What is the best treatment for forehead acne? (photo)
I’m a 20 year old female who started getting pimples 2 years ago. I get tiny to moderate sized pimples that are pus filled. One goes and another pops out elsewhere. It never stops. They leave behind PIH. They are concentrated on my forehead. BHAs, benzoyl peroxide does not work. Doxycycline worked, but after I stopped, the pimples came back. Can any doctors please advise on my acne situation and advise on the best treatment for me?
From the photograph provided, you appear to have both comedonal (whiteheads, blackheads) and inflammatory acne associated with post-inflammatory hyperpigmentation (PIH), as you have rightly pointed out.
I generally start by explaining to my patients the 4 major features of acne. In short,
1. excess sebum production (usually a result of hormonal influence)
2. formation of comedones
3. colonization with the bacteria P. acnes
4. inflammatory process, which is also the process that leaves PIH.
You mentioned your acne tends to be on your forehead; this could point towards an excessively oily T zone, which is common in oily and combination skin types. In addition, there is a subtype of acne, known as pomade acne, which is acne on the foreheads, temples and hairline, due to the use of certain hair products.
As for treatment options, as other doctors have pointed out, a treatment ladder (i.e step-wise approach) and combination treatment are commonly used to best target each individual’s factors contributing to his/her acne.
Topical retinoids, azelaic acid, benzoyl peroxide, systemic antibiotics such as doxycycline, erythromycin and trimethoprim, hormonal medications, and isotretinoin are just some of the common medications used to target acne. In addition, daily skin care products such as a suitable cleanser, toner and moisturizer play an important role as well. Each individual will need a customized, tailored approach and there is no one-size-fits-all method to treat acne.
I would suggest you see a trusted doctor to determine your type of acne and help you identify certain factors/triggers that may play a part in your acne condition, before embarking on a treatment plan customized by your doctor.
Dr. Joanna Chan
Hi Troubled, acne is indeed a bothersome but controllable affair. Most of the time it is about proper skin care and control until the sebaceous gland activity settles but this can take several years.
Do refer to my previous post here: Treating Acne for managing acne.
Control of recalcitrant acne typically requires continued use of the topical creams that you have mentioned above - Benzyl peroxids, BHA /AHA toners, Differin, antibiotic gels etc - and intermittent maintenance procedures such as chemical peels and lasers to help with the acne and PIH.
The more definitive solution would be the use of oral isotretinoin, but we try to reserve that for last due to its potential list of side effects.
Do not hesitate to arrange for a proper consultation to explore possible options; the earlier the acne is controlled, the less the scarring that themselves require treatment later.
Dr Shane Tan
There are several effective and proven methods of dealing with acne.
- Topical antibiotic gel
- Topical retinoid
- Chemical peel (salicyclic acid 20% to 30%)
- Oral medications (COCP/ Spironolactone/ Isotretinoin)
For stubborn cases, you can start with a combination treatment initially and slowly wean off the oral medications. Every treatment has its own pros and cons so speak to a doctor to find out what is the best approach for you. Do ensure adequate sun protection to reduce risk of PIH. Hope this helps.
Dr Jiwei Wu