Appropriate Prescriptions?

[verticalrisings]

Since I turned 25, I started getting pimples here and there.  The acne worsened throughout the year into cystic acne on the cheeks when I moved overseas.  I lived overseas for a year, then moved back to the states, where all my acne disappeared for two months.  It returned again slowly, starting out with a small rash (which went away with Desonide Cream .05%), then milia/whiteheads all over my cheeks, and then red pimples with white pus spreading from my cheeks to my chin now.  My dermatologist diagnosed me as have moderately severe acne and prescribed me Doxycycline Hyclate 100mg 2x a day and Differin Lotion .1%.  I know this will take 3-4 months for results to actually show.  It's been about a month and I feel like my skin is still purging (still with red pimples and white pus), which is fine with me.  Although I trust my dermatologist and feel his prescriptions are working for me, my family worried that I am not improving fast enough and dragged me to see a second opinion just in case.  The second dermatologist worries me, as he rushed through the visit, barely looking up to take any examinations.  My family is insistent on me adding more ointments (that the second dermatologist prescribed) to my routine, but I am not sure if I should follow through with it.  The second dermatologist has told me my skin is red and in order to prevent scarring, to apply the following in addition to the Differin at night:

Morning: Clindamycin, then Hydrocortisone Cream 2.5%
Night: Differin, then Hydrocortisone Cream 2.5%
Continue with Doxycycline 100mg 2x day

I've read various reviews on using hydrocortisone cream for the face with people stating it thins out your skin and worsens acne symptoms.  I feel the Clindamycin is acceptable, but I am wondering if it is safe to use the hydrocortisone cream or if I should substitute it with desonide OR just skip those two ointments altogether?  I don't mind using Differin by itself if it comes down to it.  But, if these ointments do help with redness and scarring and is safe to use without making my skin worse, I will use it.

[Bhupinder Kaur, MD]

Hello,
It can be due to cystic acne. Cystic acne is the most severe form of acne. Cystic acne affects deeper skin tissue than the more superficial inflammation from common acne. Since they are severe, so systemic medications are usually required. The treatment consists of topical and oral antibiotics, tretinoin, oral contraceptives in females and Intralesional corticosteroid injections. Very severe cases may need excision and drainage. Also the treatment has to be taken for a long time so that relapses do not occur. You should follow the treatment of oral antibiotics like doxycycline but for the topical steroids you should consult your dermatologist and taper of the drug.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your dermatologist. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[mpthom73]

I've never had serious issues with acne, but in the last year, my cheeks and chin have broken out, a few times with cysts forming also.  I went back today, and asked her if there was anything we could do to reduce whatever was going on. This is my regimen that she gave me:

Morning: Clindamycin, then Hydrocortisone Cream 2.5%
Night: Epiduo, then Hydrocortisone Cream 2.5%
Doxycycline 100mg 1x day

Just thought I'd post to let you know my regimen was similar, and I found yours looking to see if it seemed like too much. I also read an article about hydrocortisone being unsafe for prolonged use, but I trust my dermatologist, so I'm going to stick it out. Hope it goes well for both of us!!!