Should I go to a dermatologist or a cosmetician for my skin problem?

November 6, 2014 5:29 PM

I'm 23 years old and I have had rough tiny bumps all over my face for a few years now. They are not really acnes because they do not go away and are skin-colored. I have a good skin care routine, which I cleanse and moisturize daily and I use a Clarisonic about 3 times a week. Nothing seems to help my skin be smooth. I'm not sure if my condition should be seen by a dermatologist or not since it's not really a major problem. Should I go to a dermatologist's office or a cosmetic skin care center that offers chemical peels and microdermabrasions? Here's a picture of how my skin looks.
posted by missybitsy to Health & Fitness (17 answers total)

Go to a dermatologist. They are best qualified to help guide you, and might be able to recommend something. I'm skeptical towards going to a cosmetic skin care center first: their role is to sell services, not get your skin healthy.
posted by troytroy at 5:37 PM on November 6, 2014

Have you discussed this with your GP? They might be able to give the best guidance (and do it for free if you ask during a physical)

Also, if you have insurance, the dermatologist might be covered.
posted by schmod at 5:38 PM on November 6, 2014

I have this same problem. A dermatologist could prescribe you Retin-A, which can help. I've also used Acne Free which has Benzoyl Peroxide and you can buy at a drugstore without a prescription. If you get a facial, request "pore cleansing" and they'll drain the bumps - kind of gross and a little painful, but works great.
posted by Toddles at 5:39 PM on November 6, 2014

Those look like closed comedones to me. Unfortunately, they're pretty stubborn. I'd recommend trying an AHA treatment (check out Paula's Choice), basically a chemical exfoliant. If that doesn't work, you may want to try getting a retinoid cream from a dermatologist. I'd recommend against chemical peels or fancy facials-- a lot of spas aren't trained in dermatology and their formulas can be too harsh or irritating, and 'extractions' can cause worse infections if done incorrectly.

They could also be caused by a bad reaction to one of your cleansers or moisturizers. I've read about some people getting closed comedones from cetyl alcohol, a common ingredient in moisturizers.
posted by sonmi at 5:40 PM on November 6, 2014

Also, using the Clarisonic 3 times a week may be overkill and possibly irritating your skin-- try cutting back to once a week or less and see if that improves things, too.
posted by sonmi at 5:43 PM on November 6, 2014

They look like clogged pores. What happens when you steam your face and then squeeze them?
posted by Jacqueline at 5:46 PM on November 6, 2014

Thanks for the answers so far, everyone! When I try to squeeze them, nothing come out. It's very hard to squeeze them because they are so small and they are like raised bumps instead of a hard plug.
posted by missybitsy at 6:22 PM on November 6, 2014

Have you considered allergies? Do you have a cat? I had something similar for years when I had cats. Have you tried switching detergents? Fabric softeners?
posted by mareli at 6:23 PM on November 6, 2014

There are very few dermatologic emergencies. Don't feel bad about seeing a dermatologist for a minor issue, that's pretty much their wheelhouse. Unfortunately, many dermatology practices are into selling you cosmetic stuff too (it's a cash business instead of dealing with insurance!). Based on my experiences I will only go to academic centers for derm issues, ymmv. (the academic places will STILL sell cosmetic services, but they don't push them as hard)
posted by treehorn+bunny at 6:59 PM on November 6, 2014

It looks like keratosis pilaris to my untrained eye, but I agree with other posters that you should see a dermatologist and not opt for spa treatments without knowing what it is.
posted by Specklet at 7:03 PM on November 6, 2014

Yup, closed comedones. Add AHAs and BHAs (alpha and beta hydroxy acids) to your skincare regimen. If they don't do much, the next step is to try retinoids. Fatty alcohols in skincare products can cause these in some people.
posted by quince at 7:21 PM on November 6, 2014

This is not medical advice. This is what worked for me.

I went to a derma for something similar — closed white and/or skin-colored bumps all over my chin. I can't remember what the derma said, or even if she gave me a "named" diagnosis, but I think they were a combination of milia and closed comedones. She gave me some retinoid stuff that was super expensive and irritated the SHIT out of my skin. I have combo skin, oily t-zone, and this stuff made my skin flake off. My sking was so dry and irritated I decided the bumps were better than the cracked pain.

On a friend's advice, I went to Philosophy in Nordstrom and talked to the salesgirl about my situation. She gave me a ton of samples and I ended up buying the Clear Days Ahead sample package. It took some trial and error, but this is what I use now and my skin is SO MUCH BETTER. At first I used it all the time, but my skin has cleared up enough that now I just use the facewash daily and the treatments as needed.

The benefit of going to Nordstrom is that I was able to return a few items that either didn't work or irritated my skin and get samples for things before committing to them. It's a lot easier to try different things without having to resort to Rxs.
posted by Brittanie at 7:35 PM on November 6, 2014

What type of shampoo are you using? Does it contain sulfates? I have the same problem all over my face (with my forehead being the worst) when I use shampoos with sulfates (aka most shampoos). It's maddening.
posted by Hermione Granger at 8:19 PM on November 6, 2014

Please don't try to squeeze those bumps! They will just get inflamed and look worse. I would definitely go to a dermatologist for this. I think keratosis pilaris (KP) or milia are distinct possibilities, but only a derm can diagnose for sure and prescribe the right treatment. I have milia on my face that responds well to topical antibiotics, and KP on my legs that I treat with lactic acid lotion. It took me a decade to work up the nerve to talk to a dermatologist, and then suddenly I had a treatment plan in place that got rid of it. Go!!!
posted by joan_holloway at 9:05 PM on November 6, 2014

I have closed comedones! I am also prone to keratosis pilaris, and from your picture I would put money on closed comedones and not KP. AHAs/BHAs really help diminish both CCs and KP, though they are stubborn.

I found some good advice from the subreddit r/skincareaddiction

Avoid physical exfoliants (i.e. scrubs and microbeads etc) as they are abrasive; steaming your face will dry it out; do not squeeze your bumps.

I would say that the general skincare regimen suggested by this subreddit and elsewhere can work out quite expensive (particularly chemical exfoliants) and also takes quite a long time, because you should only introduce new products one by one so you can gauge how helpful they are. So, while I absolutely do not want to suggest that this problem you have is not a problem (these bumps do a number on my self-esteem), I will say that closed comedones are far, far more obvious to you than to anyone else. In fact, they are only really noticeable at all at close range, when the light rakes across your face.
posted by dumdidumdum at 3:04 AM on November 7, 2014

Sounds like seeing a derm is an option, so do it.
posted by Lesser Shrew at 6:04 AM on November 7, 2014

In the meantime, ease up on the clarisonic to once a week, change your pillow cases often and use mild old fashioned cold cream to remove your make-up to avoid alcohols in your regimen.
posted by jadepearl at 12:32 PM on November 7, 2014