Brief Answer: Kindly see teh suggestions below Detailed Answer: Hi XXXXXXX Welcome and thanks for posting your query to Healthcare magic. 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 almost vanishes 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 and sometimes over medications 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 at the age of 25 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. In your case you took abrupt and higher doses of Evening primrose oil softgels(1000mg) - 4 in a day - which is too much high to be taken!!!! This including rest of the medications also are of no help in acne and must be stopped at once. So probably you got some idea regarding your acne. Kindly give me brief idea regarding so that I can suggest you further: - your marital status and your job profile. - If married then future planning about pregnancy or if blessed with kids then are you feeding your baby. - status of your pimples - how often in a week/month you get big pimples. - Are there any scars and/ or pigmentation. - It would be better if you can upload a close picture of face. For that you have a feature to upload images by yourself at the right side of the query page, please utilize that so that I can answer your further queries. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia). There are certain best of suggestions which you can follow till I suggest you further: 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). Hope these informations will help you. Regards. Dr Sanjay Kumar Kanodia MD (Dermatology)

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Brief Answer: Kindly see the suggestions below Detailed Answer: Hi XXXXXXX Thanks for your swift reply and uploading all the pictures to see the actual status of your face. Now after considering all the facts provided by yourself I can make out that you have got grade 3 acne which we call as nodular acne. Now these type of acne are basically influenced by the hormonal upsurge and most often just before menstrual cycle too. Over-medications as you have asked can aggravate the situation but is not the main implicating factor. Though you have taken evening primrose capsules in a very very high dose but even then it will not cause much harm to you, so there is not a thing of worry to you. As I have previously guided you that acne mainly and solely hormonal issue and other of the factors are just subsidiary factors which aggravates the situation more. It can never occur due to deficiency of vitamins and minerals so you should not at all correlate any of your acne with vitamin and mineral deficiency. Therefore also I strictly and firmly suggest you to not to take any of vitamin tablets as a self medications. None of vitamin and mineral will going to affect the issue of acne by any means. So is also true for the allergy part to something. Yes if you have applied some kind of creamy stuff or still applying then it can cause blockage of the pores and resultant acne. I can very well see that you have applied some kind of cream on both of your cheeks. My dear lady it is also too much of the cream of anything which you have applied. This can also aggravate you r acne on higher side. Now the only part which remains is hormonal issue- yes at the age of 25 also you can get pimples. Before the age of 30 years anyone can get pimples. Young lady you are not old enough to get hormonal upsurge at the age 25 years, so do not worry about the same. For the part of best of management- As you are unmarried lady so isotretinoin can be taken as one of the best measure to take care of the problem. But mind it should not be first of the measure to treat your problem. In my opinion it can be taken care of by simple of measure of topical and oral management. For the same kindly follow the regimen below: - Apply a gel based topical application containing clindamycin and adaplene gel ( Deriva C gel). It should be applied at night time only. A very thin application of gel is sufficient on the affect3ed area only so that it should not be visible to the naked eye. I again make a point that in the pictures I can see you have applied the cream which is sufficient to apply for 10 days. So accordingly you can make how much is to be applied. You may feel mild to moderate of burning sensation if you are applying on higher side. So a mere touching of the gel is sufficient. - Take oral antibiotic such as Azithromycin 500 mg 4 days per week for 3 weeks. - Take a good pain killer tablet such as ultracet or combiflam for 2 times a day for 5 days. - Do not apply any other creams or any moisturisers or anything else on your face. - Do not take any other oral stuff as vitamins and minerals as these will not help at all in reducing the intensity of the problem. - Now despite 2-3 weeks of proper treatment if you do not feel better then additionally isotretinoin can be added as per strict dermatological supervision only. I hope these informations will help you. with regards, Dr Sanjay MD Dermatology

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Brief Answer: kindly see the suggestions below Detailed Answer: Hello young lady, Welcome to the forum again and thanks for asking further queries. Now as per role isotretinoin – yes it gives a long term remission for acne but not lifelong!!! As for any of the drug isotretinoin also has got its own side effects. The most important one is that we cannot make it as a mainstay of therapy in females especially in young females. But even then those females who are not going to be married in near future (at least for 6 months) then it can be used as a mainstay of the therapy. Above of all isotretinoin MUST BE USED under strict dermatological supervision only. It is not an over the counter medication as its dose has to be actually judged by the dermatologist. Once started it is to be given for a period of 4-6 months according to its total cumulative dose. So you can get from points that though it is a wonderful drug but with its own advantages and disadvantages. It is also to be understood that isotretinoin do not provide benefit as soon as it is started. It needs 6-8 weeks of period to see its good effect. Though I have proposed a treatment where if at all you do not get relief in 2-3 weeks then you can consult a good dermatologist to start isotretinoin. Azithromycin is an antibiotic which can be given at the maximum of 2-3 months in reducing dose so we cannot expect long term remission with same. That is why in acne we start with oral and topical therapies and then prefer to maintain with topical therapies only, which proves very good in long term remission. The good effect once achieved can be maintained by adapalene gel alone. Regarding your high testosterone level- your gynaecologist has very wisely prescribed you the hormonal pills but rather I would have preferred Cyproterone Acetate & Ethinylestradiol combination (Ginette-35 or Diane-35) as these contains cyproterone which is better suited in acne conditions. These actually will help in lowering the testosterone hormone and thus the acne itself. It can be taken for 3-6 cycles without any side effects. So finally my suggestion is – To take care of immediate problem of big eruptions. A hormonal pill can be added up as per gynec supervision. If there is less of improvement then isotretinoin can be added under dermatological supervision. I hope these informations will help you. If you have any further queries i will be glad to help. with regards, Dr Sanjay MD Dermatology

