Looking for a miracle worker: Bay Area acne dermatologist recommendations?
June 1, 2011 6:48 AM   Subscribe

Looking for a miracle worker: Bay Area acne dermatologist recommendations?

The last recs from AskMe are from 2009 or 2004. Thought another roundup would be worth it. This is for my husband who has had painful cystic acne for almost 2 decades now, back, neck, face. Otherwise healthy as a horse so I'm thinking that accutane is the next step if his liver can handle it. I've been opposed to it but I've seen that there are some that got good results without the scary side effects. The dermatologist here in NYC was a quack; the Retin-A, clindamycin, differin, rosula, made his skin softer but made NO difference in breakouts. And he was so good with the routine too, to no effect. We're moving to the Bay area today and this madness just needs to stop.

I'm looking for someone really serious about results, and who could be a good, cautious guide with accutane.

posted by scazza to Health & Fitness (3 answers total) 2 users marked this as a favorite
I had a really good experience with Dr. Reese at Union Square Dermatology (yelp link). I didn't personally end up needing Accutane, but according to Yelp other patients do, and he definitely seems up on all the latest techniques. I particularly appreciated that he took the time to understand my needs and medical situation.

And while they definitely sell all sorts of fancy "product", they don't push -- I showed him my cheap-o Daniel Kern cleanser and he declared it perfectly suitable.

Do check, however, that they take your insurance. Seems like PPOs are not a problem, but some HMOs are.
posted by CruiseSavvy at 8:13 AM on June 1, 2011

I don't have a Bay Area recommendation, but I do want to chime in to say that Accutane may be the answer (obviously research the side effects and make your own mind up, and IANYD). I took low-dose accutane (10-20mg/day) and it worked wonders. I was in a rather different situation, as I had monthly mild/medium breakouts for hormonal reasons, but the Accutane was a life-saver. I took it for about a year, and about 6 months in, my skin looked less oily, and the regular break-outs had just about stopped; the only side effect I had was somewhat dry and sensitive skin (but my skin has always been sensitive since Tazorac). I have no experience with cystic acne, so I can't advise on your particular situation, but the research I did before taking Accutane seemed to suggest that side effects are dramatically reduced with somewhat lower doses, and that they are still fairly effect (research I did before I went on it seemed to suggest that it was the cumulative dose your body gets rather than the daily dose, meaning that taking a lower dose for a longer period of time is effective and has the added benefit of fewer side effects).

I also want to ask why you believe your NYC dermatologist was a quack. As far as I'm aware, clindamycin, differin, etc. are very standard first-line approaches in acne-treatment, and good dermatologists won't usually prescribe Accutane without trying these less severe approaches first. Obviously not everyone responds to these treatments, but that in and of itself doesn't suggest that the doctor followed the wrong approach. I tried almost everything (clindamycin, benzoyl peroxide, retinoids [retin-a, taz, differin], AHA/BHA, azelaic acid), with varying but not satisfactory degrees of success. I was glad to have tried the less invasive options before trying Accutane, because it can be severe, and I still use BHA and azelaic as maintenance now that I'm done Accutane. I do feel for your husband - acne can be both painful and awful for the self-esteem - and I wish you luck in finding a treatment that is a good fit, and that his body responds to.
posted by UniversityNomad at 12:51 PM on June 1, 2011

I recently visited Dr. Kathleen Kramer at Palo Alto Medical Foundation about (non-acne) skin issues. She spent a lot of time with me, explained several options to me, and gave me detailed instructions on when I could use and how I could combine several different topical medications. She was straight forward in her answers and didn't talk down to me at all. My skin is better than it has been in a long time, and now I'm on medicines with fewer potential side effects.

I've heard that PAMF can get expensive if you're on a PPO, but if they're compatible with your HMO, it's great.
posted by asphericalcow at 10:25 PM on June 1, 2011

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