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Disappointed with Dermatologist (Teen Acne)


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Dd 15 suffers from cystic acne, and it's an extreme case (face, neck, back).  We worked with her pediatrician and did the antibiotic route and topical cream, but the results were not great.  It turned out that the antibiotic she was on can cause/mimic the effects of lupus, which we have an awful family history of.  The pediatrician would not prescribe any more antibiotics, and insurance stopped covering the majority of topical creams.  It took forever to get the referral and appointment for the dermatologist.  Dh had to take her because I was at work, and it was absolutely ridiculous.  We knew she could not take accutane because of her other medication (antidepressant), but were told that she would probably be prescribed a birth control pill to get her hormones under control, along with some light treatments and stronger cream.  

The dermatologist wanted to put her on exactly what she had already tried, could no longer take.  My dh explained it to him, doctor said it wasn't in her chart.  Dh called me, I called the nurse's desk and was informed that yes, dd's chart was very specific about not taking that course of antibiotics anymore as well as the accutane.  Doctor continued to disagree with dh, so I had nurse call the dermatologist.  The dermatologist walked back into the exam room with two printouts from Amazon.  He said she should wash her face with Cetaphil and try the Neutrogena On the Spot medication.  Dh asked why no other treatment options, and doctor said nothing else was available for dd.  He did, however, offer a coupon for a "new" face wash through his pharmacy rep, not covered by our insurance.  Seriously.  WTH.  

I feel bad for her, although she doesn't say anything, I know it bothers her.  Anyone have any real solutions?  We've cut out dairy, working on reducing sugar in diet.  We are currently using Dermalogica acne wash for face and body, and the last of the cream prescribed by the pediatrician.  

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Sorry, this is frustrating.

If you want to try birth control, why not simply get it from another source and not the derm? It sometimes helps; worked well for my DD with moderate acne that didn't respond well to antibiotics.

Can the psychiatrist who prescribed the antidepressant reevaluate the prescription and see if there is an alternative that would allow her to take accutane? It was the only thing that helped my DS after many frustrating courses of antibiotics.

Good luck

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Have you tried proactive?  That was extremely helpful to me and turned my complexion around when I was in my 20's.  My kids do have some acne but haven't needed anything that heavy duty yet.  It's probably similar to acne.org.

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Is there another dermatologist you can try if any of the remedies people are recommending? Is there maybe a teaching hospital that would see her? Generally speaking, they seem to do well with unusual cases. 

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((((readinmom & dd15)))))

Sometimes diet can be a big cause of skin conditions. Have y'all eliminated things like dairy? That's the number one cause of acne. A friend's dh was nicknamed "Red" because his face was, well, red. She decided at one point in their marriage to change their diet, and she eliminated all sorts of stuff, including dairy. To her great surprise, her dh's skin cleared up such that people who had known him since high school did not recognize him.

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I'm sorry.  I'd really try to meet with another dermatologist.  Two of my dd's have cystic acne, and one of them is severe.  Nothing touched it, not Proactive or any other popular product like that.  She is now on a variety of prescription topical creams (which we pay for out-of-pocket because insurance no longer covers them over age 18), an oral antibiotic, and birth control pills.  Her dermatologist says there are a number of oral antibiotics that would work.  Can you try a different one that wouldn't negatively affect your dd?  My dd isn't on oral antibiotics long-term.  She did it for about six months at the beginning, and every few years seems to need it again for about six months.  She has not yet tried Accutane, and her acne has mostly been controlled.  Most of the time her skin is beautifully clear, actually!  It has been about 7 years.  It was a really tough case though.  With all of her strong creams, antibiotics, and birth control, it still took four months before it started to show any signs of turning around at all.

My other dd's acne is also cystic, but not quite as severe.  She controls it mostly by her diet.  She is completely GF and is very careful about what she eats.  She uses all natural creams -- like coconut oil.  Her complexion isn't perfect, but she's happy with where she's at.  But again, hers was not as severe.

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Prescription wise I think you could try Retin-A.

Over the counter wise you could try Proactive.  It worked wonders for my sister when we were kids. I think she stayed on it until her first pregnancy.

I found as a kid that if I was breaking out it was usually due to dehydration, and drinking more water and putting moisturizer on my face helped more than peroxide based products.

I've heard good things about a book called The Clear Skin Diet.  It's low fat whole food vegan.  I would watch that closely because some teens find that anxiety increases when they cut out all saturated fats.  Others feel better on a low fat diet.

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Ds uses Retin-A. The dermatologist started him on an antibiotic and a low dose of Retin A. Then we stopped the antibiotic and went to a stronger dosage of Retin-A. It's the only thing that keeps his face acne free.

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11 hours ago, peacelovehomeschooling said:

I would love more information about this.  Are their products really better than the usual over the counter products?  Are they expensive?

You can explore the "Shop" portion of their website.  It gives explicit directions on HOW to clean your face.  It explicitly says it takes a month (or more?!?) to see results.

It's NOT magical, but it is a combination of 3 products = Cleanser, Treatment & Moisturizer. 

We probably spend about $25 per month for the amount he uses, buying the large containers & getting free shipping.  It's what has worked for our ds.

Also, there are many, many previous WTM threads about Teen Acne, if you want to get a wider variety of feedback. 

Our other children had milder acne, which responded well to OTC Cleanser, Treatment & Moisturizer . . . like the Cetaphil & On-the-Spot products you were given by the Derm.

It's worth researching or experimenting with other options! 

(I would try eliminating problem foods, too, as suggested above.  It made no change for our ds.)

