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As Dr Chua has eluded, moisturising your skin is important, even more so for oily/combination skin types because it can help reduce sebum production preventing acne. May I suggest moisturising your skin after toning, both morning and night. That being said, if your current skin care regime has worked excellent for you, you may want to stick to status quo. (: With warm regards.
The dosage of injection of steroids is very low. However, if you keep having shots very often, there will be issues such as skin atrophy (dents, loss of skin color) and skin thinning. Please re-evaluate your whole acne treatment regime to reduce such occurrences! Here are a few questions to consider: Do you get big cystic ones just before periods? If so, a daily contraceptive pill to regulate your hormones will be good. Are your nails long and do you like to pick at your face? Lots of bacteria are hiding underneath your nails. Do you have lots of body hair? Irregular menses?
Good questions! I agree with Dr Chua’s reply on the pros and cons of Fractional CO2 lasers versus Infini RF. In addition, I would like to address your question on the ideal length of time between subcision and Infini RF treatments. The ideal interval between treatments is 4-6 weeks. This is to allow for adequate skin recovery. Hope that this answers your questions!
With regards to your question: Fractional CO2 lasers generally penetrates deeper than Erbium lasers Fractional CO2 lasers also generally penetrates deeper than Fractional RF devices EXCEPT Microneedle RF machines that can reach a depth of 3. 5mm (only in some machines) which in this case will have a greater penetration depth as compared to Fractional CO2 machines.
2 weeks would be a tad early to stop the treatment, as mentioned. A course of antibiotics usually takes at least 3 – 4 months. Sometimes, Differin can cause an initial outbreak during the first month or so and if it causes excessive dryness, irritation and flaking of the skin, I would advise using it once every 3 days first and then slowly increasing the frequency to daily. If you have cystic acne, I would advise draining the cystic acne and consider injectable steroids so as to arrest the inflammation and swelling. This will decrease the risk of subsequent scarring.
I agree that seeing a gynaecologist directly might make the most sense as regardless of history taking by the GP, the ultimate confirmatory diagnosis is still ultrasound of your ovaries. They would be better placed to discuss with you on treatment modalities.
These appear to be small box scars and would benefit from skin resurfacing. Needle subcision and collagen stimulators can help complement laser treatment as well. The costs involved depend on the centre you go to but usually starts from 300 and above for a single session of either treatment. Effects are usually seen after 2 to 3 weeks from first treatment since it is dependent on collagen remodelling. Sometimes the results can appear so gradually the individual may not notice any obvious improvement.
PRP at the present moment is not available in Singapore. It does help with acne scarring though, and you might have to go to neighbouring countries to do the treatment (including Malaysia). Having said that, you can consider Rejuran/skin boosters/microneedling that can help in a similar fashion. Your 2nd question on which is better — it depends on the severity and type of scars. But usually Fractional laser is the backbone of laser therapy. So consult your doctor early to discuss the available options.
I know how frustrating it is to face the issue of persistent acne. There is no real evidence that skin gets resistant to topical products but obviously anecdotal accounts would suggest otherwise. To cut it short, it sounds like you might need some oral medications like doxycycline or isotretinoin to improve the acute flares first, while using a appropriate skin regimen. From personal experience myself, when facing a flare we tend to overdo things, be it using OXY 10 five times a day and having chemical burns, or washing our face 10 times a day.
There is a cumulative therapeutic dose in the range of 120mg – 140mg/kg that some doctors adhere to in the bid to reduce the relapse of acne. Sometimes, doctors may prescribe lower doses (with lower side effects) until the acne has cleared and continue the course for a few more months after. It really depends on the prescribing doctor as each has his/her own protocol. If you find that you are still having relapses with lower doses then discuss with your doctor the option of a course to achieve the therapeutic accumulative dose.
Dr Theng has answered you wonderfully. And yes hormonal acne can be a common cause of back acne. You may need to advise us further on whether you might be on any meds that throw your hormones out of whack. You can treat it like face acne, and I have used a combination of acne topicals and chemical peels/laser treatments for my patients with back acne conditions.
To address your questions: 1. Generally subcision (I assume with some collagen stimulators) will lead to collagen stimulation, and this is also what CO2 laser aims to do. Some experts suggest that an interval of at least 4 – 6 weeks is kept between each collagen-stimulating treatment for optimal results. There is no real good answer – as social downtime and other considerations have to be taken into account by the doctor in recommending the treatments. My personal preference though is not to stretch the treatment too wide apart – 6 months does seem to me to be a little long.
Thank you for your question. A skin cyst or nodule is classified based on the content of the lesion. If you don’t have acne on your face or back, it is less likely the 2 cysts are cystic acne. From what you have described earlier, the remaining cyst content is soft, and doesn’t resolve after 2 months. My top suspicion would be an epidermal cyst. Epidermal cysts are benign and often found on the trunk, head and neck. They contain smelly sebaceous and keratin materials, and can cause acute inflammation when they are irritated. Regardless of the cyst content, 2 things you can do now.
With regards to your question, The number of sessions really depends on 2 main factors: How your skin reacts to the treatment. For some individuals, good results may be seen after 3 sessions whilst others may require 6 or even more sessions. The depth of penetration of the laser. If mild settings are used then more sessions may be required and results may not be as satisfactory. Additionally, as Dr Chua CY has pointed out, combination treatments usually yield more effective results. I personally do not usually just stick with one kind of treatment modality to treat acne scars.
It sounds like you are suffering from depressed (atrophic) acne scars. There are actually a few different subtypes: box, rolling and ice pick scars are all depressed scars. Basically a large range of skin energy-based devices can help to level them – there is an article on acne scar treatments on Human that summarizes these devices. Subcision, fillers and medical peels to free up scar tissue and enhance collagen growth over the scar areas can also help complement. Skincare is also important to prevent worsening of your current condition.