Dermatology noob doesn't know where to start
March 8, 2011 3:02 PM Subscribe
Dermatology: Yay or Nay?
Disclaimers: YANMD, everyone's skin is different.
Now. I'm 30 years old with the cystic acne of a teenager. I have tried everything, including:
*Proactiv
*The crazy castor oil treatment that MeFi swears by
*Changing the cosmetics (that I've used for 10 years for no problem) to the newer Bare Minerals stuff
*Water only
*The usuals like Beta Hydroxy, salicylic acid, other pharmacy treatments
*Cortisone shots directly to the blemish, from my doctor
*Prescription Retin-A, from my doctor
Ok. None, and I mean none, of this has worked. In fact, it seems to be worse than ever. Therefore, it seems the next logical step is getting my very own dermatologist.
However, due to my history of fighting this crap, I'm burnt out. I have this terrible feeling that literally nothing will work—even the dermatologist's treatment.
Upon researching, reviews of treatments have been mixed, ("lol my skin so bad m boyfrin say my face r pizza, lol. dr say i get better an i did") and treatment descriptions that seem very superlative and over-promising. ("...leaving your skin firm to the touch, wrinkle-free forever, and with the kisses of angels on your brow.")
Sigh. Can anyone give me anecdotes—positive or negative—that I can more accurately base my decisions upon? What cystic acne treatments have shown a high success rate? What are the downsides?
Really—it's less question than "help me figure out where to begin."
Disclaimers: YANMD, everyone's skin is different.
Now. I'm 30 years old with the cystic acne of a teenager. I have tried everything, including:
*Proactiv
*The crazy castor oil treatment that MeFi swears by
*Changing the cosmetics (that I've used for 10 years for no problem) to the newer Bare Minerals stuff
*Water only
*The usuals like Beta Hydroxy, salicylic acid, other pharmacy treatments
*Cortisone shots directly to the blemish, from my doctor
*Prescription Retin-A, from my doctor
Ok. None, and I mean none, of this has worked. In fact, it seems to be worse than ever. Therefore, it seems the next logical step is getting my very own dermatologist.
However, due to my history of fighting this crap, I'm burnt out. I have this terrible feeling that literally nothing will work—even the dermatologist's treatment.
Upon researching, reviews of treatments have been mixed, ("lol my skin so bad m boyfrin say my face r pizza, lol. dr say i get better an i did") and treatment descriptions that seem very superlative and over-promising. ("...leaving your skin firm to the touch, wrinkle-free forever, and with the kisses of angels on your brow.")
Sigh. Can anyone give me anecdotes—positive or negative—that I can more accurately base my decisions upon? What cystic acne treatments have shown a high success rate? What are the downsides?
Really—it's less question than "help me figure out where to begin."
The best thing that's ever happened to me in terms of my skin is taking 100mg of minocycline daily. My complexion cleared up dramatically and has been better than it has ever been.
posted by la petite marie at 3:10 PM on March 8, 2011
posted by la petite marie at 3:10 PM on March 8, 2011
I don't have cystic acne (I don't think) but my dermatologist prescribed Acanya. I use it once in a while and it seems to work.
For where to begin, I'd ask your friends. I asked around my colleagues recently and was surprised by how many of them have dermatologists. Hope that helps, good luck!
posted by kat518 at 3:11 PM on March 8, 2011
For where to begin, I'd ask your friends. I asked around my colleagues recently and was surprised by how many of them have dermatologists. Hope that helps, good luck!
posted by kat518 at 3:11 PM on March 8, 2011
Wait, you're 30 with bad skin and you've never been to a dermatologist? For goodness sakes, just go already! I personally didn't get anything good out of seeing one in my teenage years, but everyone is different. You'll never know until you see one. "Help me figure out where to begin" is exactly the question you should ask the doc. So get going!
posted by phunniemee at 3:12 PM on March 8, 2011 [8 favorites]
posted by phunniemee at 3:12 PM on March 8, 2011 [8 favorites]
The only thing that really and truly made my acne go away was birth control pills. You might want to try that (or switching pills) before doling out a bunch of money to a dermatologist. It's been my experience (and many others' who I've talked with) that the kind of acne you are experiencing is largely hormonal.
