What could be the reason for the red bumps on my face that keep spreading?

Hello,

Welcome to icliniq.com.

Thank you for your query.

I understand your concern. I saw your clinical picture (attachment removed to protect the patient’s identity). There are a few comedones and inflammatory papules. This is acne vulgaris grade two.

Isotretinoin (Roaccutane) is known to make the pimple bigger at the start of treatment. It is called the therapeutic paradox. As you continue taking it for months, it shrinks the oil-producing glands and helps eliminate cystic and inflammatory acne.

Rosacea presents with similar lesions like red bumps and pustules, along with visible blood vessels (telangiectasia-which is a classic feature of rosacea), mainly involving the central face. Symptoms of rosacea are flushing of the face on eating spicy food, on taking hot beverages like tea or coffee, during a stressful period. In addition, flushing of the face occurs on exposure to sunlight, during physical exercise, and upon approaching hot flame.

Do you have any symptoms mentioned above? Any family history of rosacea? What acne medicines have you tried so far? How long have you been taking Roaccutane? Kindly follow-up with the information.

I hope this has helped you. Thank you.

Hello,

Welcome back to icliniq.com.

Thank you for the reply and additional information.

The image (attachment removed to protect the patient’s identity) does not look like rosacea. There are few comedones in the picture you have attached; comedones are the most characteristic acne lesions. Clinically this is acne vulgaris and not rosacea based on the pictures, symptoms, and history you have provided. I suggest you to follow a few instructions mentioned below.

1. Continue and complete the course of the capsule Isotretinoin (13-Cis-Retinoic Acid) that you have already been prescribed. You should see improvements in about eight weeks of treatment.

2. Wash your face with mild cleansers like Cetaphil (niacinamide (vitamin B3), panthenol (vitamin B5), and glycerin cleanser) if your face is dry, or use Benzoyl peroxide face wash if your face is oily.

3. Wash your face three times a day to remove excess oil and dust which accumulates over time on the face.

4. Use a good sunscreen with SPF 50, and apply it to the whole face 30 minutes before you step out, irrespective of the presence of sunlight. UV rays will always be there during day hours (even if cloudy). Apply every four hours for maximum benefits. This is because, sunscreen can protect your skin from UV rays for four hours. Hence you need to repeat it every four hours. Always use non-comedogenic sunscreen.

5. Do not pick or squeeze your acne. It will leave dark pigmentation and scars, which are even more difficult to treat.

6. Regular physical exercise is essential to keep hormones under check. Exercise for at least 40 minutes a day, six days a week.

7. Avoid oil massage to the scalp. It will aggravate dandruff. If there is oil flow on the facial skin, it can clog the pores leading to comedones.

8. Eat vitamin A-rich fruits and vegetables like papaya, mango, muskmelon, pumpkin, carrot, and beetroot. These have beta carotene in them, a good antioxidant for healthy skin.

9. Drink two to three liters of water per day to keep the skin hydrated.

10. Always use water-based cosmetics, which have the “non-comedogenic” label on them.

11. Stress management is essential. Stress (mental as well as physical) causes acne breakouts. Meditation is very helpful for controlling mental stress.

12. Avoid waxing hair on the face. Waxing irritates hair follicles and can aggravate pimples. However, threading to remove unwanted hairs over the face is fine. Threading has no effect on acne.

13. Steroid causes very bad acne, it makes the skin very thin and sensitive. Avoid over-the-counter (OTC) steroid creams.

Let me give you some information regarding acne:

1. Acne is a disorder of the pilosebaceous unit, pilo-hair, and sebaceous- oil-producing gland. These pilosebaceous glands are densely distributed over the face, neck, chest, back, shoulder, and arms.

2. Sebaceous gland produces oil that is expelled out through the duct, which opens on the skin surface.

3. As long as this duct is intact, oil flows freely out onto the skin. If there is any blockage in the duct, the oil cannot come out, then it starts irritating the surrounding skin and causes comedones.

4. Our skin has a commensal harmless bacteria called Propionibacterium acne (P acne). This bacteria acts on the oil collected inside and causes inflammation leading to red bumps, pustules, cysts, or nodules as it progresses. If acne is not treated on time, it will leave scars.

5. Hormones have a strong effect on acne; increased androgen hormone can cause thickening of the wall of the duct, leading to its blockage causing comedones (black and white heads). PCOD or PCOS - polycystic ovarian disease or syndrome, is the most frequent hormonal disease causing acne in teenagers as well as adult women.

6. Environmental or Emotional factors: Hot and humid climates, causing increased sweat, can clog the pores. The application of oil or oil-based cosmetics, or steroid creams can cause acne. Psychological stress is one of the important factors in acne.

I hope this has helped you. Thank you.