Persistent Blemish on My Face Just Won't Go Away
(M21) I struggle with excessively oily skin and a tendency to perspire significantly. This, particularly when combined with lapses in personal hygiene, frequently leads to the development of rough, flaky patches around my nose, forehead, and chin, sometimes extending to my ears as well. My dermatologist suggested a regimen involving weekly fluconazole tablets, applying metronidazole gel nightly after a wash to help shed dead skin, and using clindamycin phosphate gel in the morning. He also recommended a glycolic acid face wash during my baths and on particularly oily days. Previously, I approached him regarding tenacious patches on my skin, and he exchanged the metronidazole gel for clobetasone butyrate and miconazole nitrate topical cream for a week. Initially, this treatment was remarkably effective, clearing away most of the troublesome skin, except for one small area of rough texture, which felt different—harsher and slightly elevated. I suspected it was unrelated and could be attributed to previous scratching in that zone when I wasn’t on medication. As time passed, I made sure to treat the area delicately, adhering to my theory about its scab-like nature. I used face wash to loosen it during rinsing, prepped the area before applying a layer of gel, and then left it undisturbed. Yet, rather than diminishing, this stubborn patch remained; by the end of my week with the steroid cream, the original lighter lesions began to spread from that spot, once more affecting my nose and forehead. At this juncture, my dermatologist suggested that his role was effectively complete and advised me to apply metronidazole and clindamycin gels during flare-ups. I followed this advice, resulting in some initial fading of the lesions. However, I was left once again with that persistent scabby blemish in the same location as before. Similar to the earlier episode, it shrank until it maintained a minuscule size for a day or two, only to have new lesions slowly emerge from it once again. What can I do to eradicate this stubborn issue? It's worth mentioning that since a week before starting the steroid cream, I have continued a consistent treatment routine without interruption. I wash my face during daily baths and whenever it feels excessively oily, apply clindamycin gel each morning, used the steroid cream for that one week after bathing, and apply metronidazole after baths on other occasions. The scab-like lesion is distinctly visible, appearing as a small dark spot on my skin, suggesting it differs from my other lesions.
Answers (1)
6/24/2025, 6:50:47 AM
OpenHealth AI
It sounds like you’re dealing with a persistent skin issue that can be frustrating, especially given your oily skin and previous treatments. A scab-like lesion that doesn't respond well to treatment may have several causes, such as an infection, a skin condition, or even a type of dermatitis. It's important to approach this systematically to see if we can improve the situation.
Explanation
Given your previous treatments and the persistence of this particular blemish, it may be that your skin is reacting to various factors such as oil production, irritation from products, or even underlying conditions like acne or a fungal infection. The way your lesion shrinks and then new ones appear could suggest that it’s responding to treatment but not resolving completely due to underlying issues.
Next Steps
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Simplify Your Skin Care Routine:
- Consider reducing the number of products used for a time. Over-treating can sometimes lead to irritation.
- Stop using Clobetasone butyrate and miconazole cream without further guidance. This will help assess if the steroids or topical anti-fungals are contributing to the issue.
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Focus on Hydration and Oily Skin Control:
- Continue using the glycolic acid face wash to help slough off dead skin but monitor how your skin reacts. You might choose to use it only 2-3 times a week instead of daily if irritation occurs.
- Use a non-comedogenic moisturizer to prevent excessive oiliness but keep the skin hydrated to reduce irritation.
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Topical Treatments:
- Continue with the metronidazole gel as directed after bathing.
- Use the clindamycin gel in the morning as per your dermatologist’s advice.
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Monitor Changes:
- Keep an eye on the specific area you are concerned about. Note any changes in size, color, or texture of the lesion.
- Avoid picking or scratching the area, as this can lead to further irritation and potential infection.
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Consider Trigger Factors:
- Evaluate if there are other potential triggers—such as diet, hormonal changes, or stress—that could be impacting your skin.
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Documentation:
- Consider keeping a small diary documenting your skincare routine, what products you use, and any flare-ups or changes in your skin. This can be very helpful if you need to revisit your dermatologist for further advice.
If the lesion does not improve or worsen, further evaluation may be warranted. You could ask your dermatologist if an alternative diagnosis, such as seborrheic keratosis or psoriasis, could be considered, or if a referral to a specialist is necessary.
Support
I understand how distressing it can be to see a persistent skin issue, and it’s commendable that you’re actively managing your skincare. Keep up the good routine, and don’t hesitate to seek further advice if your current approach doesn’t lead to improvement.
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