Brief Answer:
Acne and dandruff

Detailed Answer:
Hello,

Welcome to healthcare magic.

I understand from your query that you are having acne and dandruff problems which are recurring.

Acne is due to your adolescent hormones and you will continue to have it till that hormonal influence is over. It might be 30 years or even 32. Adult acne is becoming more common due to the influence of stress, pollution and bad dietary habits. Hence, what was initially called as a teenage problem is now seen to continue well into the mid - 30 's.

From your history, I understand that the acne had gone into remission due to doxycycline and isotretinoin. But you need to maintain the remission using a maintenance cream.

Topical retinoid and benzoyl peroxide are the best topicals for maintenance . Since you are not getting much benefit with adapelene gel alone, you can apply a pea size amount of a gel containing a combination of adapalene 0.1% and 2.5 % Benzoyl peroxide at night over pimple prone areas so that you won't get any relapse. Clindac A is not a good maintenance cream as it is a plain anbibiotic which works against active pimples.

Use the gels for 6-8 weeks even after the acne lesions have completely subsided to prevent relapse.

Avoid creams on your face.

Avoid too much oil on your scalp.

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 like papaya.

Seborrhoeic dermatitis is a chronic condition, but very much controllable. It is caused by an yeast called malasezzia. This yeast is a normal resident of human body and once its colony increases you mount reaction against it causing dandruff. This yeast loves oil and therefore it is seen more in oily skinned. That is where hormones work. Androgens increase the production of oil from our sebaceous glands. Hence, this can co-exist with acne and this also will last until the hormonal influence is over

So the aim of any treatment is to bring down the colony of malasezzia. Anti-dandruff shampoo containing ketoconazole and ZPTO can be used 3 days a week for a month to control the dandruff and maintain it atleast once a week to prevent yeast from multiplying.
If you suppress the yeast from multiplying by using the shampoo as a maintenance once weekly, it will prevent the recurrence.

Hope this helps you.

If you have any more queries, I will be glad to answer.

Take care.

Regards,
Dr. Johny Chacko

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Brief Answer:
Acne management

Detailed Answer:
Hello,

Welcome back.

There is no definite explanation as to why acne occurs on certain areas of the face. It occurs in areas where there are maximum number of oil or sebaceous glands which varies from person to person.

Isotretinoin is a drug with significant side effects which need to be monitored. Liver function tests and lipid profile have to be done monthly. It is usually reserved for severe cases. If your acne is confined to limited areas as you have mentioned, I feel you can try using the gel I have mentioned. If there is no or minimal response after 4 weeks of use, I suggest you to consult a dermatologist to discuss about the need of Isotretinoin. Do not start the tablet on your own.

Hope this clears your query.

Take care.

Regards,
Dr. Johny Chacko

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