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Dr. Nair
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 8192
Experience:  MBBS, MD (Dermatology, Venereology & Leprology)
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I have these strange lesions on my face and a few on my upper

Customer Question

I have these strange lesions on my face and a few on my upper arms that just don't go away. When one begins to heal another will take its place. It looks like some kind of pimple but doesn't behave like any pimple I've had in the past. Each lesion has multiple pores clogged with white plug like seeds. They look like the hard seed core in a white head but with a white head they are easily extracted by applying pressure or with a comedone extractor and a white head only has one of these hard white centres.

The lesions I have on my face right now have multiples of these hard white seed like pore plugs and they are almost impossible to extract. The overall lesion is superficial but these whites things appear to be deep rooted, I say deep rooted as feel as though they are attached to something. The only way I have been able to extract them is by inserting a needled into the pore to loosen the white matter and then plucking them out with tweezers. They are painful and last for weeks. They do not seem to heal until I have extracted all of the white plugs. If I don't extract the white plugs they become more and more inflamed. The lesion itself does not bleed however once I have extracted a white plug there is lot of blood from the actual pore.

I have uploaded a photo of a lesion. The white plugs are extremely difficult to photograph however there are a few visible in the photo. http://i44.tinypic.com/24phvso.jpg

I have been to my local Doctor on numerous occasions. The first visit he said it was impetigo and prescribed antibiotics. The second and third visit he said I had a staph infection and on both occasions prescribed antibiotics. The last visit he said it was acne rosacea and again prescribed antibiotics. None of the antibiotics I have taken have made a difference and the lesions continue to plague my skin. I’ve never had acne, I’ve only ever suffered from the occasional pimple here or there but nothing serious and they always cleared within a few days and left no scarring.

Can you offer me any insight as to what this might be? I don’t know what else to do!
Submitted: 2 years ago.
Category: Dermatology
Expert:  Dr. Nair replied 2 years ago.
Hi,

The lesion in the photograh is traumatized. Can you please take some of other areas that have not been? Both face and arms if possible please. I don't mind waiting so you can do so at your convenience.
Customer: replied 2 years ago.
What do you mean by traumatized? This is a photo i just took of the same lesion as the previous photo http://i40.tinypic.com/vspgjs.jpg and this photo is of another another lesion http://i44.tinypic.com/14j9k07.jpg
Expert:  Dr. Nair replied 2 years ago.
Thank you for the new photographs. Just to confirm - these red sores develop from the white spots on their own and not after your attempts to extract them? If so are these spots painful? Do the sores heal with scarring?
Customer: replied 2 years ago.
They start off looking like a single blocked pore - a slightly raised blackhead except the centre is white and not black. After attempting to extract the single core without success, within hours multiple white cores appear. A very thin flat smooth scab layer forms which causes white puss to build up underneath and because the scab layer is so thin, it splits open has I move my face or peels off when I wash my face.

I am also unable to cover it with makeup as nothing sticks to the thin scab. On the rare occasion when I do attempt to cover it with makeup, I have to apply an extremely thick layer of concealer but after only a few hours the pus builds up breaking throughout the thin scab.

Surprisingly it doesn't seem to leave scarring but when it does heal over, you can still see the white cores just beneath the skin layer and within weeks its back again in the same spot. Its almost like it doesn't actually heal but just goes dormant for a while.
Expert:  Dr. Nair replied 2 years ago.
I hope you find our interaction helpful. If you are satisfied with my response(s) please remember to press the ACCEPT button.

Thank you for the information. I was thinking of vasculitis (inflammation of the blood vessels) but from the additional information you have provided this seems like Acne Excorie. The white spots sound like closed comedones. Acne with predominantly comedones is called comedonal acne. Acne Excorie results from patient's trying to extract this comedones. Here is more information on the subject:

http://dermnetnz.org/acne/acne-excorie.html

As far as treatment goes you really need to stop trying to extract these white bumps. For treating the white bumps I would strongly recommend discussing oral isotretinoin (Accutane) with a dermatologist in person. A 4-5 month course can take care of the problem. Regular acne treatment is not very effective nor are oral antibiotics.
Customer: replied 2 years ago.
I understand what you're saying, at first i thought it was acne as well but what i can't understand is why the core just will not come out and why are there so many in the one sore. As i mentioned previously, i've had the odd pimple before and using a comodone extractor the single core would come out effortlessly and they've healed within a few days. The multiple cores is these just do not come out and the most number of sores i've had on my face at any one time is 3 - 4. If it's a form of acne shouldn't there be a lot more eruptions?
Expert:  Dr. Nair replied 2 years ago.
I hope you find our interaction helpful. If you are satisfied with my response(s) please remember to press the ACCEPT button.

No not necessarily. Comedonal acne can have very few lesions on the face and all of these can be just the white bumps that you have described. There may or may not be any typical pimple or zit.
Customer: replied 2 years ago.
Is there anything else it could possibly be? I've read the information you provided and whilst i do agree that my attempts at extracting the white solid cores do contribute to making the sore red and angry, i don't continue to 'pick' at it once they're gone.

I've also got 2 on my forearm, I've never heard of acne on a persons forearm. My sister had acne so i'm aware of what it looks like. I've also never heard of any type of acne which is near impossible to remove the hard white centre core. Also, don't acne comedones have one central core? The sores i have have multiple pores clogged with hard white stuff that just does not come out. It often pokes out of the pore but it still so difficult to remove. Even when i grab with tweezers, it's still difficult to remove. It's like it's attached to something and often it breaks off with the root part remaining in the pore.
Expert:  Dr. Nair replied 2 years ago.
I hope you find our interaction helpful. If you are satisfied with my response(s) please remember to press the ACCEPT button.

Well the only other thing I can think of, and this is regarding the lesions on your forearms, is Keratosis Pilaris. Regarding the multiple comedones in one bump - these are known as polyporous comedones and can occur in acne.

I think the simplest way to get a definitive diagnosis would be to request a skin biopsy from a representative lesion. You would need to discuss this with a dermatologist. If not then a therapeutic trial with oral isotretinoin will be the next best option. Regards.
Customer: replied 2 years ago.
So you think it's Acne Excorie on my face but Keratosis Pilaris on my arms?
Expert:  Dr. Nair replied 2 years ago.
I hope you find our interaction helpful. If you are satisfied with my response(s) please remember to press the ACCEPT button.

Yes possibly. Acne is common on the shoulder and upper arm but not on the forearm.
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 8192
Experience: MBBS, MD (Dermatology, Venereology & Leprology)
Dr. Nair and other Dermatology Specialists are ready to help you
Customer: replied 2 years ago.
What's on my forearm is exactly the same as what is on my face. It must be something othe pr than acne.
Expert:  Dr. Nair replied 2 years ago.
Hmm okay here are some other possibilities - milia, molluscum contagiosum, keratosis pilaris atrophicans facei. Please look them up and see if any resembles what you have.

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