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Brief Answer: you will be alright soon Detailed Answer: Hi XXXXXXX ( very nice name), As per your further queries: FOR DANDRUFF : Scientifically and medically our skin is a multiple layered structure. Our skin gets renewed every day. The layer which is present on the top today will be fallen off tomorrow. It will not be present tomorrow and would be dead skin in form of scales. This process is not actually visible on normally. So we can say we are just one day old from our skin most superficially. Now in some persons it is renewed at a faster pace. Because of hygiene and scalp hair this dead skin in form of scales gets entangled and trapped in form of visible of scales known as dandruff. It varies from person to person and also on other of factors which makes the difference inter-individually. Coming on to your problem which is scientifically known as “pityriasis capitis” is highest in twenties and then recedes by itself in later part of life. It is due to the fact that the renewal of skin and the fatty acid secretion in scalp is highest at this part of life. There are no such important predisposing factors except for few which can make the situation worsened such as individual's own tendency to renew the skin, application of hair oil and environmental factors. We can not change our own tendency to renew the skin but the personal measures of hygiene as well as the environmental factors can be modified. AS for other of the factors in acne, it is just an aggravating factor and not the mainstay of the factor and therefore cannot cause such an outburst of acne. It will definitely help us if we take care of dandruff on its best. For the remedy part follow the things below: 1.Wash your scalp daily. I guide my patients to wash twice in a single bath. It means when you are washing your scalp apply first time shampoo for washing the hair part only, then rinse it off immediately with water. Reapply the shampoo again immediately, leave it for around 5 minutes, do a good gentle massage by your fingers for around 2 minutes and then wash it off. By doing so for around 7 days you will get good benefit. 2. Stick to one good shampoo which is suiting your hair, don’t change the shampoos frequently. If you are using any conditioner also then to be used over the strands of hair only and not over the scalp skin. There is no difference of shampoos, the only part is to use good company shampoos such as Laureal or Tresemme shampoo. IF the dandruff is too high then you can use any medicated shampoo containing Ketoconazole in it. 3.Do not use any kind of hair oil or any oily or creamy stuff any time on your scalp. 4.Comb your hair at least 3-4 times a day and most importantly at night time so that the dust particle and other of dead skin is taken off. So for betterment of high oil secretion the only good solution is daily washing with any good shampoo. Reduce your exposure to hot and humid climate with any consumption of spicy food. Regarding your query of taking YAZ and isotretinoin - For me treating acne is really a very much personalized approach for each patient. I have had suffered a lot from acne problem and probably I treated myself at the best. Treating acne for me is really an art where you need multiple of your armamentarium ready for one or the other situation. Hormonal pills do have long term efficacy and isotretinoin is also helpful for long term. If a topical therapy is properly utilized simultaneously, I don’t think that you would have such kind of out burst again. I hope you got all your answers. If you want any future help you can visit directly to my page: bit.ly/drsanjaykanodia My wishes for your early and best recovery, Dr Sanjay MD

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Brief Answer: Mometasone is mild to moderate potency one Detailed Answer: Hi XXXXXXX Welcome to the forum again and thanks for asking your further query. Regarding the usage of Melalite XL- you are partially correct that it contains the steroid mometasone in it but on regards to break out by mometasone is a very rare event. This is on the basis of the fact that steroids are divided into various classes- from mild to moderate to high potency. Mometasone is a low to medium potency steroid, it is not a high potency steroid. Generally side effects of steroids are due to high potency steroids and not mild to moderate potency one. Above of all it had been used in combination with tretinoin and hydroquinone. So the potency decreases more to milder side only. Do not worry, any of the things of acne would definitely be better after proper dermatological guidance and further usage of isotretinoin. All the best, Dr Sanjay

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Brief Answer: Eat a nutritious diet with fruits and sprouts Detailed Answer: Hello young lady, Good morning. There has been a lot of discussions regarding diet causing acne. Even then latest of thought is that all the food which contains high index of sugar along with chocolates other supplement like coffee and milk products can induce acne formation. You can avoid these food items. I do not want to suggest you any supplements/ tablets for acne. Rather it would be better that you should eat the healthiest of your diet containing fruits, salads, sprouts and green leafy vegetables with adequate of water intake every day. All these will actually make the healing and regeneration power of your skin on better of side. I personally do not believe in giving any tablets as supplements and believe in diet specifically. Isotretinoin will be the best option in your case. As already said- it will also take atleast 6-8 weeks to show its good effects. So do not lose your heart. Be brave and confident- the things will be better soon. This is just a youth related bash and not a disease in itself. I myself suffered a lot from acne and today I do not even remember the old things. I am pretty confident that you will be alright soon. With best wishes, Dr Sanjay

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