posted by Surinam Toad at 3:12 PM on March 8, 2011 [1 favorite]
posted by Surinam Toad at 3:12 PM on March 8, 2011 [1 favorite]
So I'm confused have you never seen an actual dermatologist? Your previously prescribed treatments were from a primary care doctor? If your question is "Should I go see a board-certified dermatologist?" then my answer is definitely yes. And for what it's worth, I found that spironolactone worked wonders for me and was only prescribed after I went and saw a real dermatologist. Most primary care docs had never heard of using spironolactone for acne (it's most often prescribed as a diuretic for congestive heart failure!) but for women, it can really help. I was probably 34 or so when I finally found it and it was the best thing I'd used in 20 years of treatment.
posted by otherwordlyglow at 3:13 PM on March 8, 2011
posted by otherwordlyglow at 3:13 PM on March 8, 2011
I used to be you. Accutane cleared up my skin for good. Honestly, I never even imagined the day that I'd love my skin, but the last few years have been wonderful and completely worry-free.
I did two courses separated by about a year. I only ever had one breakout about a year after the first course of Accutane, but my dermatologist agreed that it's time to end this crap once and for all and had me take a second course. If I ever get pimples or blackheads again at some point in the future, I wouldn't hesitate to do it again.
posted by halogen at 3:16 PM on March 8, 2011 [1 favorite]
I did two courses separated by about a year. I only ever had one breakout about a year after the first course of Accutane, but my dermatologist agreed that it's time to end this crap once and for all and had me take a second course. If I ever get pimples or blackheads again at some point in the future, I wouldn't hesitate to do it again.
posted by halogen at 3:16 PM on March 8, 2011 [1 favorite]
I had very bad acne as a teen until my doctor gave me a nearly bottomless prescription for tetracycline. I needed to keep taking it until I was in my mid 20s. This was back in the early 80s, so I don't know if a GP today is likely to offer you the same prescription. Definitely see a dermatologist if your doctor can't help you.
posted by bonobothegreat at 3:18 PM on March 8, 2011
posted by bonobothegreat at 3:18 PM on March 8, 2011
I briefly saw a (crappy) dermatologist when I was 27 and then waited until I was 31 to see another. It took almost a year to get stuff sorted out, but man I wish I hadn't suffered with bad skin for so long. Go to the dermatologist!
I'm on spironolactone too. The diuretic effect can be a bit annoying (especially if you are not blessed with a bladder the size of a horse as I am) but other than that I have had no side effects. It took a while (and a dosage increase) for it to really kick in and work, but my skin is pretty nice now. It's not perfect, but now I will leave the house without makeup and let my boyfriend see me after I've washed my face at night.
posted by elsietheeel at 3:19 PM on March 8, 2011
I'm on spironolactone too. The diuretic effect can be a bit annoying (especially if you are not blessed with a bladder the size of a horse as I am) but other than that I have had no side effects. It took a while (and a dosage increase) for it to really kick in and work, but my skin is pretty nice now. It's not perfect, but now I will leave the house without makeup and let my boyfriend see me after I've washed my face at night.
posted by elsietheeel at 3:19 PM on March 8, 2011
I will second the spironolactone. Birth control pills (generic Ortho Tri-Cyclen) cleared up my acne that I struggled with for nearly 10 years. Sprinolactone (25mg/day) took care of the residual oiliness and occasional pimples. (And otherwordlyglow is exactly right. Most doctors are totally ignorant of using sprironolactone for acne.) A nice birth control/spironolactone cocktail will probably do the trick.
Also, don't delay treatment. You deserve it. Acne can make you terribly depressed and reclusive. Get treatment now!
posted by Surinam Toad at 3:20 PM on March 8, 2011
Also, don't delay treatment. You deserve it. Acne can make you terribly depressed and reclusive. Get treatment now!
posted by Surinam Toad at 3:20 PM on March 8, 2011
Yes, it's time to find a dermatologist -- or look for another one if the doctor who has been helping you is one.
When I was very young, I had very bad cystic acne; the only good news was that my skin did not scar. This was before Proactiv and even the currently available benzoyl peroxide products which work well on the sort of less dramatic acne I occasionally get now. After a bit of whining on my part, it finally occurred to my mother that a trip to a dermatologist might be in order; he immediately put me on tetracycline, which calmed it down and, over time, cleared it up. Subsequent to that, the sort of acne breakouts I would get would ebb and flow with my hormones and never again took on that hard-core cystic aspect.
I'm not suggesting that tetracycline is the answer in your case (IANAD), but I do think it's time to see a specialist -- to wit, a dermatologist.
