Prof.Dr. Ayşe Serap Karadağ
Memorial Atasehir Hospital
- What is Acne (Pimples)?
Acne, a recurring skin condition, occurs as a result of abnormal increase in keratin tissue and excess oil secretion in hair follicles and sebaceous glands under the skin, leading to blockage after a period, followed by the multiplication of bacteria settling in this environment and causing inflammation.
- What are the Symptoms of Acne (Pimples)?
Acne can appear in different forms. When hair follicles are initially blocked, small skin-colored white bumps and blackheads called comedones form. Bacteria multiply and inflame these. The inflamed hair follicle bursts outward. As a result, painful, red swellings (papules, pustules, nodules, and cysts) are observed.
- What are the Causes of Acne (Pimples)? Why does Acne occur?
Hormones, genetics, environmental factors, medications, cosmetic products, nutrition, and stress play a role in the development of acne. Acne begins primarily when sebaceous glands start production during adolescence. Hormones such as increased testosterone and androgens during this period cause the sebaceous glands to work more. An increase in acne is observed in various conditions that increase hormones (such as polycystic ovary syndrome, obesity).
- How is Acne (Pimples) Treated? How does Acne go away? What is good for Acne?
Acne treatment is one of the best-known treatments by dermatologists, and it is successfully treated with creams, oral antibiotics, or vitamin A-containing pills. Skincare is also essential. The use of dermocosmetic products that will eliminate oil formation, cleanse bacteria, and remove oil and dirt residues in the pores, used as a support, increases the success of the treatment.
- Does Acne come from the liver?
Acne is definitely not related to the liver. It is only a skin disease. However, it can occur in some diseases where hormones increase in the blood.
- How to Get Rid of Acne Scars?
For scars, cosmetic procedures such as peeling (chemical peeling), microneedling, and laser treatments are performed by physicians. Medical treatments given for acne are generally not scar treatments. However, some creams containing retinoids can reduce scars to some extent when used for a long time.
- How to Get Rid of Acne as Quickly as Possible? How to Get Rid of Acne in 1 Day? How to Get Rid of Acne in 1 Week? How to Get Rid of Acne in 1 Hour? How to Get Rid of Acne in 1 Night? How to Get Rid of Acne in 2 Days? How to Get Rid of Acne in 3 Days?
Acne treatment requires patience. Although the creams provided can dry up inflamed lesions quickly, one should not expect a magical cure in a day. It is unscientific to promise that the acne will completely heal in 1 or 2 days. Some special peeling methods or types of laser can expedite healing, but it recurs later. Medical treatment should be used regularly and should continue for 2 days a week after healing to prevent recurrence. It is essential for individuals with acne to choose a suitable dermatologist and go through this long process together, which is very important in facilitating treatment and preventing recurrence.
- What are the Types of Acne?
There are childhood, adolescent, and adult forms of acne. There are also comedonal, papulopustular, nodular, and cystic types based on severity and the lesions that appear. There are also very severe types (acne fulminans, acne conglobata).
- Where does Acne Appear?
Acne is seen on the face, the front of the trunk, and the back where sebaceous glands are abundant. The T-zone of the face, called the forehead and the nose, is the most common area. In adulthood, it is more common in the chin and neck area.
- Are Acne Creams Effective in Treatment?
Dermatologists recommend very effective acne creams. In many cases, there is often no need for expensive methods or cosmetic procedures.
- Can Acne Masks be Used in Treatment?
There are products in the market under the name of acne mask with very different contents, and most of them have no scientific basis. Some of them can cause irritation on the skin and allergic reactions that they cause can damage the skin. Therefore, it is necessary to prefer suitable products by consulting your doctor.
- What Herbal Treatments are Good for Acne?
Especially in Chinese medicine and the Far East, herbs are widely used in treatment. Looking at evidence-based medical methods, herbal treatments recommended to be effective for acne are tea tree oil, green tea, resveratrol, and bee venom. Studies have been conducted on basil, lemon, orange, pettigrain, pumpkin, juniper, lavender, patchouli, sandalwood, amaranth, arnica, asparagus, birch, narcissus, jasmine, modesty tree, coriander, jojoba oil, Labrador tea, neem, pine, poplar, ravent, soapwort, nettle, and turmeric. Although their effects have not been fully proven, they have been shown to have beneficial effects on acne. Unfortunately, there is insufficient evidence regarding the doses and application methods of these products and whether the products sold on the market have the real content. Applications should be done carefully.
