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Thank you for your query.
As per the history and image provided (attachment removed to protect the patient's identity), it is grade 4 acne vulgaris. Acne usually appears due to multiple factors, including hormonal imbalances, climate changes, dietary changes, genetic factors, and using skin products. Therefore, I suggest you to follow a few instructions mentioned below.
- Use Salicylic Acid 2 % and Glycolic Acid foam face wash. I have included the generic name or the contents of the product so that you may be able to purchase a product which is containing these ingredients. Apply twice daily, massage gently in a circular motion for one minute, and wash off.
- Apply Duac gel (Clindamycin Benzoyl Peroxide) 1.2 % or 5 % in the morning after washing your face for two months. Apply only on the acne lesions.
- Use a cream that contains Adapalene (retinoid) and Clindamycin (antibiotic). Apply the cream at night on the acne areas only as a spot treatment for two months.
- Take a tablet of Ascorbic acid (vitamin C) 500 mg. It is a chewable and take it after food twice daily for two months.
- Avoid sweets, fried food, milk, dairy products, and red meat.
- Consume more fruits and vegetables, and increase your water intake.
- Take a capsule of Doxycycline (antibiotic) 100 mg twice daily after food for seven days. Make sure you have no history of antibiotic allergy before consuming this medication. In case of allergies, kindly avoid the medication.
- Take a tablet of Pantoprazole (antacid) 40 mg twice daily for half an hour before food for seven days. This is consumed to avoid gastric issues due to the consumption of antibiotics.
- Also, facial chemical peels with glycolic acid are procedures done in sessions of two weeks to one month for at least six sessions. Other methods, like laser therapy, done in sessions, are procedures that help in better recovery. Procedures like laser can be done after 18 years of age. However, chemical peels may be done otherwise.
- Acne may be on and off depending on hormonal changes, climate, and dietary changes. Therefore, external factors like diet can be managed. However, hormonal factors being internal may not be managed. Therefore, management of acne may have to be done frequently till the acne lesions decrease in appearance. For this reason, consistency is key.
Kindly consult a specialist, talk to them and take medications with their consent.
I hope this has helped you. Thank you.