Hang in there! As generations of grandmothers have exclaimed, this too shall pass.
posted by cool breeze at 3:22 PM on March 8, 2011
When I was very young, I had very bad cystic acne; the only good news was that my skin did not scar. This was before Proactiv and even the currently available benzoyl peroxide products which work well on the sort of less dramatic acne I occasionally get now. After a bit of whining on my part, it finally occurred to my mother that a trip to a dermatologist might be in order; he immediately put me on tetracycline, which calmed it down and, over time, cleared it up. Subsequent to that, the sort of acne breakouts I would get would ebb and flow with my hormones and never again took on that hard-core cystic aspect.
I'm not suggesting that tetracycline is the answer in your case (IANAD), but I do think it's time to see a specialist -- to wit, a dermatologist.
Hang in there! As generations of grandmothers have exclaimed, this too shall pass.
posted by cool breeze at 3:22 PM on March 8, 2011
Yes dermatology.
The idea that acne can be outgrown is a lie that adults tell to blame children for the skin diseases they suffer. Presumably the goal is to manipulate the children into making better lifestyle choices than those imposed on them by those selfsame powerful adults, but I digress.
Cystic acne is not something you're going to be able to treat with OTC remedies alone. Some of these things will help, but skin is idiosyncratic so you could literally spend years of your life and thousands and thousands of dollars on trial and error just to improve your skin by 5%. Don't waste your time and money like that. Get specialist help.
posted by tel3path at 3:32 PM on March 8, 2011 [4 favorites]
The idea that acne can be outgrown is a lie that adults tell to blame children for the skin diseases they suffer. Presumably the goal is to manipulate the children into making better lifestyle choices than those imposed on them by those selfsame powerful adults, but I digress.
Cystic acne is not something you're going to be able to treat with OTC remedies alone. Some of these things will help, but skin is idiosyncratic so you could literally spend years of your life and thousands and thousands of dollars on trial and error just to improve your skin by 5%. Don't waste your time and money like that. Get specialist help.
posted by tel3path at 3:32 PM on March 8, 2011 [4 favorites]
I had painful cystic acne in my early-mid 20's. Gorgeous glowing skin in my teens, and then I hit like 20/21, and my skin started freaking out with large marble-like zits that form under your skin, rarely come to a head, and hurt like hell. Used Proactive for a little while, helped only marginally, and then I suddenly became allergic to it. Retin-A did absolutely nothing. Had a bad experience with a bigoted asshole dermatologist--he was no help at all. And yes, because of him, I don't like nor have been back to see a dermatologist since.
But thanks in large part to finding the right kind of birth control pill for me (it is trial and error unfortunately, but do tell your doc *exactly* what you experience, if this is something you might consider), my skin is so so so so much better. It's probably a combination of the pill and adopting a more natural skin-care routine, and no NEW or EXCITING or REVOLUTIONARY fraudulent skincare crap. Just water, sometimes baking soda, sometimes an oil-free Burt's Bees scrub. But mostly just water (washing face with it, and drinking a lot too).
I get whiteheads occasionally, and less frequently, more bona fide zit-tastic pimples. But no more cystic pimples. Hallelujah.
posted by raztaj at 3:34 PM on March 8, 2011
But thanks in large part to finding the right kind of birth control pill for me (it is trial and error unfortunately, but do tell your doc *exactly* what you experience, if this is something you might consider), my skin is so so so so much better. It's probably a combination of the pill and adopting a more natural skin-care routine, and no NEW or EXCITING or REVOLUTIONARY fraudulent skincare crap. Just water, sometimes baking soda, sometimes an oil-free Burt's Bees scrub. But mostly just water (washing face with it, and drinking a lot too).
I get whiteheads occasionally, and less frequently, more bona fide zit-tastic pimples. But no more cystic pimples. Hallelujah.
posted by raztaj at 3:34 PM on March 8, 2011
I had cystic acne as a teenager, and it got to the point where I really had to see a dermatologist myself. I'm glad I did. He determined what my family doctor hadn't - that I actually had a staph infection in addition to the acne. He prescribed sulphamethoxazole pills and Retin-A cream. A serious, painful, and years-long problem cleared right up. NOTHING my family doctor had given me had worked. This was in the nineties, so there were fewer options then than now, but I had tried all the acne treatments of the day AND birth control with either no results or worsening acne. Sulpha pills were the answer at the time. Moral of the story: there are specialists for a reason.
posted by katillathehun at 3:36 PM on March 8, 2011
posted by katillathehun at 3:36 PM on March 8, 2011
The only thing that ever made my acne go away was a strict regimen of the following:
1) shower at night with ivory soap and wash hair with daily clarifying suave shampoo
2) shower in the morning with ivory soap and wash hair with daily clarifying suave shampoo, using suave conditioner (not coconut scented!) once a week/as needed
3) Johnson and Johnson's Baby Lotion on my face after the morning shower and before make-up application
4) Cover-up stick as needed.
