How to manage persistent acne and dark spots near mouth?

Hi,

Welcome to icliniq.com.

I understand your concern.

Thank you for your informative inquiry and for providing the photograph (attachment removed to protect the patient’s identity). Based on your symptoms and observable skin changes, you appear to have inflammatory nodulocystic acne with post-inflammatory hyperpigmentation (PIH). As you indicated, this type of acne is deeper, more painful, and more likely to cause scarring or pigmentation, particularly around the lips and cheeks.

Here is a step-by-step plan to help you manage it effectively:

Treatment plan

1. Cleansing (twice daily)

Use a mild salicylic acid-based face cleanser (acne clarifying cleanser).

Wash carefully, without scrubbing or over-cleansing.

2. Morning routine.

• Apply Clindamycin 1% gel to active lesions to help reduce bacterial load and irritation.

• Apply a noncomedogenic moisturizer (example, Cetaphil DAM, Neutrogena Hydro Boost).

• To guard against pigmentation, use a broad-spectrum sunscreen with an SPF of 30 or higher (such as La Roche-Posay or Re'equil).

3. Night routine.

• After cleaning, apply a pea-sized amount of Adapalene 0.1% gel (example, Differin) to the afflicted regions.

• Begin with three nights each week and progressively increase to all nights as tolerated.

• This helps to reduce irritation and unclog pores.

4. Spot treatment (optional).

• Apply Benzoyl Peroxide 2.5% gel to inflamed/painful areas once a day.

• Do not use it in conjunction with Adapalene.

5. Lifestyle and additional tips.

• To avoid scarring, do not pick or squeeze blemishes.

• Avoid using thick or greasy cosmetics.

• Keep your face clean and refrain from touching it regularly.

• Avoid harsh scrubbing and homemade cures.

• Drink plenty of water and eat a balanced diet.

When to visit a Dermatologist in-person

• If there is no noticeable improvement after four to six weeks, consider:

• Oral antibiotics (example Doxycycline or Minocycline) for six to eight weeks.

• If you have a history of irregular periods, facial hair, or rapid acne flare-ups, you should have a hormonal evaluation.

• After active acne has been treated, consider chemical peels or laser treatments for pigmentation.

Please continue this program for at least six to eight weeks to notice significant results. I'm available to clarify any processes or provide advice on prescription options as needed.

I hope this helps.

Thank you.