How do I overcome the tiny whiteheads in my chin and jaw area that has no itching or pain?

Question

Hello doctor,

I have been getting tiny whiteheads on my chin and jaw area. They are not painful, do not itch, and have no inflammation. Unfortunately, it is difficult to clearly picture these bumps because they are so small and white. I would not worry about it because, as I said, they are tiny, but I am worried that these little whiteheads may be a symptom of rosacea. Last year, I had a massive flare-up and had to see a dermatologist. The malar region of my face was red, swollen, and bumpy. My dermatologist tentatively diagnosed granulomatous rosacea or a foreign body reaction due to the area's hyaluronic acid fillers and Aptos threads. She prescribed a months-long course of Minocycline and a short course of Prednisone. It helped a lot. A few months later, I had a biopsy, and no disease indications were found. At most, the biopsy "could" point to stage 1 rosacea. My dermatologist said she is confident that the flare-up was a foreign body reaction. However, for months I have lived in fear of rosacea; I know it is a progressive and disfiguring disease, and every spot or blush sends me into hysterics (I am not exaggerating). So I have somewhat of a phobia. Some tell me that these small, non-inflamed white spots are a classic symptom of papular-pustular rosacea. Is this true? I also wonder about a differential diagnosis of keratosis pilaris; I get white, non-inflamed bumps on my arms and thighs. Or could they just be blocked pores or follicles? I have noticed more acne on my neck where it comes into contact with it. I do not think these spots are milia, as they are pretty easy to open and remove with a sterile needle. They are very superficial. I am 35-year-old and on the following medication. Diane-35 and Spironolactone 50 mg a day for acne. Mirtazapine 30 mg daily, Paroxetine 20 mg daily, Lyrica 75 mg twice a day, and Xanor 0.5 mg twice daily, all for anxiety and depression triggered by my skin concerns. Other than that, I use a very gentle skin routine and have not exfoliated for months. Could these white bumps be a build-up of debris, such as dead skin cells? Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern. As per the history provided, based on the description and location of the lesions, they may most probably be closed comedones due to excess sebum secretion and clogging of pores. Multiple factors, including hormonal fluctuations, climate changes, dietary factors, and skin care products, might be reasons for excess sebum secretions. Although there is a history of the rosacea-like lesion due to post-foreign body reaction, papulopustular rosacea may also be accompanied by rosacea. But they appear different from closed comedones as they present with redness, inflammation, tenderness, pain, discomfort, and itching. On the other hand, closed comedones do not present with these but are only cosmetically bothersome. As you have rightly mentioned, they are not Milia as well. Open comedones appear as tiny white lesions which are asymptomatic on the chin and jaw lines and are easy to pop out since the pores where they appear would be open, as the name suggests. Do not worry. They are not infectious and may be removed with a comedone extractor easily. However, due to recurrent sebum secretions on facial skin, which is a normal phenomenon and may vary in severity among individuals, they may appear on and off, and each time they appear, they may be removed manually. As you have mentioned, white pustules on arms and thighs are folliculitis which may be non-infectious due to being non-inflamed and appear due to clogging of pores on areas of small or large follicles which may appear anywhere on one's body depending on the severity of sebum secretion. They may also be managed using medications each time they appear. Keratosis pilaris also mentioned appears and presents differently than the description of the lesions. So they may be ruled out. My suggestion, Salicylic acid 2 % or glycolic acid face wash may be used twice daily. Apply, massage in gentle circular motions, and wash off within one minute. Peroclin 2.5 % gel (Clindamycin and Benzoyl peroxide) may be applied on the affected area on your chin and jawline as a spot treatment at night for three weeks or till they lessen in appearance. They may also be manually removed. Mupirocin cream is to be applied to the lesions on the arms and thighs twice daily after cleaning the area with soap. Lukewarm salt water may clean the area before applying the cream. Lukewarm salt water helps in popping out of the pustule on its own within three days. Take Tablet ascorbic acid 500 mg chewable tablet to be taken twice daily after food for two months. They help in faster healing of the white lesions. Kindly make sure to avoid oily and fried food, red meat, milk and dairy products, and sweets. Instead, consume more fruits, vegetables, fiber-containing food, and at least 12 glasses of water a day. These dietary changes would help with preventing the recurrence of the lesions. Glycolic acid chemical peels are done in sessions of six every two weeks to one month and may also be helpful for skin rejuvenation and reducing sebum secretion. These are procedures that may be done following direct consultation with a dermatologist. They may be beneficial to prevent recurrence as well. Hope I could be of help and wish the above details were informative. Kindly follow up in case of further queries. I hope you find it helpful. Kind regards.

Answer 2

Hello,

Welcome back to icliniq.com.

They do not appear to be papulopustular rosacea. Therefore do not worry. Since you also have a history of PCOS (polycystic ovarian syndrome) and the medications, including antidepressants, may alter the sebum production on your skin, leading to breakouts, comedones, and acne. You may continue using Metronidazole gel only if there is redness and inflammation in the affected areas or cheeks. You may also undergo chemical peels while on the above medications. However, while undergoing chemical peel treatment, kindly refrain from using other physical or chemical exfoliants. If you are not considering chemical peel procedures, you may go ahead with using exfoliants (physical or chemical, either)at home. Also, do not use both exfoliants, but stick to either. As I mentioned, dietary changes may also be considered to prevent its appearance and reduce current lesions. They would be very helpful in the long run as well. Kind regards.

Answer 3

Hi,

Welcome back to icliniq.com.

I hope you find it helpful. Kind regards.

How do I overcome the tiny whiteheads in my chin and jaw area that has no itching or pain?

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