[30F] With persistent facial acne and non-healing scars

Patient Description

A 30-year-old female has been experiencing constant pimples on her face for the past 5 months. Typically, she has between 3 to 4 pimples at a time, which appear red, inflamed, and sometimes have whiteheads. The patient reports that her acne scars do not heal. She has not found any treatments that help to reduce or relieve her acne and has not consulted a dermatologist. Her daily skincare routine includes face wash, moisturizer, and sunscreen. She has not noticed any specific triggers such as certain foods, stress, or hormonal changes that worsen her acne. The patient is not currently taking any medications, including birth control or other hormonal treatments, and there have been no changes in her diet over the past 5 months. She mentioned being exposed to new skincare products, makeup, or environmental factors but did not specify which ones. Additionally, she has no history of pre-existing conditions or chronic illnesses. The patient experiences dryness on her face and reports itching or pain when applying acne cream. There have been no changes in her menstrual cycle or other hormonal changes recently, and she does not have a family history of acne or other skin conditions.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your persistent acne and non-healing scars:

  • Acne Vulgaris: This is the most common type of acne, characterized by red, inflamed pimples and whiteheads. It can be caused by a combination of factors including excess oil production, clogged hair follicles, bacteria, and inflammation. Persistent acne can sometimes be more challenging to treat and may require a combination of therapies.

    • Treatment: Typical treatments include topical retinoids, benzoyl peroxide, salicylic acid, and antibiotics. In more severe cases, oral medications like antibiotics, hormonal treatments, or isotretinoin may be prescribed by a dermatologist.
  • Post-Inflammatory Hyperpigmentation (PIH): This is a common condition where dark spots or scars remain after the acne has healed. It is more common in individuals with darker skin tones and can take a long time to fade.

    • Treatment: Treatments for PIH include topical treatments like hydroquinone, retinoids, and chemical peels. Sun protection is crucial to prevent further darkening of the spots.
  • Dry Skin: Your mention of dryness could be contributing to your acne. Dry skin can lead to an overproduction of oil as your skin tries to compensate, which can clog pores and lead to acne.

    • Treatment: Using a gentle, non-comedogenic moisturizer can help balance your skin's hydration levels. Avoid harsh cleansers that can strip your skin of its natural oils.

What you can do

While it's important to consult a dermatologist for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Gentle Skincare Routine: Stick to a gentle skincare routine. Use a mild, non-comedogenic cleanser and moisturizer. Avoid products with harsh ingredients that can irritate your skin.
  2. Topical Treatments: Over-the-counter treatments containing benzoyl peroxide or salicylic acid can help reduce inflammation and clear up pimples. Be cautious with these products if they cause excessive dryness or irritation.
  3. Sun Protection: Use a broad-spectrum sunscreen daily to protect your skin from UV damage, which can worsen acne scars and hyperpigmentation.
  4. Avoid Picking: Try not to pick or squeeze your pimples, as this can lead to scarring and worsen inflammation.
  5. Hydration: Keep your skin hydrated with a non-comedogenic moisturizer to prevent dryness and overproduction of oil.
  6. Track Your Symptoms: Use MDandMe to journal your symptoms, track your progress, and get insights. This can be helpful information to share with your healthcare provider.

What you should look out for

Reasons to see a dermatologist more urgently include:

  • If your acne is causing significant emotional distress or impacting your quality of life.
  • If over-the-counter treatments are not effective after several weeks of consistent use.
  • If you develop severe acne, such as cysts or nodules, which can lead to scarring.
  • If you notice any unusual symptoms, such as severe pain, swelling, or signs of infection.

Remember, while these tips can help manage your symptoms, it's important to seek care from a real health professional to receive a formal diagnosis and appropriate treatment.

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4 mo ago

People Also Ask


What are some common causes of persistent acne in adults?

Persistent acne in adults can be caused by a variety of factors including hormonal changes, stress, genetics, and lifestyle factors such as diet and skincare products. It can also be due to excess oil production, clogged pores, bacteria, and inflammation.


How can I treat post-inflammatory hyperpigmentation (PIH) from acne?

Post-inflammatory hyperpigmentation (PIH) can be treated with topical treatments like hydroquinone, retinoids, and chemical peels. Consistent use of sunscreen is also important to prevent further darkening of the spots.


Why might my skin be dry even though I have acne?

Dry skin can occur with acne if the skin's natural oils are stripped away by harsh cleansers or treatments, leading to overproduction of oil as the skin tries to compensate. Using a gentle, non-comedogenic moisturizer can help balance hydration levels.


When should I see a dermatologist for my acne?

You should see a dermatologist if your acne is causing significant emotional distress, if over-the-counter treatments are ineffective after several weeks, if you develop severe acne like cysts or nodules, or if you notice unusual symptoms such as severe pain or signs of infection.


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