Chronic recurrent acne vulgaris

History of acne vulgaris for past 9 years. History of oral retinoic acid- twice, history of allergy to topical retinoic acid, now came with the complaints of multiple small pustules over right cheek and forehead along with aggravated acne vulgaris (like big hard swelling). O/E acne over shoulder is noted. Scalp examination doesn't show dandruff as he takes regular hair wash. H/O similar episode 3 months back, microscopy done, adviced topical benzoyl peroxide, had allergy and skin exfoliation was given topical steroids. History of topical facials, steaming and icing done at home for past one month. Weekly once microneedling (0.5mm) at home for 1 month. Diet, water are taken as required. Uses Cetaphil cleanser or homemade coconut oil soap as per his wish on his face, as he feels the cleanser doesn't remove the sebum enough as he goes to gym and dance class. Sleeps at 12. Not uses sunscreen, benzoyl peroxide or clindamycin as he feels that he is only in home during lockdown. What's the source of infection? What would be the line of management to get good & permanent control of his acne.

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Saslic DS forming facewash twice Clindaycin + Nicotinamide oint. Clarithromycin 500mg OD

In very severe cases, lower initial doses in addition to oral corticosteroid medications may be needed. However, more recent studies have demonstrated that higher cumulative doses that exceed 200 mg/kg may be more effective to reduce the rates of acne relapse and retreatment .

? NODULAR ACNE. NEED'S. CLARITHROMYCIN..500MG..DAY ISOTRETOIN 20MG DAILY.. TOPICALLY CLINDAMYCIN ADAPALENE OINTMENT..

Tab Zithrox 500 X 5 day Such 3 cycles with a gap of 10 days Clindac A gel locally

Azee500 mg od1 month Clindamycin oint bd

Rx clindac A gel Aluderm ointment