Acne or not?

Hello,

I'm 41 years old, but up to 7 years ago did not have any skin problems worth mentioning.  I then went thru a very stressful time in my life and started to get bad acne on my back, shoulders, etc.  My dermatologist finally suggested a small dose of Accutane - 1 pill/week.  That cleared things up great and everything was fine.  A couple of years ago I started to see white bumps on my shoulders and upper arms.  I could wake up in the morning and have whole new clusters, but they mostly seem to get more aggravated at the end of a stressful day, after a couple of drinks, or after sex.  My dermatolgist keeps telling me it's keratosis Polaris and there's nothing I can do, but from what I read KP is more redish dry bumps.  The strangest thing about these is if I push lightly right next to each of them with tweezers a small white plug pops out (if I push too hard they bleed a bit).  Even though they're small, the scab tends to be deep and take a while to heal on it's own.  I could push on a cluster of 10 with a tweezer, one at a time, and a little white plug would pop out of each, but no real puss or anything.  FYI, I also occasionally get them on my sides, mostly around the oblique area.  Same thing, I push a bit with tweezers and a plug pops out.  I tried stopping the accutane for a couple of months but they didn't go away (some acne returned).  Any suggestions?  (p.s. I'm more of a mediteranean skin-type, alittle on the oily side).

[Alan Rockoff, MD]

I can't really tell from your description whether this is acne, folliculitis, keratosis pilaris, or some combination of all three.  What I am sure of is that you aren't doing yourself any good by picking them off with a tweezers.  Please leave them alone and get a dermatologist's opinion.  I must say I'm a little skeptical that what you first had was acne, since 1 pill of Accutane per week is too low a dose to do much of anything.  But whether it was acne then or not, it isn't necessarily that now.  Leave it be and check it out.

Best.

Dr. Rockoff