- What Should be Used to Dry Acne?
Your creams and cleansing products that reduce bacteria, eliminate oiliness, and correct the structure of the hair follicle recommended by your doctor will dry out acne quickly.
- Is Acne Surgery Performed?
Acne is generally a disease that heals with medical treatment without the need for surgery. However, surgical intervention may be performed to drain very severe inflammatory and abscessed acne lesions rarely or to reduce inflammation by injecting drugs into them.
- What Should be Done to Reduce Acne?
First of all, the reasons causing acne should be prevented if any. Although acne is generally due to the skin structure, hormonal problems, oily makeup products or cosmetics applied to the skin, hormones taken orally, cortisone, and vitamin-containing pills should be asked for in later occurring acne. In the skin, which is normally oily, the reduction of oiliness with dermocosmetic products is necessary
- What helps with acne pain?
Acne does not hurt unless it is inflamed. If there is pain, oral antibiotics and treatments to reduce inflammation will be beneficial.
- Is acne vitamin A treatment effective? (Acne vitamin A, vitamin A for acne, does vitamin A help with acne?, does vitamin A cream help with acne?)
Vitamin A is the most important treatment for acne and provides a definite solution in 2/3 of patients. It is necessary to use it for at least 6 months at the dose recommended by your doctor for permanent recovery. It has been approved since 1980 and is widely used worldwide. In the last 40 years, a more effective acne treatment has not been found during this process.
- Is there a relationship between acne and vitamin B? Does vitamin B cause acne? Does vitamin B deficiency cause acne?
B12 vitamin is the most common vitamin that causes acne. Acne develops shortly after using B12 injections. Medications, vitamins, and cosmetic products used for sudden onset acne should be thoroughly reviewed.
- What is the relationship between acne and vitamin C? Does vitamin C cause acne?
Does vitamin C cause acne scars? Vitamin C does not cause acne. Dermocosmetic products containing vitamin C are very useful in removing acne scars.
- What is the relationship between acne and vitamin D? Does vitamin D cause acne? Is vitamin D good for acne? Does vitamin D deficiency cause acne? Can excess vitamin D cause acne?
This topic is controversial. In some studies, a deficiency of vitamin D has been observed in acne patients, but routine assessment of vitamin D deficiency is not performed in acne patients. Vitamin D supplementation should be given to individuals known to have a deficiency.
- What is the relationship between acne and vitamin E? Does vitamin E deficiency cause acne? Can excess vitamin E cause acne? Is vitamin E used in acne treatment? Is it good to apply vitamin E to acne?
Vitamin E is primarily an important vitamin found in anti-aging products. It does not have a direct relationship with acne.
- Does Omega-3 cause acne? Is Omega-3 good for acne?
Omega-3 does not cause acne. In fact, having a diet rich in omega-3 can be beneficial for acne. Additionally, in individuals experiencing an increase in blood lipids when using vitamin A, omega-3 can be given to lower blood lipids.
- When should acne patches be used?
Acne patches are not a highly recommended method. Acne should not be covered.
- How should acne care be?
It is very important to wash the skin with suitable dermocosmetic cleansers (gel, foam, or lotion) in the morning and evening. Cleansers that will irritate and dry the skin like soap are not recommended. Washing the skin more than twice a day will disrupt the skin's protective layer, making it more sensitive and prone to allergies.
Sometimes medical treatments can dry the skin and make it sensitive to the sun. Therefore, it is recommended to moisturize the skin morning and evening with suitable products that have moisturizing and sun-protective effects. This will increase the skin's compliance with the treatment.
- Is acne contagious?
Acne is definitely not contagious.
- Does hepatitis B cause acne?
Hepatitis B does not cause acne.
- Does hepatitis C cause acne?
Hepatitis C does not cause acne.
- What should be done to prevent acne? Acne-preventing soap, acne-preventing lotion, acne-preventing cream, etc.
In the past, treatment was only given when there was acne, and all treatments were stopped once it improved. However, newly published treatment guidelines recommend using retinoid or azelaic acid-containing creams 2-3 times a week at night to prevent recurrence after acne treatment. This way, invisible and non-visible pimples are cleansed and recurrence is prevented.
- What should be done when acne appears?
