I have issues with my facial skin. I have lots of acne with uneven skin and now marks which may be permanent. My skin is highly sensitive, and I do not know my skin type. I have a history of acne and have got treatment for the same from several doctors. I do not use any cosmetic products or moisturizers. I am also not taking any medications currently. Please help.
I read your query and can understand your concern.
Having gone through the history provided from your end, as well as the image (attachment removed to protect the patient's identity), it appears to be acne vulgaris along with post-inflammatory hyperpigmentation (PIH) and atrophic acne scarring.
Most often, in the case above, the most common skin type would be oily or combination skin type, wherein there are more oily areas over most parts of the skin than dry.
Acne vulgaris is caused due to multiple factors, including genetic susceptibility, wherein similar conditions run within the family and get transmitted genetically due to fluctuations in the hormonal levels, especially in the androgen levels and sometimes in the female hormone levels. In the case of young females, it is pretty common to have PCOS or polycystic ovarian syndrome, in which there is a fluctuation in the hormonal levels leading to multiple symptoms, including acne, unwanted facial hair growths, hair loss, as well as menstrual irregularities. However, all the symptoms may not be present, and to rule out PCOS, it is always advised to consult a gynecologist in person. Other causes of acne include stress, sweating, climate changes, dietary factors including intake of more oily and fried food, sweets, red meat, milk, and dairy products, using any unique skin care products which you have mentioned that you are already not on, due to intake of any medications for any underlying medical conditions.
Post-inflammatory hyperpigmentation or PIH and atrophic scarring post-acne are most often due to chronic pricking of scars, due to longstanding untreated severe acne, along with excess sun exposure. Therefore, for reducing the appearance of post-acne hyperpigmentation and scarring, medications alone would not suffice and would require treatment with procedures and medications for better results.
I would suggest the following:
1. Ahaglow S (Alpha hydroxy acid) foaming face wash to be used twice daily to cleanse your face. It is to be used in the morning and at night in a sufficient quantity, applied in gentle circular motions for one minute and washed off. They may be continued to be used for months.
2. Clindamycin with Nicotinamide gel may only be used on the affected acne area in the morning. They help reduce pigmentation and have an antibacterial property to reduce the chances of acne. They may be used daily in the morning after using the face wash for months together.
3. Aziderm 10 % cream may be applied on the affected areas at night only on alternate nights. This medication is powerful and therefore has to be used with caution. A minimal quantity of the cream may be applied to the affected area in a very thin layer. Make sure the cream is applied only to the acne lesions and areas of hyperpigmentation. They may be continuously applied for 12 weeks. In case of a history of hypersensitivity and allergies, this medication may be avoided. This medication does not cause side effects if used in the smallest quantity possible in a very thin layer.
4. Tablet Limcee 500 mg chewable tablets (ascorbic acid) may be taken once daily at night after food which is to be chewed and eaten for two months. They help in reducing the recurrence of acne. In addition, its antioxidant properties reduce the chances of hyperpigmentation. It is to be noted that extremely hot food items, such as scorching drinks or milk, may be avoided during the consumption of this medication.
5. Glycolic acid chemical peels effectively reduce post-inflammatory hyperpigmentation, acne, and scarring. In this procedure, a solution consisting of glycolic acid is applied to your face and left for 5 to 10 minutes before washing off. This is usually done in sessions of at least six every two weeks.
6. Laser techniques, including Erbium lasers, Q switch lasers, and Carbon lasers, are available to reduce the intensity of the acne and resurface the skin where there is scarring due to acne. These procedures are also done in at least six sessions every three weeks.
7. Platelet-rich plasma or PRP, along with micro-needling using derma rollers, can be done once a month. In this procedure, about 10 to 12 ml of blood would be drawn and centrifuged in a machine to extract blood growth factors which are then applied onto micropores, created by using derma rollers by rolling them up and down on the affected area of the skin. The growth factors present in the blood would help in collagen production, thereby reducing the appearance of scarring caused post-acne.
The procedures mentioned above are done at a dermatologist clinic, so I suggest you consult a dermatologist for the treatment.
As I have mentioned above, acne is caused due to multiple external and internal triggers, of which the external triggers may be controlled. In contrast, the internal triggers may not be controlled. Depending on exposure to triggers, there is a chance of acne recurrence. However, avoiding habitual pricking of acne and making dietary changes, including oily and fried food, milk and dairy products, sweets, and red meat, will help reduce acne and post-acne scarring to an extent. Consistency with the medication and procedures is always advised for reducing the recurrence of acne, treating the current acne, and reducing the appearance of post-acne scarring.
Hope the details provided above were informative as well as provided clarity.
Thank you and take care.
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