If I deviate from that regimen, for even a day, instant break-out! I have VERY sensitive skin that needs products with minimal additives. Ivory soap and baby lotion work far better than anything topical I ever tried, or was given by a dermatologist.
posted by whimsicalnymph at 3:36 PM on March 8, 2011 [1 favorite]
1) shower at night with ivory soap and wash hair with daily clarifying suave shampoo
2) shower in the morning with ivory soap and wash hair with daily clarifying suave shampoo, using suave conditioner (not coconut scented!) once a week/as needed
3) Johnson and Johnson's Baby Lotion on my face after the morning shower and before make-up application
4) Cover-up stick as needed.
If I deviate from that regimen, for even a day, instant break-out! I have VERY sensitive skin that needs products with minimal additives. Ivory soap and baby lotion work far better than anything topical I ever tried, or was given by a dermatologist.
posted by whimsicalnymph at 3:36 PM on March 8, 2011 [1 favorite]
Oh but I will tell you one thing: with leave-on treatments, leave them on untouched for 30 minutes to give them time to bind to your skin. Any moisturizer etc can come after 30 minutes.
No-one will tell you this, but it was a big waypoint on my trial-and-error odyssey when I happened across the person who did tell me this.
Also, hormonal birth control says on the leaflet, and the same is stated in every article you read that it "can" take "up to" three months before your skin gets better. Actually hormonal birth control can take as long as nine months to work. Another thing nobody will tell you. But in my case I saw a dramatic decrease in oiliness right away - like, within hours.
That's two things. I'll butt out now.
posted by tel3path at 3:36 PM on March 8, 2011 [1 favorite]
No-one will tell you this, but it was a big waypoint on my trial-and-error odyssey when I happened across the person who did tell me this.
Also, hormonal birth control says on the leaflet, and the same is stated in every article you read that it "can" take "up to" three months before your skin gets better. Actually hormonal birth control can take as long as nine months to work. Another thing nobody will tell you. But in my case I saw a dramatic decrease in oiliness right away - like, within hours.
That's two things. I'll butt out now.
posted by tel3path at 3:36 PM on March 8, 2011 [1 favorite]
Accutane is a miracle drug. Accept no substitutes.
posted by leotrotsky at 3:47 PM on March 8, 2011 [1 favorite]
posted by leotrotsky at 3:47 PM on March 8, 2011 [1 favorite]
I'll just add to the pile -- yes, you should go see a dermatologist (if you haven't already. I was a tiny bit confused by your post). Does your city have one of those local magazines that does an annual "Best of" issue? I grew up outside Washington DC and the Washingtonian Magazine devoted a whole issue each year to ranking local doctors and their specialities. Maybe you could find someone reputable that way.
I have cystic acne, too (and am in my mid-to-late twenties) but I got it under control. Over a year ago, I told my then-boyfriend that I had a dermatologist appointment and his reply was "Wait, why would someone with perfect skin go to a dermatologist?" Believe me, comments like those are worth the struggle you're going through! Here is what worked for me after suffering off and on for a decade before that:
-Altralin gel ($250 without insurance, but you probably have insurance, right?). I apply this almost every night. I think it is like Retin-A but gentler. It helps a lot to make my skin smooth and even kind of glowing, but it takes a while to work and you need to make it part of a consistent routine.
-100 mg of doxycycline (an antibiotic) each day. This is the single most important and effective part of my skin care.
-Cortisone injections directly into the cyst (but I rarely get them anymore). I just make sure to have an arrangement with a dermatologist where I can call and get a same day appointment to just have the injection done. Usually, a dermatologist can find 5 minutes to see you just for this, but you need to be direct with them in your first appointment about doing this. You can also call the receptionist and ask if there are any cancellations that you can jump on. They were fine with me doing this once or twice a day until we found an opening.
-plain old clearasil or cetaphil for face wash
-CVS-brand non comedogenic moisturizer or cetaphil moisturizer if needed
-Yasmin birth control (taken so that I skipped my period for all but 4 times a year to avoid the hormonal fluctuations that often led to my break outs)
-I almost never wear make up and try to always sleep on a clean pillowcase.