Acne should not be tampered with, and medical treatments should be used. When you consult a doctor, the treatment plan will be based on the prevalence and type of acne. Unsubstantiated treatment recommendations should be avoided.
- What foods cause acne? Is there an acne diet?
Although the relationship between diet and acne has been a topic of debate for a long time, in recent years it is known that some foods can exacerbate acne. These foods are high glycemic index foods that increase insulin release, leading to increased sebum production from the sebaceous glands and the proliferation of acne. It is advisable to avoid high glycemic index foods such as pastries, white flour, white bread, potatoes, pasta, sugar, fast food, processed sugary cereals, rice, and potatoes. Smoking and alcohol consumption should be limited.
Components found in milk trigger enzymatic reactions that cause the formation of acne lesions, and particularly, consuming low-fat milk increases acne lesions and their severity. Excessive milk consumption should be avoided. There are negative reports about chocolate triggering acne as well. Excessive consumption of chocolate should also be avoided.
If a person believes that certain foods trigger their acne after eating (such as seeds, chips, chocolate, etc.), it is recommended to reduce their intake.
- How should one eat to prevent acne?
To prevent acne, it is recommended to consume low glycemic index foods (whole wheat bread, legumes, whole grains, nuts, lean meat, dairy products, lean red meat, most vegetables, and fruits). Green tea, due to the epigallocatechin-3-gallate it contains, reduces sebum production on the skin, thus reducing acne lesions and severity. Antioxidant vitamins and minerals (Vitamin A-E, selenium) and zinc can help reduce acne lesions.
- Does toothpaste help with acne?
Toothpaste has no place in acne treatment and can harm the skin's pH balance.
- Is there a nettle treatment for acne?
Directly applying nettle can irritate the skin. However, if its content can be obtained, it may be beneficial for acne. Such products are not available in our country.
- Can aloe vera be used for acne?
The extract directly from aloe vera may be beneficial.
- Is applying garlic on acne helpful?
There are magical formulas related to garlic circulating on the internet. These should not be trusted too much. If obtained as an ingredient, garlic may be beneficial due to its antioxidant properties.
- Is putting a band-aid on acne helpful?
A band-aid should not be applied to acne. In enclosed, poorly ventilated environments, microorganisms can multiply more, and when the hair follicle is closed, the trapped oil, dirt, etc., can delay healing.
- Is turmeric beneficial for acne treatment?
The substance curcumin found in turmeric has been tried and shown to reduce inflammation and bacteria in various skin conditions due to its antioxidant properties. Currently, there are no high-level studies in acne treatment, but it is still believed to be beneficial. If curcumin can be obtained in powder form, it may be beneficial. However, homemade masks with turmeric mixed with vinegar and lemon can cause more harm than good, irritating the skin and causing allergies.
- Is ginger beneficial for acne treatment?
There is no proven beneficial effect of ginger in acne treatment.
- Is olive oil beneficial for acne treatment?
Olive oil and other oils can clog pores and lead to an increase in acne. All oils should be avoided for acne-prone skin.
- Can a baking soda acne mask be used in treatment?
Our skin is a protective cover made up of substances such as sweat and fatty acids that surround our body. This cover has an acidic structure, which is expressed in units called pH. The ideal pH value for our skin is 5.5 (ranging from 4 to 6). This acidic structure prevents the settlement of microbes such as bacteria and viruses on our skin. If the acidic structure is disrupted, the skin will produce more oil to try to repair it. Products containing baking soda are alkaline and completely disrupt the acidic structure of the skin. In this case, the skin will dry out and, at the same time, increase oil production to repair the damage. Similarly, alkaline-based soaps and cleansers that are not compatible with the skin's pH and mineral sodas with a pH of 6.3-7.1 will also be irritating. The ideal cleansing product should have a pH of 5.5 and should not disrupt the acid-mantle layer. Those who use products with high pH values will have an increased amount of bacteria causing acne, and additionally, water and moisture loss on the skin will increase, resulting in eczema and dryness.
- Can natural masks be used for acne treatment?
Home masks for acne. There are many effective and safe medical treatment methods used in the treatment of a common disease like acne, which has a significant impact on the patient's psychology with the marks and scars it leaves behind. In today's conditions where there are so many various proven products, the methods suggested without any scientific basis from various sources not only fail to produce results but also cause skin side effects. It is quite significant that most of these recipes are found on cooking websites. You should not use masks other than those recommended by your dermatologist.
