Q. How to get rid of the acne on my cheeks, chin, jawline and neck.
Hello doctor,
I have been dealing with acne on my cheeks, chin, jawline, and neck for the past four years. I have recently graduated my bachelors and got accepted to medical school. I previously thought the acne was due to stress, but since graduating I have still been having breakouts and tried Benzoyl peroxide, Retin A products, and salicylic acid treatments. All of which clear up temporarily but then get worse.
I am not on any medications (no birth control either) but currently started taking a few supplements to see if it would help. I take fish oil, probiotics, and turmeric for the past week and now it seems to be helping a little, but I also just got off my period and had some flare-ups on my cheeks. I am in the military, and out of all honesty I have tried getting appointments with my doctor, but she always recommends the same treatment with Benzoyl peroxide and Retin-A.
She even had me on Spironolactone a few years ago, but I have a low natural BP, and that just made me dizzy from lowering my BP more. I wish to see a dermatologist, but the military makes that difficult to do unless I wanted to pay out of pocket to see one. My skincare routine consists of using Glowbiotic MD face wash, diluted apple cider vinegar toner, and plain Aloe vera for moisturizer. I try to keep it simple to not irritate my skin more than it is. Please advise.
Hello,
Welcome to icliniq.com.
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.
2. Stress.
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.
Thank you doctor,
I have regular periods. I do think I lose more hair in a day than I should, but I am not sure what constitutes as a lot. My facial hair is so blond that you cannot notice it, but I do pluck the hairs around my upper lip and pluck my eyebrows a lot. Again, I am not sure if that means I have excess facial hair growth or not. I do have an appointment with my primary care physician, so I will be able to discuss all this with her as well and tell her your recommendations for medication and hopefully find a course of action. I am tired of dealing with this, and as a future doctor, my image is very important to me.
Hello,
Welcome back to icliniq.com.
Losing up to 100 hairs per day is considered normal. Excess facial or body hairs indicate thick and dark hairs in male pattern distribution that is on cheeks, upper lip area, and suprapubic area. Discuss Doxycycline, and Isotretinoin with your doctor. If you are very much bothered by acne, I would suggest Isotretinoin for you.
Isotretinoin prevents scarring as well. Isotretinoin has few side effects like it elevates serum lipids, cholesterol that we monitor monthly. One cannot get pregnant while on Isotretinoin. It is teratogenic, and hence we do urine pregnancy test monthly to make sure the patient is not pregnant. We suggest birth controls. Your doctor will give you the Isotretinoin booklet to go through.
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