ASK THE DOCTOR – Acne is a scourge for many… my latest post.

Question: “For as long as I can remember, I have suffered with such bad skin. Lots of girls my age (29) complain about spots or blemishes which annoys me as I suffer with near enough boils on my face. They come up like lumps, feel like bruises and nothing I do gets rid of them. I cleanse, tone and moisture my face daily so my skin is extra clean so it’s not from dirty pores. 

My wedding is coming up, and I just don’t know what I can do anymore. No amount of make up covers them, and I don’t want to go into my thirties looking like a teenager with spots, or boils in fact. 

Right now, I have 5 on my face and 4 on my neck, and they’re not only unsightly, but sore too. I’ve also been on the pill for 10 years and wonder if this is contributing to it?”

2Dr Mukesh: 

I sympathise with you as this is a common enough problem found in men and women, it is unsightly and quite painful physically.

The simple truth is that there is no regime of skin care that you can do that will stop it. If I am correct without having actually examined your skin and taken a proper medical history it sounds very much like Acne Conglobate or Cystic Acne.

Acne Conglobata is a type of acne that leads to cysts under the skin which are painful and inflamed. It can affect the face and other parts of the body such as the neck and back or chest.

There is hope though, you need to go to your GP and ask to be referred to a Dermatologist as the treatment of choice is Roaccutane plus or minus long term antibiotics. Sometimes I will even inject the cysts with a special steroid that makes them shrivel up quickly and lessens the scarring left when the cysts burn out.

Sometimes changing your pill to one which has Cyproterone Acetate in it can help too, but as you said you’ve always had bad skin. I would just get on with getting to a doctor who specialises in skin now as your wedding is close and time is not on your side unfortunately.

The official advice is summarized below:

What is acne conglobata? Acne conglobata is an uncommon and unpleasant form of nodulocystic acne in which there are interconnecting abscesses and sinuses (channels under the skin). These result in unsightly hypertrophic (thick) and atrophic (thin) scars. There are groups of large macrocomedones and cysts that are filled with smelly pus.

Acne conglobata is occasionally associated with: Other disorders associated with follicular occlusion, particularly hidradenitis suppurativa, a condition in which similar boil-like lesions and scars occur in the armpits, groins and under the breasts.

Nodulocystic acne may very rarely be a manifestation of a genetic disorder, PAPA syndrome.

What is the treatment for nodulocystic acne? Treatment of nodulocystic acne can be challenging and may require a combination of medicines. Topical treatment is usually ineffective.

The recommended treatment for nodulocystic acne is isotretinoin (Roaccutane), which should be commenced early to prevent scarring. The treatment is required for at least five months, and further courses are sometimes necessary.

Patients with acne conglobata often need additional treatments, such as:

  • Oral antibiotics
  • Intralesional steroids
  • Systemic steroids
  • Hormonal therapy in women

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About Dr Lalloo:

Dr Lalloo is qualified from the Royal College of Surgeons in Dublin, and has a fellowship in surgery from the Royal College of Surgeons Edinburgh. He is a fully qualified GP with an interest in skin surgery and dermatology. His registered qualifications with the Irish Medical Council are MBBCh, FRCS Edinburgh, MICGP. Dr Lalloo is on the specialist register with the Irish Medical Council.

Dr. Lalloo is a recognised expert in medical aesthetics having establishedCosmedics Clinic in 2002 when medical aesthetics was in its infancy in Ireland. He is a member of the British College of Aesthetic Medicine and on the committee of the Primary Care Surgical Association.