What causes painful acne on the face?

Hello,

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Thank you for your query.

I read your query and viewed the image provided (attachment removed to protect the patient's identity). They appear to be acne vulgaris. These occur due to multiple reasons, including genetic transmission (increasing susceptibility), hormonal imbalances such as changes in androgen levels, excess sebum secretion due to climate changes, sweating, stress, using skin products, frequent shaving too close to the skin, dietary changes, vitamin deficiencies and consuming medications for any underlying medical conditions. External factors like diet can be managed; however, internal hormonal factors may not be in one's control. Therefore, management of acne may have to be done frequently till the acne lesions lessen in appearance. For this reason, consistency is key.

I suggest you to follow a few instructions mentioned below:

1. Use Salicylic acid 2 % and Glycolic acid foam face wash. Apply twice daily on the face and particularly on the affected area. Massage gently in a circular motion for one minute and wash off. Continue the same for a few months.

2. Use Peroclin gel 2.5 % (Clindamycin and Benzoyl Peroxide) in the morning after cleaning your face for two months. Apply only on the acne lesions. It may be used continuously for months.

3. Use Azelaic acid cream on the affected area on alternate days only at night. Make sure your face is cleansed and dried well. Your hands and face should be absolutely dry without any moisture. Apply the cream in a pea-sized quantity only on the affected areas in a very thin layer. Do not use it all over the face; do not use it in large quantities since the medication is strong and may cause irritation. Kindly avoid the medication in case of extremely sensitive skin, and in that case, the above-mentioned Clindamycin gel may be used twice daily instead.

4. Take a capsule of Doxycycline (Tetracycline) 100 mg twice daily for seven days. They are antibiotics specifically meant for acne and folliculitis. However, kindly ensure there is no history of antibiotic allergy before consuming the capsule.

5. Take tablet Pantoprazole (proton pump inhibitor) 40 mg for seven days 30 minutes before food to prevent acidity due to medications.

6. Take a tablet of Ascorbic acid (Vitamin C) 500 mg after food twice daily for two months.

7. Avoid sweets, oily, fried food, milk, dairy products, and red meat.

8. Consume more fruits and vegetables, and adequate water intake is adviced with at least 14 glasses of water per day.

9. Intralesional corticosteroid procedures (ILS) can also be done at a dermatologist's clinic for cystic acne for faster reduction. They are injections of triamcinolone (glucocorticoid) in the affected area for faster relief by reducing inflammation in the area.

10. Procedures such as chemical peels with glycolic acid can be undertaken. These are usually done in six sessions of two weeks to one month.

11. Laser therapy, including carbon laser with Q switch and erbium lasers, helps directly destroy the bacteria present and mildly peel the area. They are also done in sessions.

Kindly consult a specialist, talk to them and take medications with their consent. Also, consult your dermatologist to undergo the special procedures mentioned above.

I hope this has helped you. Thank you.