Nodulocystic Acne with Urticaria with Dandruff

A 16 year old male, a student of Class 12th Chief Complaints Complaints of excessive itching in scalp, lesions over face and spontaneous eruptions of itchy lesions over body which resolves on its own Physical Examination Overweight, weight is 78kgs Management I had started him on - Tab Isotretinoin 20mg OD, Tab Montair Fx after dinner, Tab Levocet 5mg after breakfast, Benzoyl Peroxide 2.5%twice daily For dandruff, to apply candid B lotion over scalp followed by shampooing with Keraglo AD twice weekly in first 2 week He has been relieved in his dandruff issue a lot, but mild relief in Acne after two weeks of below treatment and still has urticaria persisting. I am planning to increase the isotretinoin dosage to 20mg BD, benzoyl peroxide 5% twice daily and put him on bilastine 20mg morning an montair LC at dinner time. Kindly guide me further especiallg for Acne and Urticaria

(Edited)

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Dear Dr Ajit Singh After reading answers from my  colleagues, there is hardly anything to add about Acne vulgaris. In any modalities of treatment chosen by clinician, the result varies from patient to patient. 2 plus 2 may not be 4. Oral antibiotic like DOXICYCLINE or AZITHROMYCIN. May require periodically for few months. Locally CLINDAMYCIN, BENZYL PEROXIDE etc are useful. Once inflammatory lesions subside, use of local ADAFERIN gel with or without antibacterial will help in preventing new lesions. The patient is just 16 years old. One may need to manage recurrences for few more years.

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Dr.Ajeet Singh.., For NODULOCYSTIC ACNE needs surgical correction... Medical treatment will give only 30 to 40 % results... Here the drug of choice is ISOTRETINOIN 20 mg for 4 weeks... Cap vit E with omega fatty acids... Surgical correction is... First do COMEDONE EXTRACTION with ELECTROPORATION...to remove the debris and solid pus in the nodules.... By using PEELS....JESSNER PEELS in the combo pack ...keep on both cheeks for 3 mts and do MICRODERMABRASION.... will get smooth shiny and contour skin ..pits also reduced in this treatment... Morning SUNSCREEN ...matted technology is preferably... Night AZELAIC ACID 15% topical application is the best and after 2 hrs ..better to wash to avoid further irritation... Antiacne face washes... beneficial..

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Since pt is overweight and may be obese as well First of all she should be asked to lower the weight and reduce BMI Manage diet to avoid fatty and junk food responsible for obesity and weight and thence harmonal changes To get good results in acnes diet weight and obesity to be managed by regular exercises and yogas Since these are nodular acnes need antibiotics like azithromycin or clindamycin orally as well as locally Review after 3months Some of nodular acnes will need expression

Thanx dr Pranab Bera
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NEED'S.. * CLARITHROMYCIN..500MG.. * ISOTRETOIN 20MG DAILY .. * ZYCLIN NANO OINTMENT.. * BILASTINE 20MG OD.. * CANDID TV .. SHAMPOO.. * PEELING WITH EXPERTS OPINION..

Tnx &wc Dr Ajeet Singh
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Dx-seborrhic dermatitis with Acne. Rx-1-Triben AD shampoo locally daily for scalp wash.then twice weekly. Tab elarmin SR 1-1. Cap Ravedox LB 1-1. Clid gel locally after mouth wash. Tab zix-p 1-1. Tab becoplus 1od ×10 to 14 days.

Doxycycline 100 mg cap 1 bid,followed by 1 OD.x 10 days. Keta console hair shampoo..Once a week.x 3 weeks. Allegra 180.mg 1 tab OD.x 7 days. Salicylic acid + Benzyl peroxide + Resorcinol..Application. B Complex cap.1 OD. Ivermectin 6 mg +Albandazole 400 mg.1 tab OD , weekly x 2 weeks. If needed Corticosteroid for shorter span as par withdrawing protocols.

Benziturn 5% apply morning nd night Benz+ clinda soap Isotretinoin 20 mg od for 20 days TAB AZEE 500 od for 3 day(for 1st 10 days) Then follow by next ten day CAP DROXICYCLIN 100mg od for 10 days Acne in forehead main reason is dandruff So rx for dandruff Mojosalic lotion nd Ketocip shampoo If there is itching present then give also l dio 1 od

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Doxycycline 100mg OD also works well. But has to be taken for about 6 months daily.

I am agree with@Dr. Kute Ankush Sir.

Treatment is ok just add Dazit-m tablet Tablet levosiz 10 Epilyno lotion apply on Face Max Rich moisturizer apply whole body Blood for Total IgE absolute eosinophils tc dc