I had a small pimple-like bump on my neck. My doctor treated it with tablet Prednisone, but now I have a larger cyst-like knot on my throat under my beard, which is getting bigger. I am now on my third antibiotic, but it is getting worse. Kindly help.
I read your query and can understand your concern.
Having gone through the history and image provided from your end (attachments removed to protect the patient's identity), I suppose it to be a folliculitis cyst.
Cystic folliculitis occurs due to multiple reasons, including genetic susceptibility and dietary factors, including the consumption of oily and fried food, sweets, red meat, milk, and dairy products. They may also be caused due to hormonal imbalances, increased sweating, stress, and alterations in sebum production and secretion, thereby causing activation of the bacterial commensal, which is present within one's skin. They may also occur due to frequent usage of razors and using medications for an underlying medical condition.
I suggest the following.
A salicylic acid facial cleanser is to be used externally. Apply, massage for one minute, and wash it off. This is to be used twice daily and can be continued for months.
Peroclin (Clindamycin and benzoyl peroxide) 2.5 % gel needs to be applied twice daily on the affected area and can be continued its usage for months or till there is a reduction in the formation of folliculitis or acne-like lesions.
Capsule Doxycycline 100 mg should be taken orally, one capsule in the morning after breakfast, and one capsule at night after dinner for seven days. This is an antibiotic; therefore, it is advised to make sure that there is no history of allergies to any antibiotics before consuming this medication. Kindly stop the medication after seven days.
Tablet Pantoprazole 40 mg twice daily, 30 minutes before breakfast and 30 minutes before dinner, may be taken to avoid acidity caused by the intake of antibiotics.
Tablet Ascorbic acid 500 mg can be taken once after dinner and once after breakfast for two months. Intake of beverages or food that is too hot must be avoided during this medication intake to prevent abdominal discomfort. Milk consumption also is advised to be avoided during this period. Consumption of this medication would help faster healing and frequently prevent infection formation.
Procedures including intralesional corticosteroids in the form of Triamcinolone injections may be taken once or multiple times four weeks apart to help reduce the inflammation's intensity and bring down the swelling which is caused due to cystic folliculitis. A professional usually does this procedure at a dermatologist's clinic; therefore, I request you consult a dermatologist to undergo the process.
Besides, consultation with a general surgeon is also advised to rule out the other possibilities of the formation of the cystic lesion. The doctor would also do an incision and drainage, a procedure to remove the cystic material by placing an incision on the cystic area to eliminate the pus-filled area within the cystic lesion.
Following this, the doctor might take a swab test of the material which is present within the cystic lesion to run a culture and sensitivity testing to rule out the presence of the bacteria and to prescribe the antibiotics appropriately.
Avoid consumption of oily and fried food, sweets, red meat, milk, and dairy products, as they may trigger the formation of folliculitis due to the alteration in sebum secretion. Make sure to consume at least 14 glasses of water in a 250 ml glass size daily and to include more fruits and vegetables, and fiber in your diet.
I also suggest changing razors to prevent their recurrences.
The possibility of recurrences in the case of folliculitis or acne formations is normal. They are usually managed externally by avoiding the risk factors resulting in their formation, which has been mentioned. In the case of internal factors, including hormonal changes and genetic susceptibility, the chances of controlling the same would be difficult. Due to the formation of the on-and-off nature of the same, I suggest you follow the above advice and seek an in-person consultation with the surgeon and a dermatologist to take the medications and undergo the procedures mentioned above with their consent.
I hope this helps.
Thank you and take care.
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