Huge nodular pimples?

[LegginMF1]

Hi, I am a 37 yr old female who up until now has never experienced any form of acne, not even when I was a teenager. Starting about a year ago I started getting one white head somewhere on my face during the week before my period. It has progressed to something more I think.

Now at any given time I have 1-2 huge nodular pimples. They start out as a very sore and inflammed spot (so sore that I can feel them during facial expressions or when I talk) . They progressively get bigger over a period of 2-3 weeks and usually reach the size of a pencil eraser. They have a very definate form, you can feel the sac under the skin (just like a cyst) I do not pick at them until they start itching like mad and they will often spontaneously rupture. Then if I don't squeeze them they will just keep filling up and rerupturing. Once I start squeezing them they will produce copius amount of pus that is very dark almost has a greenish tinge to it. they will usually produce pus 3-4 times a day for up to 5 days before they will crust over. When they heal they do not leave a crater but they do leave a pigmented spot (whether I have picked at them or not)

I went to the dermatologist and was basically told to wash my face more often and to change my pillow case everyday. I followed his advice and frankly it's not working. I have rescheduled another visit and need to know what tests/ I should insist on and what topics possibilities I should cover with him. I had skin cancer and this guy basically patted me on the head and told me no honey it's just a mole. In reality it was squamous cell and it took me five monhts of badgering to get him to remove it and send it to the lab.. I need to be armed with some info on possible conditions to specifically tell him to test for.
I am trying to change dermatologist but you know the insurance nightmare. Seems he's part of the group and I have to be referred and it takes 3 mos to change Drs and the next closest one is like 90 miles away so for now I'm stuck with him. Jody

[Alan Rockoff, MD]

I would guess that you have adult acne, which is not as unusual at 37 as you might think.  It takes more than washing better and changing your pillowcase to treat this.  The only test that might be relevant is a bacterial culture.  From your end, leaving the bumps alone an d not squeezing is hard, but crucial.  Treatment may include oral antibiotics, creams, and injections of cortisone.  

It's important to have a doctor whose judgment you trust, so I would set in motion any actions that will get you to that place as soon as possible.

Best.

Dr. Rockoff

[andreea]

I am a 19 year old female and I suffer from nodular acne too on the face and on the back.  My derm told me that a bacterial test isn't necessary as acne isn't an infectious disease. He put me on Ro-Accutane and Isotrexin instead. One of my nodules got infected however and he drained it and put me on antibiotics for ten days to avoid further infection.
I was wondering if a bacterial test might be a solution, in spite of my derm dismissing it and whether draining it was a good choice.(it had gotten quite big, the size of a quarter of a ping pong ball). Maybe you could help me with some advice :)