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I´m 32 yo, I had cystic acne as a teenager.. required two cycles of Accutane at ages 21 and 23. After that I has had problems in my scalp and also face. I think that I have a mild-severe acne in beard area persistent papules occasionaly pustules, not a real problem. The real problem is in my scalp, in the posterior part of my neck always have almost a dozen of lesiones, papules, pustules, they itch a lot, sometimes are painful. I have tried almost everything:

1. Topical antibiotics: Clindamycin, Erythromycin

2. Oral Antibiotics: Tons of doxycycline

3. topical steroids: from hydrocortisone to clobetasol

4. daily wash with Acetyl-Salicylic Acid (ASA) 2%

5. Antidandruff shampoos like Selsum-Blue or Neutrogena.

I don´t know what else should I do.. Derms doesn´t help much...

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Maybe ingrown's? You ever run a razor up the back of your head?

I would try letting your hair grow out a bit and see if that helps. Look painful

and odd its only coming in at that spot

Edited by Zraden
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Try to find a shampoo without sodium lauryl (or leureth) sulfate. Both are common skin irritants and found in most commercial shampoos. Finding a shampoo without SLS helped my scalp a lot.

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Dry Scalp is a common side effect of accutane users and yes it could be permanent. We all know dry skin= breakouts. Same thing goes for your scalp. Just research it I'm not lying. If its not that then it could be ingrown hairs, I use to get them from shaving ever since I stopped shaving I don't get them anymore I just trim as short as possible.

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Might be folliculitis (infected hair follicles). I suspect fungal variety since many of the items you list are antibacterial and they didn't help. I used to have it. Using an antifungal shampoo with ketocnazole every 2-3 days made a major improvement (1% OTC Nizoral or 2% Rx shampoo). It completely cleared when I also switched to a sulfate-free, paraben-free shampoo on the days when I didn't use ketoconazole shampoo. Don't expect instant results, might take a couple months. Maybe let your hair grow out a little. Trimming it short could cause some irritation.

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I dealt with this exact condition for about 15 years. My dermatologist had me on "maintenance" antibiotics for more than ten years. They helped a little, but not much. I tried everything I could think of including diet changes, different soaps and shampoos and topical medicines. I finally came up with something that works for me. Here is the formula:

Using plastic or glass measuring tools, place one tablespoon of 88% lactic acid in a measuring cup. Add distilled water to make one cup. Stir and pour the mix into a squeeze bottle. (I use a plastic condiment bottle like you might use for ketchup--purchased at Wal-Mart.) Add one teaspoon of salt and shake until salt dissolves. Massage this liquid into scalp and face twice each day and allow to dry.


1) 88% lactic acid can be obtained from Amazon. Search on "Lactic Acid for Brewing"

2) I use Morton's Canning and Pickling Salt. It's just plain salt without any additives (not expensive)

3) Use distilled water. Other types of water will have minerals that may counteract the lactic acid. It's less than a buck a gallon at Wal-Mart

The mixture causes a "pins and needles" kind of stinging while it's wet--especially if you do it right after showering, but it's not too bad. It takes time to work. I noticed some changes fairly soon--less swelling, fewer flare-ups. After about a month, I quit my antibiotics. The acne got a little worse for a few days, but then began to improve again. After four months, the pimples and cysts are completely gone. I still use the solution once or twice a day, but sometimes I forget. I will eventually try stopping of a few weeks to see if it comes back, but I haven't tried that yet.

So, how did I come up with this mix? My idea was to mimic an old-fashion pickling solution. Vegetables, like cabbage (sauerkraut), are pickled by submerging them in salted water. The salt inhibits the "bad" bacteria, but the lactic acid bacteria tolerate salt well. The lactic acid bacteria thrive in the mix and produce lactic acid. The acid further inhibits "bad" microbes. Skin is naturally acidic and salty, but we constantly wash away the salt and expose the skin to alkaline substances like soap and pool water. The solution restores the acid and salt to the skin, making it a bad environment for "bad" microbes. Over time the bad microbes die out and the "good" microbes take over. That's my theory anyway, but either way it works for me.

Edited by Oscor
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