Brief Answer:
Rule out PCOD

Detailed Answer:
Hello and Welcome to Healthcaremagic.

I am Dr. Kakkar and I have understood your concern. I have also looked at the Image. You seem to have Adult onset Inflammatory acne

I would like to gather some more information from you in order to be able to help you better.

--Do you have any abnormality in your menstural cycles?Are they regular or irregular?
--Do you have Coarse Facial Hair too?
--Do your acne flare up at about the same time as your menses happen?

I would suggest a few blood tests for underlying hormonal abnormality e.g Serum testosterone, Serum DHEAS, Serum LH, Serum FSH etc, Pelvic Ultrasound.

Polycystic Ovarian disease is always a possibility that has to be ruled out in females with Acne. PCOD in females classically presents with signs of hyperandrogenism e.g Acne , Hirsutism, Hair fall, Irregular menstural cycles along with Cyst on Ultrasound.

Specific Treatment for PCOD is with oral monthly hormonal pills/OCPs(Oral contraceptive pills) e.g Ethinyl estradiol and cyproterone acetate pills are available as a pack of 21 tablets. It should be begun on the first day of the menstural cycle and taken consecutively for 21 days and then stopped, when periods will follow. As soon as the periods happen it is then again started on the first day of the menstural cycle and so on for 6-12 months.

You should continue with the antiacne treatment that you have been using: i.e Clindac A gel , Benzac- AC gel. You can add a topical retinoid e.g Adapalene gel (Adaferin gel) for night time use. Retinoids are antiinflammatory, comedolytic and therefore also prevent new acne.

Besides these, for inflammatory acne I would suggest oral Antibiotics: either Azithromycin/ Doxycycline OR Minocycline. The antibiotics can be continued for 4-12 weeks depending on the response.

Use a mild cleanser like cetaphil twice daily. Harsh cleansing causes the skin to become excessively dry which in turn causes rebound oiliness.
Avoid all the regular use creams, moisturisers, sunscreens that you may be using for the time being till you are on anti-acne treatment.
Avoid taking facials.
Avoid picking your acne.
Since Acne and seborrheic dermatitis/dandruff are usually associated it is advisable to use an Anti-dandruff shampoo since acne is worsened by dandruff.

I would advice you to see a dermatologist and get a prescription out for your problem after having a discussion with him keeping all these points in mind.

I am here to help you with any clarifications you desire.

take care
regards

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