I am suffering from small bumps on the area of my ear piercings. These bumps bleed when I accidentally scratch them. Please help.

The bleeding bumpy lesions on your earlobes most likely suggest a diagnosis of pyogenic granuloma (PG). PG is among the relatively common skin lesions and is believed to occur due to a reactive proliferation of capillary blood vessels. Some degree of discomfort and repeated mild or sometimes profuse bleeding is a hallmark of PG, which is true in your case as well. Though its real cause is not completely known, certain mild traumatic injuries such as ear piercing or staphylococcal infection of hair follicle are among the common precipitating factors. Therapeutic options to treat the lesions of PG include freezing through liquid nitrogen cryotherapy and chemical cauterisation through silver nitrate. For bigger lesions, electrical cauterisation or electrodessication and curettage are the treatment of choice. In about 10 per cent cases, recurrence of PG can be observed, where its complete surgical excision is a curative treatment. Also, you should immediately stop wearing any ear studs or earrings until your pyogenic granuloma is completely treated.

My 15-year-old son has been suffering from acne for three years. Since last year he has started getting large cystic lesions on his face, shoulder and upper back, which are leaving scars after healing. Oral antibiotics and creams are failing to improve his skin condition. Please advise.

Your son is most likely suffering from nodulocystic acne, which in its more severe form is also known as acne conglobata. This form has quite different presentation and behaviour in terms of its skin lesions as well as its response to various acne treatments. On acne severity scale, it is considered to be most severe type while comparing with common forms of mild to moderately active acne. About 10 per cent of total acne sufferers can develop severe nodulocystic lesions, as it is in the case with your son. The treatment of nodulocystic acne requires more specialised therapeutic approach, as majority of the sufferers fail to respond to common/routine acne treatments, including oral antibiotics and various topical preparations, which has been true in the case of your son as well. Oral medication with a certain drug is one treatment option. But the patient needs to be closely monitored for any potential adverse effects. The monitoring protocol requires to do periodic blood works in addition to monthly clinical consultations and observations. Once the active acne gets successfully treated, then we can address your son’s second issue of post-acne scarring.