c serum at night. Drink plenty of water. Healthy lifestyle and balanced diet rich in fruits and vegetables. Use Sunglasses while out in the sun. Hope this helped, Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Johny Chacko (2 days later)

Dear doctor Thanks for replying. i have a few more questions 1. Is salicylic acid face wash safe during pregnancy? 2. Is topical azithromycin good in my case? if yes, what strength? 3. The ranbaxy suncros sunscreen that you had suggested, Is it safe to continue during pregnancy? 4. Can you suggest me some cheap alternative to Kaya's vit c serum? Is there any drugstore/medicated brand that makes the same/similar product? 5. Is ponds gold radiance serum or olay serum any good ? 6. How good is neutrogena rapid wrinkle repair night cream? 7. right now i have two cystic acne on my face....should i go for antibiotic treatment that you suggested? 8. Do cystic acne always take time to die/dry up? mine take 3-4 weeks ...is that normal? Thank you so much doctor. Regards XXXX

Answered by Dr. Johny Chacko (4 hours later)

Brief Answer: Answers Detailed Answer: Hello XXXX Welcome back, 1. Salicylic acid face wash is not safe in pregnancy. You may continue it till you get pregnant. Stop once pregnancy test is positive. 2. I am not aware of the availability of topical azithromycin in India. I don't think it is available. 3. Ranbaxy suncros gel /aquagel is safe in pregnancy. 4. Kaya's antox vit c is a very good product. Cheaper alternatives are VC15 serum (Cipla) 1500/- or Epishine (Ethicare remedies) 1000/- 5. I have neither personally used or recommended these products so I won't be able to comment on them. Both of them lack vitamin c. 6. In view of your acne , kindly avoid creams even if it is a good brand like neutrogena. 7. I think you should take azithromycin for your cystic acne as suggested. 8. Yes cystic acne takes long time to subside, even 6-8 weeks. Hope I have answered your query. If you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health.

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