Hi,
Thanks for writing to us.
These 'small black pimple kind of things that release rice like grains' are nothing but comedones( blackheads).
You seem to be suffering from Acne vulgaris. From the pics these seem to be of mild to moderate grade. I can also see increased hair growth over your face.
I would like to know
Since how long are you having these lesions
Medicines used so far to control them
If your periods are regular as most of the time in adult age, acne has a hormonal precipitating factor.

To help you out with your skin concern, you may follow these
1) use a salicylic acid based face wash twice in a day like Saslic DS
2) use a water based moisturiser which is non comedogenic
3) get all your comedones extracted. You can extract these at home. Mildly steam your face, clean the areas from where comedones need to be extracted by using spirit, use a comedone extractor to gently remove the comedones. After removal ice the area to reduce inflammation and apply anti acne cream( clindamycin or adapalene). Those comedones that are too XXXXXXX and difficult to remove can be removed by booking an appointment with your dermatologist.
4) apply clindamycin gel in morning and adapalene gel in night over acne lesions
5) a course of oral antibiotic like azithromycin along with isotretinoin is required to settle your lesions. However these are prescription drugs and a thorough consultation with your dermatologist is mandatory.
6) you may also talk to your dermatologist regarding few sessions of salicylic acid peels as these will settle acne as well as pigmentation of acne.

Hope that helps. Kindly answer specifically to few of the queries I have put forth.
Take care.

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Hi,
Thanks for writing back.
I hope you did not use any steroid cream to control acne or improve skin as it is quite a common culprit in sudden flare of acne. Secondly I had asked about your periods per se as adult onset acne along with increased facial hair growth points towards hormonal etiology. As your periods are irregular, you need to get your hormonal profile done. Here in India we prefer getting S. LH, S. FSH, S Testosterone, S. DHEAS, S Prolactin, S. insulin done along with USG pelvis to rule out Polycystic ovarian disease. The same tests can be either advised by your gynaecologist or dermatologist.
If any hormonal imbalance is found, a hormonal therapy in the form of oral contraceptive pills should be started at least for 6 months to an year along with the measures I have mentioned in my previous post to control acne.

As such you should not try to pop the lesions with bare hands as inflammation and scarring will set in. However superficial blackheads where you can see a central black core can be removed the way I have told earlier. If they are XXXXXXX or difficult to remove, you can always take your dermatologist's help. Blackheads should be removed as these lead to formation and flare of acne. Aloe vera gel would not help in acne as such.

I would advise you to XXXXXXX a dermatologist so that investigations could be advised along with prescription of oral drugs. In the meanwhile kindly follow steps 1) to 4) of my previous post to help with your break outs.

Hope that answers your query.
Take care

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Hi XXXXXXX
Thanks for writing back.
The skin concern that you are having is acne vulgaris or pimples and it isn't some kind of serious skin disease! It will eventually go with treatment. The grade of acne in your case is mild and is mainly comedonal.

The lesions are not due to excessive cold

The etiology of pimple includes excessive hormones, bacterial growth, increased oil gland duct blockade( manifests as comedones) leading to inflammation of glands and finally spillage of these inflammatory cells in surrounding tissue.

Irregular periods since puberty or of recent onset suggest excessive androgens which can lead to acne during puberty or later on in adulthood. It is essential to do a hormonal work up as deranged hormones have gynaecological implications too.

Acne is never bilaterally symmetrical that is one cheek might have more lesions than the other one as it depends upon the androgen sensitivity of oil glands.

In your case this recent outbreak is most probably hormonal, however use of some medicines like steroids, new cosmetics or facial creams or facials can also induce acne.
These tiny lumps that you are having which release black debris is nothing but comedones. Too much squeezing of these lesions would definitely leave black marks or scars.

Follow the recommendations I have suggested in my previous post to heal your lesions. Saslic DS face wash and adapalene will both cause mild skin peeling and hence would help in XXXXXXX reduction too. Use a mild moisturiser like cetaphil or Clinique to keep skin well hydrated. It would hardly take a month for your pimples to clear off. Later on to decrease pigmentation you may use a Kojic acid or hydroquinone based cream to reduce marks. Taking few sessions of chemical peels would give wonderful results too.
I would request you to XXXXXXX your dermatologist for hormonal work up and to assess your skin well so that if oral prescription drugs are required can be added.

Hope that answers your query.
Take care.

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