Suggest Treatment For Severe Acne

Question: Dermatology enquiry

Preferably I'd welcome the help of Dr S Kakka but if not I'd like to consult a dermatologist please

About me
I am 40 year old female
chronically severely unwell with ME/CFS so am unable to attend dermatologist appointment in person
I am bedridden and generally don't get any exercise or sunlight
I struggle to manage proper personal care e.g., regular hair washing, moisturising after each face wash etc.

Acne history
I've suffered with acne since puberty.
Since bringing it under control at twenty with zineryt, i was mainly only troubled with the odd nasty hormonal acne cyst.
Unfortunately a couple of years ago with decking health and stress things flared up , but daily use of adifferin was able to suppress it all again, along with zindaclin gel as necessary, fairly successfully until about three months ago, since then I've had monthly and weekly big red spots.
I'm prone to scarring (and am scarred). and heal very slowly.
Spots often can re-emerge.
.

Problem with Treatment options
My GPs have refused all oral medicine saying I'm too generally unwell to risk oral anti biotics for not many spots, despite being big or prone to scarring
I can not take hormones as oral contraception, as I'm too immobile I'm a thrombosis risk
In uk Drs don't generally use spironolactone and they say I'm too sick to justify possible side effects
I seem to have become resistant to zindaclin gel after long term use, so I've had to ask my new dr to look at new treatments


The current problem
Recently I've been having bad skin, weekly large spots pustule type and what I think was more a deep nodule beside my nose which got quite large. I heal badly so they accumulate quickly. I have very recently a painful spot come up on my lip line too.

Treatment
My new GP put me on fucidin for the large nodule type thing beside my nose,
zineryt for my other acne around my mouth and chin.

Outcome
The zineryt works quite Well around my mouth on reducing the severity /longevity of pustules etc but it is drying and I'm still getting spots coming up a month into treatment, especially around my mouth and on my left side only, which I don't know if it has neurological cause.

I also I do not feel so satisfied with nodule resolution.

(Please see the several pictures I've included Of spots,pores/blackheads around mouth & area around nose which is redness and possible lump, but there was a permanent lump in the skin before the nodule). The worst spot at the moment is on the lip line.

Questions

1. My dr says to just keep on with the zineryt and use funcidin if lesion is big and angry, and to not use differin anymore alongside at all. But it seems quite simple and one dimensional Treatment. Is what my dr recommends a good way to proceed? I've always thought an anti comedogenic agent was necessary in acne treatment? should I be using differin alongside zineryt? How would I use term together, can they be applied at the same time?
2. For the nodule I used fucidin for about 2 weeks, along with differin. Now I have moved to purely zineryt . It's subsided but it still feels there in the skin and some days it seems like it's going to come up again, so I go back briefly to differin but only for a day or so. Has this been the right approach? I feel like it's still there simmering at 5-10% (although it's hard to say as I have a previous permanent lump in the skin at that site) - is there more I should be doing topically? Should I be using fucidin long term until it resolves?
3. Is zineryt really working if I'm still getting spots? (although I'm not sure if my difficulty applying with the roll on is causing some failure
4. My dr has prescribed cetraben lotion to combat the drying effect of the alcohol in zineryt. It's parrifin wax based - is this really appropriate for usually greasy, congested acne prone skin?
5. Do I need anything other than topical medicine for the painful spot on my lip?

Thanks for your time
XXXXXXX XXXX

Dear Dr Kakka,

Thanks for your reply and help

Regarding using BP Along with topical antibiotics, in this case zineryt, can they be applied at the same time?

Is it ok to put fucidin right near the lip?

On the big spot on the lip should I apply fucidin 1 x day and BP 1 x night only, or try to fit a 2nd fucidin in there?

Is fucidin/BP or zineryt/BPt or BP alone best to clear the nodule remnant?

I'm applying a warm compress to the big spot on lip with head on to try to draw it out, is that a good idea?

Finally, I've tried again to upload upload the pictures, as they didn't upload in my initial post

Thanks for your help
XXXXXXX XXXX
.

Hello again doctor

Thanks for your help

It was interesting to know zineryt and BP needed to be used together

I just mainly have a few questions left now to be confident about drug use and combinations
To stop antibiotic resistance do they have to be applied together at the same time of day, or for maintenance, could BP be applied in the morning and zineryt in the evening?
(Related) If acne flared again and I applied zineryt twice/day, would I need to apply BP each time with it?
Is zineryt used in combination with BP, more advisable/effective than using just 2.5% BP alone ?
In large, red, & sore pustules is fucidin always the better topical drug to use rather than topical BP or antibiotics like zineryt
Is antibiotic resistance a problem of fucidin and does BP be applied at the same time?
In large, red, & sore pustules is fucidin in day /topical BP & zineryt at night better to use rather than fucidin alone 2-3 times /day?
If I get another deep nodule start to come up, is it better to put fucidin on from the start or only switch to fucidin if it becomes really big and angry?
Before applying acne meds is it ok to apply a watery hyaluronic serum ? I usually apply moisturiser if I'm using afterwards but a serum feels better before but will it block penetration?
I have contacted the customer care service but not heard back yet
My email contact -is

YYYY@YYYY
if you could send me an email address I can send to, just to be sure on the type of pustule treatment best suited I'd be grateful, thanks for offering to do this.

Thanks for your time XXXXXXX XXXX,