Problem with acne/inflammatation around chin

[danhayes]

http://img393.imageshack.us/my.php?image=picture012croptl2.jpg
http://img293.imageshack.us/my.php?image=picture016cropgv4.jpg
http://img463.imageshack.us/my.php?image=picture014cropwh5.jpg
See pics. The spots (many have a hair coming out) pretty much stay there permanently. They been around months but got real bad a month ago. Putting retin-A on made it much worse giving massive whiteheads and cysts. After stopping it reverted to how it is now. The area is pretty dry, a little scaly, itchy and quite red.
It started in the left corner of my mouth (where I once had a massive cyst) and little spots started popping up and were especially visible if you pulled the skin. There are now plenty all over my chin, particularly in the crevice in the middle. Sometimes there are whiteheads but these are more like scabs. I get quite a lot of big spots on the corners of my mouth (esp. the left)
I saw a derm a month ago. He said it was acne and put me on accutane (my 4th dose). Its done nothing so far. This is different to the acne I'm used to. He suggested 2mg/kg/day but I'm on 1 now to avoid a bad breakout.
I've read about perioral dermatitis and have started using a non SLS toothpaste but no effect so far. I have no spots above the lip. Someone mentioned using keteronazole (nizoral) but that has SLS in. I tried azaleic acid, it did nothing. My derm prescribed daktacort but that has a steroid in it, I read these can make things worse.
I was on Azathioprine (autoimmune hepatitis) for 2 years till a month ago. I haven't had steroids for AIH in 9 months. Liver functions are fine.

[Alan Rockoff, MD]

I can't really tell from your description or the pictures.  As near as I can make out, you have a form of acne, in which case a steroid would not be the best choice.  On the other hand, your dermatologist sway you in person and I didn't.  If you are picking or tweezing any of the hairs you describe, you must stop.  Beyond that, you are going to have to rely on advice in person.  Internet research is not likely to get you anything more than confused.

Good luck.

Dr. Rockoff

[danhayes]

what form of acne?

[danhayes]

from my hours of googling I think this could possibly be "sycosis barbae" but I need an expert like you to confirm that.

What can I do for this? I have some bactroban left over from a previous folliculitis on my pubic hair about 5 months ago. Can I use that. I am concerned about using oral antibiotics as they have been known to flare up AIH (which I had, apparently due to taking finasteride/propecia). Will Nizoral help? What about the daktacort?