nearly at the end of acne treatment DS2 has missed an appointment....

[seethesuninwintertime]

.... and there aren't any more for a month so I have to ask for advice here.

Ds2 (16) is close to completing a 6-month treatment course for nodular/scarring acne using Isotretinoin. It is basically working although he is not acne free.

He has apparently completed the course of isotretinoin in itself (it runs out in a week) but needs to have a gel of some sort to transition? that's what he was told at his last appointment.

This morning he missed his follow-up appointment :(. He phoned to grovel when he got home and was told there were no more appointments for a month :(.

I am concerned that this will undermine the long-term benefit of the Isotretinoin (if there is a month-long gap between the Isotretinoin and the gel).

Is anyone able to advise on a acne-specific or how-to-beg-for-an-appointment level?
If all else fails could he see a private dermatologist? That seems crazy but it seems isotretinoin is a fairly serious treatment and not something you want to mess about with.

...... I suppose in theory I could demand that his GP make a private referral to a dermatologist .... but that seems like a terrible waste of everyone's time and money just to pick up a gel that's going to be prescribed anyway :(

Can he ask his GP to prescribe a tretinoin gel?

Phone his consultant's secretary and ask for him to write the prescription or call you? Our consultants would probably do that if it was important and you weren't in the habit of DNAing your appointments

thank you Cowburp and Polka. Is tretinoin the gel that people usually take after Isotretinoin?

He has been going to a GP-led dermatology clinic. So the GPs with an interest in dermatology are the only people who have seen him but they showed pictures to a consultant dermatologist before prescribing the Isotretinoin.

I thought a GP couldn't refuse to make a private referral if it's medically justified?

I appreciate chicken that my son has made a mistake but we punish that by grounding him, not be deliberately allowing him to suffer an adverse health effect.....

Dd had a course of it and it was never suggested to have any sort of gel or other treatment at the end. She just stopped it and that was that. No issues since.

I’d contact Dr Sam Bunting (Google) and get a private appointment with her or one of them there as there’s much better treatment than isotetroin/tretinoin (sp!) creams and gels. It is important to keep going with a routine but more so with pills like roaccutane/spironalactone

I'm not in the UK but do you not have private dermatologists that you can just call, make an appointment with and then pay rather than wasting a GPs time getting a referral?

thanks Bagels. I guess it is lucky that this is the appointment he missed....

he does still have some spots (just not the big scarring ones) so I am a little concerned.

My brother says his life was ruined by his acne :( so I know the consequences of screwing this up.

Can't you somehow have a telephone appointment with a GP or Nurse?
The amount of times I've missed appointments for my DD (from dietician, speech and language, physio all the way to paediatritian and may I add I'm not proud) and I've phoned to see if it can be settled with a phone call.

Maybe go and talk to your local pharmacist? The one that is closest to the GP.

Your issue will be that not everyone has the gel at the end, and his appointment was probably to evaluate if he needed it, and if so, prescribe it and tell him how to use it.

Has he phoned and apologise; and book the appointment for a month? He can always ask for cancellations in the meantime… but he’s probably going to have to wait to be assessed, as there’s not a “standard” treatment plan to follow.

Thank you blue-shirt. It's good to know there are alternatives. As I say, I come from a family where my brother feels his life was ruined by acne.
Yes, I had understood that routine is particularly important with these drugs so it's especially disappointing that this was the appointment he missed.

One thing I won't be doing is nothing.
I guess I can start by getting access to his medical records.

There is no need to 'demand' anything from your GP and it's completely unreasonable to behave like that. Especially when the situation is in no way the GP's fault. Their job is hard enough already without that attitude.

OP he is not being punished by the Drs, it is the reality of the NHS.

Have you spoken to his GP? Normally the treating Dr would write to the GP with the treatment plan and so that may be enough for your GP to prescribe the missing piece. Do you know what strength he is currently on?

Thank you Calico.

The "gp-led-dermatology-cinic" is very much its own thing. So you see GPs but they are wearing different hats.

I suppose one thing I can do is make an ordinary GP's appointment with one of the GPs who also runs the dermatology clinic. They won't be pleased as no doubt this messes up their systems but the NHS does not exist to punish children.....

exactly handlebars. As I pointed out (I thought fairly clearly) such a course of action would waste 15 minutes of a GP's time, a great deal more of mine, and cost me several hundred pounds.

It is certainly not my preferred solution.

I’m sorry I can’t help, only to say I had a course of roaccutane which I think is the same thing, and at the end just stopped and had no further treatment. However it did work for me in that I hadn’t had any new spots for 2 months by the time I stopped which I think was the sort of ‘test’ the dermatologist used to measure its success.

"Have you spoken to his GP? Normally the treating Dr would write to the GP with the treatment plan and so that may be enough for your GP to prescribe the missing piece. Do you know what strength he is currently on?"

Thank you left that's extremely helpful. I will phone the GP-Dermatology-receptionists on Monday and if no joy I will phone them back (it's the same people but there you go....) and ask for an ordinary GP's appointment.

Our GP practice is really efficient and calls back on the same day - my concern is that the GP-Dermatology-clinic seems very separate.

TakeYourFinal:

"Your issue will be that not everyone has the gel at the end, and his appointment was probably to evaluate if he needed it, and if so, prescribe it and tell him how to use it.
Has he phoned and apologise; and book the appointment for a month? He can always ask for cancellations in the meantime… but he’s probably going to have to wait to be assessed, as there’s not a “standard” treatment plan to follow."

ahhhh, that's not great news. I also have a very high pressure job and the idea of calling them every morning to ask re cancellations is making me feel slightly sick.

He is seriously grounded

@seethesuninwintertime is it worth you googling the doctor and seeing if they offer private clinics too?
I saw a rheumatologist privately and discovered afterwards that he is the person my mum sees on the nhs? Just thinking maybe they have a private appointment that you could get to (and pay for)

Hi Kay,

Yes, I think it may come to that! His NHS records will show who the consultant is. I would then have to ask my GP for a referral but - as I say - my brother considers his life was ruined by acne, you can't take this drug long-term so I owe it to DS (grounded or not) to get him at least advice.

thank you everyone for the advice.

Surely you had some involvement in your ds missing his appointment? Yes he's 16 but didn't you remind him or anything?
Grounding is a bit harsh when his health/face is of his benefit, not yours. Surely he knows that and missing medical treatment is punishment enough?