Edited by Beth S
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Thank you for all the support!  Right now the plan is to try the Aveeno acne pads, wash, and lotion in the morning; 5 minutes of sun for back in the afternoon; keep evening routine.  I have a call in to pediatrician regarding the b.c. pills.  I know we'll have to see an ob/gyn for those.  Sigh.  I'm giving this two weeks to show some improvement, then I'm making the call to the university hospitals.  

Thanks again!

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Check out https://www.reddit.com/r/SkincareAddiction/  There is so much good information there, especially in the sidebar. If her acne is cystic, birth control might be your best option. Be careful, though, not all BC is good for acne. This link https://www.acne.org/messageboard/topic/330166-good-bad-birth-control-pills-and-implants-for-acne/ has some great information. My children have used the acne.org routine. It worked well for one and not the other. 

ETA- You really don't need to see an OB/GYN for birth control. Birth control is prescribed for all sorts of medical reasons. Our family doc has always prescribed it.

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I would try another dermatologist. 

You could try Curology or one of the other online dermatologists if needed. You send photos, and medical history, and they prescribe stuff online. 

My teen with acne follows a similar routine to the Acne.org one but we buy AcneFree cleanser at the drug store or target instead of buying products from Acne.org.  The key is a  2.5% (not higher!) benzoyl peroxide, 2.5% benzoyl peroxide spot treatment or "mask" (some brands call it a mask), and an calming/soothing acne friendly moisturizer. 

Thayers witch hazel can feel good on super oily skin as a toner, it is alcohol free.  But if it irritates, don't use it. My teen finds it nice in the middle of the day and their skin is oily. 

Also make sure pillow cases anything that touches the face is washed often. 

Since cystic acne is often hormonal, the right bc pills could make a significant difference. 

Be gentle with the skin, acne skin is inflamed irritated skin. 

I hope you find something that works well, acne is so frustrating and uncomfortable. 

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I normally would not comment on anyone's health issues because most people are not helpful, but my heart is breaking for your daughter! Cystic acne is horrible enough but all over her neck and back??

I will share with you what I learned. All the external treatments in the world will not work. There is something wrong with her body and it is freaking out. I know you said you cut out dairy but I would urge you to cut out wheat, soy, sugar, eggs, corn, all nuts and definitely ensure that she is cutting out even minuet traces of dairy. The best way to do all this is to just eat protein, rice and veggies. Absolutely no sugar drinks. Only water. No sugar substitutes and no processed foods. And she needs to drink 3quarts to 1 gallon of water per day to help her body flush out whatever is inflaming her. 

I will say a prayer for her!

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On 5/30/2018 at 10:40 PM, Sharon77 said:

I normally would not comment on anyone's health issues because most people are not helpful, but my heart is breaking for your daughter! Cystic acne is horrible enough but all over her neck and back??

I will share with you what I learned. All the external treatments in the world will not work. There is something wrong with her body and it is freaking out. I know you said you cut out dairy but I would urge you to cut out wheat, soy, sugar, eggs, corn, all nuts and definitely ensure that she is cutting out even minuet traces of dairy. The best way to do all this is to just eat protein, rice and veggies. Absolutely no sugar drinks. Only water. No sugar substitutes and no processed foods. And she needs to drink 3quarts to 1 gallon of water per day to help her body flush out whatever is inflaming her. 

I will say a prayer for her!

Yes, I so agree with this.  Something is definitely going on internally and you really need to find out what it is if you can.  Since you've already cut out dairy, I would start with gluten next. But you really have to research to find out where gluten is hidden etc.. My Dh is celiac and one of my twin boys is definitely at least gluten intolerant (no digestive issues but very much affects his moods and mental clarity).  I hope you find out what is going on.

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In addition to what sharon77 said, perhaps check liver function as well. You could also squeeze lemon juice into water and drink this in the morning before eating; this is supposed to support liver function.

Don't let her give up because it has been a hard road so far. This can be so debilitating. Your face is what everyone sees first and you cannot cover it up. Could she try Retin-A? I think someone else had suggested it upthread. Many people seem to have found successful treatment with Retin-A. 

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Try differin.  It has been miraculous for DS.

Be careful with aveeno products. It makes me and DS break out.

 Just a bit of hope-  I had horrible cystic acne as a teen( including back, neck and chest).  Nothing work and a few years later, I no longer had it.  

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3 hours ago, itsheresomewhere said:

Try differin.  It has been miraculous for DS.

Be careful with aveeno products. It makes me and DS break out.

 Just a bit of hope-  I had horrible cystic acne as a teen( including back, neck and chest).  Nothing work and a few years later, I no longer had it.  

Yes, I agree. My dd has been using differin (OTC) for about 14 weeks. She had A LOT of purging in the first 2.5 months, I can definitely see why people give up on it. But in the last 3-4 weeks she has had only a handful of new pimples, now we just have to be patient and wait for the red marks to fade. Her skin looks the best it has in over 2 years. She also uses a benzoyl peroxide lotion in the morning (proactive lotion) but not every day. If she doesn’t get completely clear in the next 3 months we will probably try the prescription strength differin. Differin has some advantages over retin-a, the biggest one is that has anti-inflammatory properties  

Before this we had tried proactive, curology (mixed prescription cream), oral antibiotics, and we spent 7 months and several thousands of dollars with an esthetician. During the time with the esthetician she was dairy free, grain free (she’s been GF for years), nut free, no sugar, no nightshades, limited fruit, etc. That all had zero impact on her acne. 

If the differin hadn’t worked (and doesn’t continue to work) our next step would probably be birth control pills. 

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