View Full Version : acne questions

05-25-2009, 03:16 PM
Some questions for dermatologists on the board. I'm not looking for treatment advice, but for things I should be asking my dermatologist when I go see her. I don't have health insurance and as a result appointments are expensive, so I want to go maximally prepared.

I have a few blackheads (mostly on the nose) and one or two whiteheads, but most of my acne lesions are deep, painful and full of pus. I usually have about 5 or 6 of these (some emerging and some receding) at a given time. Currently I have an especially large one on my cheek that's about a cm in diameter, and a smaller but more painful one on the edge of my lip (that ridge where liner goes).

I'm 24. I've had acne since I was in middle school, although I couldn't tell you if the type I've had has changed since then. I've been on three cycles of Accutane, and while everything cleared up while I was the drug, it would return several months after the end of treatment. I've also been on long-term doses of tetracyclines, particularly minocycline since that seems to get rid of the swelling and about 90% of my acne. I'm wondering if I should ask my dermatologist to culture whatever's in one of the pustules, because I suspect Gram-negative folliculitis. I know Accutane is usually considered a solid treatment for GNF, but I've always taken antibiotics concurrently with Accutane and after the cycles have ended, so I'm guessing that my skin was primed for recolonization after my sebum levels kicked back up. I've also had a fresh ear piercing become infected with Klebsiella (I don't know if this fact is relevant to anything, but I know K pneum. is one species associated with GNF) although I'm hesitant to conclude anything since I was in the rainforest at the time being rather filthy, among other things.

I stopped minocycline treatment (which appeared to work) a few months ago, and as expected, everything came back. I'm also on topical Differin (does nothing, as far as I can tell, but still applying after 4 mo) and 2g oral niacinamide daily. I'm not sure if the niacinamide is helping, but I notice that my cysts rarely come to a pus-filled head anymore. Rather they're angry for about a week and then scab over and disappear.

Anything I should definitely ask about? Advice?

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