- Is there an acne detox?
The term "detox" has become fashionable in recent years, referring to the removal of toxins from the body. The so-called acne detox aims to cleanse the face from microbes, dirt, and excess oil. This can be done by peeling the skin through peeling methods (chemical peeling, microneedling) or using various dermocosmetic cleansers and solutions.
- Are apple cider vinegar and grape vinegar beneficial for acne treatment? Is grape vinegar used for acne?
The structure of apple and grape vinegar is highly acidic and has antiseptic properties, cleansing bacteria and opening the skin's pores by peeling (the pH of various vinegars is between 2.6-3.2). If directly applied since the skin's pH is 5.5, it can significantly irritate the skin. It can be used in a diluted form as a short-term toner to wipe and clean the skin. It can cleanse the skin from some bacteria. However, it is not very beneficial for acne-prone skin.
- How to get rid of acne at home?
There are not many methods to be applied at home for acne. Rosewater can be used as a tonic to cleanse the skin. It can reduce oiliness and balance the pH. It acts as a supporting role by cleansing the skin, but it is not sufficient on its own for treatment. You can successfully treat and eliminate acne without leaving scars or marks with highly effective treatments recommended by your doctor.
- Does acne turn into a mole?
Acne does not turn into a mole; they are completely separate conditions. Acne can leave redness, marks, and scars during healing.
- Does smoking increase acne?
The relationship between smoking and acne is debatable, but it has been reported that the frequency of acne increases in smokers, and there is a positive correlation between the amount smoked and the severity. The relationship between smoking and acne is particularly evident in post-adolescent acne.
- Does e-cigarette cause acne?
Cigarettes containing nicotine and harmful substances can cause acne. E-cigarettes also contain nicotine and various aromatic substances. Since nicotine can cause acne, acne can also be seen in e-cigarette users. The full effect of other aromatic substances is not yet known.
- Are there any harms of acne pills?
The main antibiotics and isotretinoin made from Vitamin A are used for acne treatment. Antibiotics need to be used for an average of 2-3 months. There is no serious problem with the use of acne pills under physician control.
Treatment with isotretinoin, a derivative of vitamin A (known as Roaccutane, Zoretanin, and Aknetrent), can be the definitive solution for acne treatment, providing long-lasting improvement. In approximately 2/3 of patients, acne typically does not recur after treatment, while in the remaining 1/3, it may recur if sebaceous glands are still active and producing excess oil. The most important feature of this medication is that the person using it should not become pregnant during treatment. However, one month after discontinuing the medication, it is safe for a person to become pregnant as the drug is completely eliminated from the body. Isotretinoin does not have a significant negative impact on the liver or kidneys but can slightly elevate blood lipid levels. Before starting treatment, the patient's blood is tested, and if the results are within a healthy range, treatment can commence, with periodic monitoring of blood values during treatment.
- Is there acne light therapy?
Blue light, also known as LED light, can be used for acne. This light kills the bacteria causing acne and cleanses the inflammation caused by the bacteria. However, it is not a treatment available everywhere. Its effect lasts for a while, and then acne can recur.
- How to heal acne scars? What helps with acne scars?
Acne scars usually occur when the patient picks at the acne and pops it, causing irritation. Various wound healing creams with herbal content are used for these wounds.
- Can babies and children get acne?
Acne can occur in newborns due to the effect of hormones passed from the mother up to 2-3 months, but this is temporary and insignificant. Acne can also be expected to occur in the period from 3 months to 1 year, which continues up to 1 year and is also temporary. There is no need for much research for the occurrence of acne in these ages. However, in the age range of 1 to 7 years (pre-adolescence), acne is not common in normal individuals. If acne occurs at these ages, the child should definitely be evaluated hormonally and in terms of early adolescence. After the ages of 7-8, acne can be seen as one of the signs of adolescence.
- How is acne treated in babies and children?
Creams used for acne in babies are used for baby acne. Antibiotics from the tetracycline and doxycycline groups and creams from the nadifloxacin group, as well as A vitamin pills, are not used because they may affect dental and bone development. A vitamin pills can be used in very severe cases.
- What should be considered in the treatment of acne in babies and children?