I went on Accutane as a teenager but it didn't help my acne and I am certain it caused me to become depressed. Your experience, of course, may be different.
posted by pinetree at 3:59 PM on March 8, 2011
I have cystic acne, too (and am in my mid-to-late twenties) but I got it under control. Over a year ago, I told my then-boyfriend that I had a dermatologist appointment and his reply was "Wait, why would someone with perfect skin go to a dermatologist?" Believe me, comments like those are worth the struggle you're going through! Here is what worked for me after suffering off and on for a decade before that:
-Altralin gel ($250 without insurance, but you probably have insurance, right?). I apply this almost every night. I think it is like Retin-A but gentler. It helps a lot to make my skin smooth and even kind of glowing, but it takes a while to work and you need to make it part of a consistent routine.
-100 mg of doxycycline (an antibiotic) each day. This is the single most important and effective part of my skin care.
-Cortisone injections directly into the cyst (but I rarely get them anymore). I just make sure to have an arrangement with a dermatologist where I can call and get a same day appointment to just have the injection done. Usually, a dermatologist can find 5 minutes to see you just for this, but you need to be direct with them in your first appointment about doing this. You can also call the receptionist and ask if there are any cancellations that you can jump on. They were fine with me doing this once or twice a day until we found an opening.
-plain old clearasil or cetaphil for face wash
-CVS-brand non comedogenic moisturizer or cetaphil moisturizer if needed
-Yasmin birth control (taken so that I skipped my period for all but 4 times a year to avoid the hormonal fluctuations that often led to my break outs)
-I almost never wear make up and try to always sleep on a clean pillowcase.
I went on Accutane as a teenager but it didn't help my acne and I am certain it caused me to become depressed. Your experience, of course, may be different.
posted by pinetree at 3:59 PM on March 8, 2011
Hightly recommend the dermatologist. My wife has rosachea and only by going was anything getting better. I, it turns out from 20 years of surfing, have moderate to severe dysplastic nurvosa all over the place.
Dermatologists rule. Just be sure to tell them everything.. your reaction to meds, if you don't like the meds, etc etc.
posted by rich at 4:15 PM on March 8, 2011
Dermatologists rule. Just be sure to tell them everything.. your reaction to meds, if you don't like the meds, etc etc.
posted by rich at 4:15 PM on March 8, 2011
I see from your past questions that you have a history of depression; your doctor may be reluctant to put you on Accutane if it is not well-managed. For me, getting rid of the acne almost magically lifted the veil of misery and gloominess that comes with having ugly skin, and enabled me much more outgoing and confident. I admit it sounds like a cliche, but Accutane improved the quality of my life dramatically, even aspects that I didn't realize were affected by acne.
posted by halogen at 4:15 PM on March 8, 2011
posted by halogen at 4:15 PM on March 8, 2011
Go see a dermatologist.
You should've done this a long time ago instead of going through your primary care!
I started seeing one when I was 16 because of cystic acne.
Back then, I was prescribed an antibiotic... which i don't think they prescribe anymore for long-term solutions. I was on it for 4-5 years (no side-effects for me). It did clear my face up. Then I started taking birth control, which interacted with the antibiotic. So I started various topical stuff which didn't work as well, but it helped.
I'm 30 now and just in the last year my face has cleared for the most part. Not sure why. I've been using is Cetaphil to wash my face when I get home and in the morning. Nothing else.
you may want to check out acne.org. They have a section where members review the skin products that they use. You can sort by whats ranked the highest and by what kind of product. Gives you a better overview of what works the most for people.
Good luck!
posted by KogeLiz at 4:31 PM on March 8, 2011
You should've done this a long time ago instead of going through your primary care!
I started seeing one when I was 16 because of cystic acne.
Back then, I was prescribed an antibiotic... which i don't think they prescribe anymore for long-term solutions. I was on it for 4-5 years (no side-effects for me). It did clear my face up. Then I started taking birth control, which interacted with the antibiotic. So I started various topical stuff which didn't work as well, but it helped.
I'm 30 now and just in the last year my face has cleared for the most part. Not sure why. I've been using is Cetaphil to wash my face when I get home and in the morning. Nothing else.
you may want to check out acne.org. They have a section where members review the skin products that they use. You can sort by whats ranked the highest and by what kind of product. Gives you a better overview of what works the most for people.
