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I understand acne is very frustrating. Many factors play a role in acne, they are,
1. The hormone is the main factor. Here acne is seen mainly on the chin and neck. A most common cause is the polycystic ovarian disease that presents with acne, increased hair on the face, hair loss from the scalp, irregular menstrual cycles. If you have any one of these symptoms along with acne, I strongly recommended evaluation by a gynecologist.
3. Occlusion due to thick face creams, and foundation that block the pores on the face causing ductal block then inflammation. People from 13-30 years are more prone to acne.
You have cystic acne, considering the distribution around chin and jawline, Spironolactone is the best medication in your case. Since you have a problem with blood pressure, I can suggest you other treatment options. Kindly consult your doctor to discuss the suggestions and take the treatment with consent.
1. Aczone (Dapsone) 7.5 % topical gel, it is anti-inflammatory medicine but slow acting.
2. Oral Doxycycline or Minocycline for two to three months. These antibiotics are very useful for cystic acne.
3. Topical Fabior (Tazarotene) 0.01 % foam, this is the strongest topical retinoid.
4. Oral isotretinoin (Accutane) is the most effective treatment available for acne. It is weight based treatment, depending on your weight you will have to take Isotretinoin capsules for four to six months. It needs monthly blood work monitoring for serum lipids, liver enzymes, monthly urine, and a pregnancy test. Follow a monthly visit to the dermatologist.