In mild acne in babies, there is no need to always give treatment; it can also go away on its own. In children, good skin cleansing with increased sebum production and black/whiteheads is initiated, and creams containing retinoids, benzoyl peroxide, and azelaic acid are used. Adolescence acne should not be expected to go away on its own without treatment; early treatment should be started to avoid leaving marks.
- Difference between acne and wart
A wart is a bump generally seen on the hands and feet caused by the virus called HPV. It occurs in small numbers, does not burst, and grows progressively. It is rarer on the face. Acne, on the other hand, is a skin condition seen on the face, front of the body, and back, which has different types, can burst, heal by itself, and is seen in oily skin. They are completely different diseases from each other.
- Difference between acne and sebaceous cyst
Non-inflammatory acne, which is in the form of white dots, can be confused with small oil cysts on the face. The exact differentiation can be made by a dermatologist.
- Does acne change color?
Acne is generally pink to reddish in color. White inflammation can be seen in the middle. Then it dries and heals. While healing, it can leave a pink mark, which will disappear over time.
- How to get rid of red marks after acne?
There is no definitive treatment for red marks that occur after acne. They heal over time. However, some cosmetic applications can be done to accelerate healing.
- Does acne cause pain or itching before it appears?
Inflammatory types of acne can be painful. It usually does not itch. However, individuals with high stress levels scratch their acne, disrupting the integrity of the skin. Subsequently, these acne lesions, which turn into wounds, can be itchy. People who constantly scratch their acne wounds, causing wounds, should be evaluated for psychological stress and, if necessary, should be referred to psychiatry.
- Which acne is dangerous?
Acne is a skin disease and does not pose a danger in its normal severity. However, some very severe types such as acne fulminans or acne conglobata require close monitoring. In some genetic diseases called syndromes, acne can develop alongside other skin or joint diseases. These individuals need to be evaluated in detail. If very severe and bulging acne is squeezed, the inflammation can spread more to the surrounding skin and cause more scarring. In such inflammatory acne, you should consult a doctor without wasting time.
- Which acne scars don't go away?
The biggest damage caused by acne is the deep scars it leaves on the skin. These scars usually do not fade away and require medical intervention.
- Which pimples should be popped?
Playing with and popping pimples can lead to more scars and marks.
- Which acne medication is harmful to the liver?
In general, acne medications do not harm the liver. Antibiotics and vitamin A-based medications can be safely used by healthy individuals who do not consume alcohol and do not have other illnesses. Before starting the medication, liver and kidney tests are performed if the blood values are normal. Alcohol should preferably not be consumed during the treatment, as it can strain the liver in combination with medications.
- At what age does acne go away?
Acne usually starts during adolescence and the duration varies from person to person. Typically, it can improve over a few years with the severity decreasing. With appropriate treatments, it is possible to achieve faster recovery.
- Up to what age can acne occur?
Acne is not just a problem during adolescence; it can also occur in adulthood. The most common is adolescent acne, occurring between the ages of 12-24. Acne that occurs between the ages of 25-40 is called adult acne. Acne occurs when the oil glands are active and can last up to the age of 50. Acne is generally not expected in the elderly.
- At what week does acne occur during pregnancy?
Acne usually occurs more during the 3rd trimester of pregnancy.
- Who gets acne?
Acne typically occurs in individuals with excessive oiliness in their skin. However, it is more likely to occur in individuals with a family history, hormonal problems, polycystic ovary syndrome, smokers, obese individuals, those consuming fast-food, using inappropriate oily cosmetic products, consuming protein powders and whey protein for bodybuilding, and those taking certain medications.
- How long does it take for acne medications to take effect?
Acne medications usually take effect in about 6-8 weeks on average. If there is no improvement after 8 weeks, the medication is changed. If it is effective, it should be used until complete healing and then transitioned to continued treatment.
- When does acne go away?
Acne starts during adolescence and tends to last for a long time. However, adolescent acne generally tends to improve in the 20-25 age range. Acne that starts in adulthood (after 25 years of age) can also last for many years. Our goal as dermatologists is to treat these acne properly to achieve rapid healing without leaving scars.
- When should acne be squeezed?
Pimples should not be squeezed, as this can lead to more scarring. However, non-inflammatory pimples that do not have a head and are the size of a pinhead can be emptied with the help of certain tools (comedone extractor). It is important to consult your doctor about this. Skin care and peeling methods also help in cleaning these spots.
- Should acne be squeezed, or should acne be extracted?
