Complications with Acne treatment

I've been suffering acne for some years now. It's only bad around my nose and on it. They get VERY inflamed and look very ugly and large.
The first time I was treated with oral antibiotics and topical antibiotics which included topical clindamycin. I had a horrible reaction to the oral antibiotics, and ended up being treated for toxic hepatitis.
I only used the topical antibiotic afterwards, after having approval by my general practitioner.
Of course, the acne went down, it took months. However it started all over again. After a change in antibiotic gel, it calmed down for a year. Until a very large bump showed up recently. The dermatologist gave me a steroid injection, which decreased it in about a week. It came back out three weeks after.
Another dermatologist prescribed dapsone 50mg for two weeks, and half of the dosage two weeks after. Of course, four days into treatment, the toxic hepatitis arose. The doctor asked before for a liver function test, everything was normal.
What treatment should I speak to my dermatologist for the bump? It's been about a month, and it has decreased 3/4 it's size, it did break the skin and only blood and water came out. Should I ask for a topical gel instead, or is there a different type of antibiotic pill? Dapsone, or any other related antibiotic is restricted for my use. My dermatologist is highly against surgery.

[Bhupinder Kaur, MD]

Hello,
Firstly we need to confirm whether it is an acne or a small cyst. It is filled with a soft, whitish brown material that sometimes oozes out onto the skin's surface. This material is called sebum. Treatment includes small surgical opening into the skin and removing the sac (excision biopsy). But recurrence is quite common. I suggest you to get the diagnosis confirmed from a dermatologist after examination.

I hope it helps. Take care and regards.