Good luck!
posted by KogeLiz at 4:31 PM on March 8, 2011
Yes, seeing a competent dermatologist is advised. General practitioners cannot master everything.
* Beware habitual antibiotic use. This can cause IBS and antibiotic resistance.
* Accutane is some really serious, heavy-duty shit. Read the fine print before considering it.
* There are lots of treatments for acne and its after effects, including laser and chemical peels.
Find someone who is open-minded and balances risk, cost, and effectiveness of treatments when presenting them.
posted by 4midori at 4:33 PM on March 8, 2011 [1 favorite]
* Beware habitual antibiotic use. This can cause IBS and antibiotic resistance.
* Accutane is some really serious, heavy-duty shit. Read the fine print before considering it.
* There are lots of treatments for acne and its after effects, including laser and chemical peels.
Find someone who is open-minded and balances risk, cost, and effectiveness of treatments when presenting them.
posted by 4midori at 4:33 PM on March 8, 2011 [1 favorite]
Again, accutane is miraculous. It could take a month to work, but you will regret every minute you wasted before going to a dermatologist.
You could get lucky and only need antibiotics. But go as soon as you can find one to get started. THEN decide if you like the doc and shop around. I spent years tortured by bad skin. Don't spend anymore time thinking about it. It will change your life in only the way others with cystic acne can understand.
posted by crankyrogalsky at 4:36 PM on March 8, 2011
You could get lucky and only need antibiotics. But go as soon as you can find one to get started. THEN decide if you like the doc and shop around. I spent years tortured by bad skin. Don't spend anymore time thinking about it. It will change your life in only the way others with cystic acne can understand.
posted by crankyrogalsky at 4:36 PM on March 8, 2011
Yes, please please please go to a dermatologist. I had perfect skin until I got pregnant, at which point I developed cystic acne. People who have never had it can't understand it, and will recommend all kinds of topical garbage and face-washing regimens. What you need is a professional who can start an appropriate medication ASAP. For me, it was Accutane, and although it has icky side effects* it was made for clearing up cystic acne. I agree with everyone who says what an incredibly positive difference it made in my life. However, because of the pregnancy, I couldn't start any meds until after I had delivered and weaned the babe. Because of that wait I have horrible scars, including two places on my face where the skin is actually separated from the underlying muscle - permanent little pockets.
Seriously: Don't wait. Call tomorrow.
* side effects for me were super-intense drying of all of my skin, and although I was on it 10 years ago, I still think my skin is drier and more sensitive than it was before. I never had any of the psychological side effects; in fact I was more depressed dealing with the acne than I was during treatment.
posted by lilnublet at 4:40 PM on March 8, 2011
Seriously: Don't wait. Call tomorrow.
* side effects for me were super-intense drying of all of my skin, and although I was on it 10 years ago, I still think my skin is drier and more sensitive than it was before. I never had any of the psychological side effects; in fact I was more depressed dealing with the acne than I was during treatment.
posted by lilnublet at 4:40 PM on March 8, 2011
Before you start taking any drugs, I would ask to be allergy tested. Food allergies can wreak havoc on your skin. And eliminating something from your diet doesn't have the side effects that drugs or hormones can have.
posted by MexicanYenta at 4:47 PM on March 8, 2011
posted by MexicanYenta at 4:47 PM on March 8, 2011
Accutane was a miracle for me. I also have a history of occasional bouts of depression. It did not affect my mood at all.
The quality of dermatologists can vary dramatically. Try to read reviews of your dermatologist before you go. Be prepared to aggressively ask about what you're being prescribed, how long it should take to work, and when you can come in for a follow-up. If 99 percent of his or her patients are coming in for Botox treatments or hair plugs, your doctor's area of interest may not be acne and you may not get the best treatment.
Anecdotally, Retin A was never a good treatment for my cystic acne, and I don't know anyone, as a teenager, who did have success with it. I did have success with a topical antibiotic, though, Clindamycin.
My current derm (I think she's whip-smart) says that for cystic acne the pharmacy stuff just won't cut it.
posted by purpleclover at 5:10 PM on March 8, 2011
The quality of dermatologists can vary dramatically. Try to read reviews of your dermatologist before you go. Be prepared to aggressively ask about what you're being prescribed, how long it should take to work, and when you can come in for a follow-up. If 99 percent of his or her patients are coming in for Botox treatments or hair plugs, your doctor's area of interest may not be acne and you may not get the best treatment.
