Is there anything I can do about resistent acne on the neck?

I am a 30 year old female living in the south. I am having a problem with breakouts on my neck(not the jaw). When they do go away I am left with a red discolored mark. I was put on 25mg of spironolactone in August and in November it was increased to 50mg. At the end of November I also started using Atralin on my neck every 3rd night. It did get slightly better meaning they aren't lasting as long and are not getting as big but I am still getting pimples. I've had 3-4 small ones come up in the last week! The new ones come before the marks from the old ones go away. Please let me know if there is anything else that should be done. Also, how long do the red marks last? I was told it wasn't a scar. This is my routine for the neck: Wash with Cerave foaming cleanser at night, apply atralin every 3rd night, finacea and glycolix elite sunscreen or cerave spf 30 moisturizer during the day. It's sooooo embarrasing and it's really messing with my confidence! Sorry for the long.

You bring up several good points. The most common evolution of acne over a 10-15 year period is from the center of the face (“t-zone”) gradually moving out to the lateral areas on the cheeks and then, toward the end of it’s mysterious cycle, down onto the neck. I’m guessing you didn’t have it in this area when you were 16 (always exceptions though). The good news is that you may be getting closer to the end all this.

Here are some thoughts about things to discuss with your doctor/dermatologist:

  • Can you increase the frequency of the Atralin or, if that’s too irritating, change to something that’s less irritating that you could use every night (lots of options ?
  • Your spironolactone dose is  low – more common is a dose in the range of 75-150 mg – could that be increased without risking side effects?
  • If you pick at these, should a bacterial culture be done to make sure you now aren’t infected with a Staph bacteria in addition to the acne?
  • An interesting antinflammatory cream (not a steroid so won’t thin the skin), is Biafine – can be helpful to reduce redness more quickly.

For more information on acne, check out the following guides:

Acne in Depth

Acne Scars and Scars in Depth

Common Acne Terms

Seeking out a good dermatologist is important. For tips and information about how to find a good dermatologist, check out our article Tips to Find A Good Dermatologist.

Just some thoughts and hope this helps,

Dr. I

Dr. Brandith Irwin, MD

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