Pimples should not be squeezed. Squeezing pimples can spread the inflammation to a larger area under the skin, leading to a larger scar and slower healing. Therefore, pimples should not be squeezed. Only mature pimples with a white center, called comedones, can be emptied.
- Where does acne occur due to stress?
Stress is one of the most significant triggers for acne and can appear on the face, back, and chest.
- What are the signs of acne?
If acne starts between the ages of 9-13, it is one of the signs of adolescence. It does not occur without oily skin, and the oiliness starts with the effect of adolescent hormones. However, in adulthood, acne can also occur. This could be a sign of hormonal disorders like polycystic ovary syndrome or often, an increased sensitivity to hormones in the skin even if hormone levels in the blood are normal.
- How should acne-prone skin be cleansed?
Acne-prone skin should be cleansed twice a day with non-oily, non-comedogenic, and pH-compatible cleansers to remove oil, bacteria, and dirt from the skin. Sunscreen creams prepared for oily skin should be used. In patients using drying creams or pills for acne treatment, dermatocosmetic moisturizers developed for oily acne-prone skin should be used.
- How should acne be treated?
The treatment plan for acne is determined based on the severity, duration, type of lesions, presence of scars, and the patient's expectations and whether pregnancy is planned. In mild acne, creams such as retinoids, azelaic acid, benzoyl peroxide, and antibiotic creams are given. In moderate or severe acne, oral antibiotics (doxycycline, tetracycline, azithromycin) are prescribed in addition to creams. If the patient does not benefit from this treatment, isotretinoin (Roaccutane®, Zoretanin®, Aknetrent®), which is made from vitamin A, is given. Retinoid treatment should be used for at least 6 months. In those using it for a shorter time, even if the patient improves, it can recur after a while. To prevent recurrence, a treatment is given for at least 6 months, calculated according to the weight of the individual.
Specializing in medicine is important because each organ and system in our body operates differently with unique characteristics. Eye doctors, during their 4-year specialization, become experts in only eye diseases, and heart doctors specialize in heart diseases. Our skin is the largest organ of our body, and to learn its characteristics and perform procedures, an additional 4 years of specialized training is required on top of the 6-year medical school education. With 10 years of education, it is possible to diagnose and treat diseases. Unfortunately, many exploit skin patients in the market just to make money. Recipes for masks are created by claiming that almost every type of plant (garlic, onion, lemon, turmeric, ginger, nettle, etc.), yogurt, vinegar, toothpaste, and various substances will be beneficial and drying for acne. In China, alternative and herbal treatment methods have advanced, and there are good results for some treatments. However, the herbal ingredients used here are not as simple as buying from the market and applying. They involve preparing concentrated extracts of these plants and subjecting them to allergy tests before application.
- When should hormonal imbalance be suspected in a patient with acne?
If acne is accompanied by menstrual irregularities, excessive body hair, obesity, male-pattern hair loss, and insulin resistance, hormonal assessment should definitely be conducted. Also, in adult age (after 25 years) when acne begins, especially when acne is present on the neck and chin, hormonal assessment should be done. If acne is observed in children aged 1-7 years, they should be referred to the pediatric endocrine department and hormonal evaluation should be carried out.
- How should acne-prone skin be cleansed?
The skin should be cleansed twice a day with non-oil, non-comedogenic cleansers that are suitable for the skin's pH to remove oil, bacteria, and dirt. Sunscreen creams designed for oily skin should be used for oily skin types. Dermocosmetic moisturizers developed for oily acne-prone skin should be used in patients using drying cream or pills for acne treatment.
- How is acne treated?
The treatment plan for acne is based on the severity, duration, lesion type, presence of scars, patient's expectations, and whether pregnancy is planned. In mild acne, creams such as retinoids, azelaic acid, benzoyl peroxide, and antibiotic creams are prescribed. In moderate or severe acne, in addition to creams, a 3-month course of oral antibiotics (doxycycline, tetracycline, azithromycin) is given on average. In cases where this treatment is not effective, isotretinoin (Roaccutane®, Zoretanin®, Aknetrent®) made from Vitamin A is prescribed. Retinoid treatment should be used for a minimum of 6 months. Patients who use it for a shorter period may experience recurrence even if they recover. To prevent recurrence, a calculated treatment lasting at least 6 months is administered based on the patient's weight.