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.
Best regards,
Dr. Joanna Chan