Anecdotally, Retin A was never a good treatment for my cystic acne, and I don't know anyone, as a teenager, who did have success with it. I did have success with a topical antibiotic, though, Clindamycin.
My current derm (I think she's whip-smart) says that for cystic acne the pharmacy stuff just won't cut it.
posted by purpleclover at 5:10 PM on March 8, 2011
Anecdotal evidence to add to the mix.
Here is what I tried:
OTC topical acne stuff
Proactiv
Years of tetracycline (caused my teeth to gray but helped minimize breakouts- definitely not perfect)
Various birth controls
After all of that, I had a dermatologist prescribe Accutane. How I wish I would have tried it years earlier! It was magical -- seriously!
It's going to be a huge pain in the butt for you because you are a female of child bearing age so you'll have to get all sorts of tests before you start and then have pregnancy tests during the course of treatment(s). It has some serious potential side-effects but the key word is potential and I never experienced them. Truly a miracle drug for me.
posted by notcomputersavvy06 at 5:25 PM on March 8, 2011
Here is what I tried:
OTC topical acne stuff
Proactiv
Years of tetracycline (caused my teeth to gray but helped minimize breakouts- definitely not perfect)
Various birth controls
After all of that, I had a dermatologist prescribe Accutane. How I wish I would have tried it years earlier! It was magical -- seriously!
It's going to be a huge pain in the butt for you because you are a female of child bearing age so you'll have to get all sorts of tests before you start and then have pregnancy tests during the course of treatment(s). It has some serious potential side-effects but the key word is potential and I never experienced them. Truly a miracle drug for me.
posted by notcomputersavvy06 at 5:25 PM on March 8, 2011
Therefore, it seems the next logical step is getting my very own dermatologist.
Just for future reference: That's actually the first logical step.
posted by Sys Rq at 5:47 PM on March 8, 2011 [1 favorite]
Just for future reference: That's actually the first logical step.
posted by Sys Rq at 5:47 PM on March 8, 2011 [1 favorite]
i had really bad cystic acne from 18-22. i had a dermatologist. he prescribed an oral antibiotic (it's been too long and i don't remember what it was), retin-a, and some kind of sulphur cream (again, don't remember exactly what). i also got the injections at appts if there were really bad cysts.
all of this combined did work. it took awhile for things to calm down and even out. i still (at 30) get the occasional cyst (along with "normal pimples").
if you'll note, 18-22 are the years i was in college, with a lot of stressors, bad diet, smoking, and binge drinking. so, if you have a lot of those things in your life, consider eliminating them or reducing them.
anyway. i think you should definitely check out a dermatologist. they specialize in this stuff, while your GP, while likely informed, is a GP and is not a specialist.
also, i've been on lots of different birth control, and none of them did a thing for my skin, though some made it way worse.
GO TO A DERMATOLOGIST!!!!!!!!!!
posted by misanthropicsarah at 5:55 PM on March 8, 2011
all of this combined did work. it took awhile for things to calm down and even out. i still (at 30) get the occasional cyst (along with "normal pimples").
if you'll note, 18-22 are the years i was in college, with a lot of stressors, bad diet, smoking, and binge drinking. so, if you have a lot of those things in your life, consider eliminating them or reducing them.
anyway. i think you should definitely check out a dermatologist. they specialize in this stuff, while your GP, while likely informed, is a GP and is not a specialist.
also, i've been on lots of different birth control, and none of them did a thing for my skin, though some made it way worse.
GO TO A DERMATOLOGIST!!!!!!!!!!
posted by misanthropicsarah at 5:55 PM on March 8, 2011
Echoing Accutane as they only thing that worked for me. Like you, I tried EVERYTHING from age 12 to 28: drugstore creams and cleansers, benzoyl peroxide, multiple brands of birth control pills, AHA's, Retin-A, Tetracycline, etc etc. Finally, approaching 30 I was FED UP and went on Accutane. Even though my acne was not severe, it was persistent, and my dermatologist agreed I had run out of options. It worked (and I'm still mostly clear six years later).
