I recently got prescribed Spironolactone and started taking it last week. A few days later, I started developing clusters of very small things like whiteheads and bumps. Should I stop taking this medicine?
I have gone through the history and images provided by your end (the attachments have been removed to protect the identity of the patient). Acne vulgaris has multiple modes of treatment. As you have already mentioned that you are using Clindamycin as well as Tretinoin along with the recent addition of Spironolactone, there are multiple other ways to reduce the current acne rather than using stronger medications. Having said that, Spironolactone, initially for some individuals, may start causing breakouts, also called purging, which would take a few weeks to get used to and then would reduce in appearance as Spironolactone helps with controlling the sebum secretion and preventing the breakouts. Therefore it is absolutely normal to have breakouts after the intake of this medication. Since your doctor has prescribed its medication, you may continue to use them. However, I would like to let you know the other medications and procedures which are available for treating the same.
I would like to give you an idea of acne initially. Acne vulgaris, also called acne, is caused due to multiple factors, including genetic susceptibility, where there is a similar condition that runs within the family and gets transmitted genetically or due to hormonal imbalances which correspond with age groups and may also be seen among young females due to possibility of PCOS or polycystic ovarian syndrome for which I would like to request you to consult a gynecologist in order to rule out PCOS. PCOS may also be accompanied by other symptoms, including hair fall, unwanted facial hair growth, and menstrual irregularities, although these symptoms are not mandatory. Other causes of acne include dietary changes wherein there is an increase in usage of oily and fried food, milk and dairy products, sweets, and red meat and also due to climate changes, sweating, usage of any medications for any underlying medical conditions, due to any usage of skin care products as well as heavy moisturizers or sunscreens which results and clogging of the pores resulting in the formation of acne.
Acne, due to their trigger considering the external as well as internal factors which have been mentioned above, may be recurrent in nature depending upon the exposure to the different triggers. Out of which, the external triggers may be controlled, whereas the internal triggers may not be controlled unless caused due to a gynecological issue. Therefore acne may be on and off depending upon the different factors but can be managed each time they occur, and on growing older, the acne reduces in appearance due to the regularization of the sebum secretion.
My advice to you is:
1. Salicylic acid facial cleanser may be used externally. Apply a sufficient amount on the face and massage and gentle circular motions for 1 minute, and wash off. They help in regularizing sebum secretion and reducing the chances of breakouts. They may be continued to be used for months together.
2. As you have already mentioned that you are using Clindamycin, an addition of Benzoyl Peroxide or Nicotinamide into the Clindamycin gel would be more efficient in reducing the chances of acne.
Duac gel 2.5 % (Clindamycin and Benzoyl peroxide) may be used in the morning to be applied externally on the acne lesions only. They may be continued for months together. This medication is stronger and therefore has to be used with caution. A very small quantity of the medication may be applied in a very thin layer on the affected area only. They may be kept till the next wash. In case of any allergies to Benzoyl peroxide or in case they cause irritation, instead of this gel, the below-mentioned gel may be used. Actreat gel (Clindamycin and Nicotinamide gel) may be used on acne in the morning. A sufficient quantity may be taken and applied to the affected areas only and may be used for months together.
3. Skinoren 20 % cream (Azelaic acid 20 %) may be applied externally on alternate nights on the affected acne lesions only. This is a strong medication and therefore advised to be used with caution. A very small quantity of the product in the smallest quantity possible may be applied in a very thin layer on the acne lesions alone, almost like a spot treatment. This may be continued for months together; however, they are to be initially started on alternate nights, and once the skin gets accustomed to the same, they can be used every night. They help in reducing sebum production as well as breakouts. They may result in irritation, burning sensation, redness, and discomfort in the case of first-time users. However, when used with caution and when used in the smallest quality possible, it may not cause any of the symptoms.
4. There are multiple procedures that are of benefit if done along with the intake of medications. Glycolic acid facial chemical peels, which are done by applying a solution consisting of Glycolic acid, are applied onto the face and left for 5 to 10 minutes before washing off. This treatment is done at a dermatologist clinic, so I would like to advise you to consult a dermatologist in person for the treatment.
5. Ascorbic acid 500 mg tablet may be consumed daily after dinner. A single tablet may be taken after dinner for two months. They help in faster healing of acne and reducing the recurrence of acne due to their antioxidant effect. It is to be noted that this medication should not be taken along with milk or extremely hot drinks, or food items.
6. Avoid intake of oily and fried food, red meat, sweets, milk, and dairy products. Make sure to consume more fruits, vegetables, fiber, and at least 12 glasses of water per day in a 250 ml glass size.
As I have mentioned, acne may be due to external as well as internal triggers, of which the external triggers may be controlled, but the internal triggers may be difficult to control, and therefore being consistent with the medication is key and may be continued for months together for better result. Also, procedures may be combined with the usage of medication for better results, as they may be helpful in reducing the current acne without having to consume a lot of medications.
I hope the details provided above were informative and provided clarity.
.. gone through your case. The best treatment for acne scar is CO2 (carbon dioxide) laser. No cream will benefit you for the scar. For shiny skin, apply Vitamin C serum at night. For blackhead apply adapalene gel only on blackhead and whitehead with ... Read full
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