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But here is my recommendation based on current guidelines and will work if you get the prescriptions from your doctor:
Hormonal acne is caused by excess sensitivity of the skin to androgens There is also increased oil production in the glands and bacterial infection in the glands causing severe eruptions and inflammation. Treatment requires combination approach as detailed below:Over the counter options:1. Benzoyl peroxide 5% cream can be applied daily over the affected areas daytime. and 2. Adapalene gel ( Differin) can be applied at night time to reduce inflammation and scarring. Treatment needs to be continued for at least 12 weeks. Please avoid milk products as much as possible and also avoid refined sugar in your diet --they both can cause acne flare ups. If you do not see any improvement after 12 weeks of above regimen, it is time for you to see local dermatologist for prescription treatment. Following topical prescription regimen can be tried:1. a topical antibiotic gel like clindamycin % gel.If you already tried this before with no response, then next option is even stronger Dapsone 5% gel to be applied twice daily. While using dapsone avoid using benzoyl peroxide cream or face wash form as they together can cause orange or yellow discoloration of skin and hair.
2. Tretinoin A 0.05% cream can be added at night time as well. Nowadays, there is an anti androgen topical cream applied recently called Clascoterone 1% cream --can be applied twice daily over the severe lesions.
Lastly, You will need to consider oral regimen if all topical options fail ( very unlikely case).Oral Spironolactone in women and Accutane in men and women are reserved for resistant severe cases.
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