The side effects of Accutane are harsh (dry eyes, skin, lips, hair). I also had to go on birth control pills, and take time off work every month for blood tests and doctor's visits. Treatment lasts six months and I'd do it again. So yeah, see a dermatologist.
posted by exquisite_deluxe at 7:56 PM on March 8, 2011
The side effects of Accutane are harsh (dry eyes, skin, lips, hair). I also had to go on birth control pills, and take time off work every month for blood tests and doctor's visits. Treatment lasts six months and I'd do it again. So yeah, see a dermatologist.
posted by exquisite_deluxe at 7:56 PM on March 8, 2011
Given my own experiences (male, early-30s, had particularly bad cystic acne which lasted at a lower frequency but still bad through my 20s and can still occur with the right environmental factors), I would suggest:
- a low-carbohydrate diet (especially no sugar, though keeping the carbohydrate intake below 50-80 grams per day is best.) Go read one of the books by Eades or Atkins to get you started. Life Without Bread is good too.
- avoiding sodium lauryl sulphate and sodium laureth sulphate anywhere near the affected skin -- they're very irritating detergents. (this most likely includes shampoo. One of the few shampoos which doesn't include these detergents is Johnson's Baby Shampoo. However, one problem you may encounter is that if you have long hair, it's hard to get it clean with such a gentle shampoo.) Watch out, they're a popular ingredient in damn near any non-soap product for washing.
Other things which tend to generally reduce inflammation may help somewhat, e.g. omega-3 fish oil capsules (there's been evidence that the vast excess of omega-6 fatty acids from vegetables in the typical American diet is inflammatory, and more omega-3 fatty acids can offset that somewhat), and anything possible to reduce stress.
posted by mmagin at 8:21 PM on March 8, 2011
- a low-carbohydrate diet (especially no sugar, though keeping the carbohydrate intake below 50-80 grams per day is best.) Go read one of the books by Eades or Atkins to get you started. Life Without Bread is good too.
- avoiding sodium lauryl sulphate and sodium laureth sulphate anywhere near the affected skin -- they're very irritating detergents. (this most likely includes shampoo. One of the few shampoos which doesn't include these detergents is Johnson's Baby Shampoo. However, one problem you may encounter is that if you have long hair, it's hard to get it clean with such a gentle shampoo.) Watch out, they're a popular ingredient in damn near any non-soap product for washing.
Other things which tend to generally reduce inflammation may help somewhat, e.g. omega-3 fish oil capsules (there's been evidence that the vast excess of omega-6 fatty acids from vegetables in the typical American diet is inflammatory, and more omega-3 fatty acids can offset that somewhat), and anything possible to reduce stress.
posted by mmagin at 8:21 PM on March 8, 2011
This is my answer to every skin question, but makeupalley skin board. They know their shit. They may not be dermatologists, but they really do know that of which they speak, and can point you in the logical next direction. Acne.org and such also do a good job. They will be able to help you begin, though the logical next step is definitely someone who can prescribe you stuff.
posted by R a c h e l at 9:33 PM on March 8, 2011
posted by R a c h e l at 9:33 PM on March 8, 2011
Response by poster: My god, thanks so much for the comments.
Just thought I'd pop back in to share:
I have not had insurance for quite sometime, hence the reticence to see a doctor for something that isn't life threatening. Also, it's fairly easy for someone with my stupid battle to see *everything* as snake oil.
But—here I go. I'll be looking for a good dermatologist tomorrow, thanks to you guys. I just really wanted to go in with an intelligent perspective to the problem, rather than an angsty "PLEASE FIX THIS, DOCTOR!!"
I do have a history of depression (thanks for looking back in time) and didn't know that Accutane could exacerbate the bouts. Now I do. See? That's exactly the kind of background I'm going for, education-wise.
This is good. Thanks!
posted by hubble at 10:26 PM on March 8, 2011
Just thought I'd pop back in to share:
I have not had insurance for quite sometime, hence the reticence to see a doctor for something that isn't life threatening. Also, it's fairly easy for someone with my stupid battle to see *everything* as snake oil.
But—here I go. I'll be looking for a good dermatologist tomorrow, thanks to you guys. I just really wanted to go in with an intelligent perspective to the problem, rather than an angsty "PLEASE FIX THIS, DOCTOR!!"
I do have a history of depression (thanks for looking back in time) and didn't know that Accutane could exacerbate the bouts. Now I do. See? That's exactly the kind of background I'm going for, education-wise.
This is good. Thanks!
posted by hubble at 10:26 PM on March 8, 2011
This thread is closed to new comments.
All that said, yes, dermatologists can help with cystic acne, especially if your case is persistent enough to need something strong like Accutane.
posted by joan_holloway at 3:10 PM on March 8, 2011 [4 favorites]