Cystic acne sufferers, share your skincare routine please.

[MikeLitoris]

I've had CA for a few years on and off. Usually treatable with a course of Duac, lymecycline if its a bad one. The last year or so it's been exceptionally bad. 6 months of lymecycline and some zinertyn (sp) haven't touched it.

My skin has become really sensitive too, I'm finding my usual face wash & moisturiser are making my skin quite tight. Rather than just the chin spots, my pores are really blocked too and i'm getting blackheads too.

I picked up some La Roche-Posay EFFACLAR DUO[+] UNIFIANT but I have no idea where to use it in a skincare regime. (before or after moisturiser?)

anyone help would be massively appreciated!

My private appointment was £200, same as hulder, just FYI.

This is probably going to sound stupid, but does anyone know how you would get.l a referral to a dermatologist? Do you just ask the GP? I just can't afford £200 atm

Yep, make an appointment and ask your GP. They can refer you to an NHS dermatologist if there is an issue they think they can help with. Just like any other specialist really.

I got referred through my GP, just asked specifically to be referred to a private dermatologist as the waiting list for private was nonexistent compared to the NHS. But like I said, that was just because of time constraints. The dermatologist I saw worked in the NHS too and I may well have seen him in the end if I'd gone NHS.

Thanks so much

Go to the GP. First of all see if any of the GPs at your surgery has a special interest in dermatology - if so, see that one - they may be able to sort you out in house.

If not, you will need to try whatever GP suggests first - usually religiously for at least 12 weeks, it takes that long to see if it has any effect. Lots of treatment failures in acne are due to people giving up too soon or then giving up once their skin has got a bit better.

If not working, go back and ask again - either GP will try something else or ask for derm referral.

For private appointments, you can just book direct. Your local NHS hospital probably offers private appointments and will have derms specialising in acne, as will your local private hospital. You literally just ring up and ask for an appointment. When DH needed a cyst removing urgently with a long NHS wait I just rang our NHS private suite, they gave me the name of 3 plastic surgeons and I picked the one who had the earliest appointment. Easy.

If you have private health insurance, you will need a GP referral for it to be covered by your insurance.

I went from Dianette to Yasmin + Spiro without a dermatologist. I figured that anti androgen meds works for me. I made an appt with a GP with a special interest in Derm/ gynae and showed her an RCT (randomised controlled trial) showing it's effectiveness. Explained how the combination mimics the chemical composition of Dianette without the risks. Look on Acne.com or org, can't remember. There's a forum where lots of people talk about their experiences with Spiro.

Just get a routine appointment with your GP bloody, you've tried a few things there but you haven't had oral antibiotics so they're likely to want you to try those. The key thing is that if things don't work, go back so they can try the next step in the ladder. Often people think there's no point then leave it another couple of years until they're miserable again- they then often end up going back to the first step or moving very slowly through the treatment options.

Mike there's no age limit on spironolactone, it isn't licensed for use in acne, it's more of a side effect, that's why it's generally be initiated by a dermatologist (GPS prescribe it for its licenced indications though). It's used for heart failure and sometimes blood pressure so usually in a much older age group than you. You'd probably need occasional blood tests to check your kidneys and potassium. I'd say it's probably considered a "safer" drug than dianette.

That said it isn't like roaccutane which can only be prescribed as part of a specialist dermatology service (sometimes this is a GP with a special interest but it wouldn't usually be by your own GP at your surgery). If your GP is familiar with this use then they might be happy to prescribe.

Thanks all.

Hoping to get an appointment on Wednesday to get a referral. I've been lucky with scarring so far but the last few flare ups have started to leave some :(

I dont think Dianette or Yasmin would be any good for me anyway, I'm terrible at remembering to take the pill everyday long term (looks at dd1)

Tbh it would probably be worth paying to see someone straight away considering how much I've spent on skincare over the last few years.

Hey Mike, hope the appt goes well today. Are you hoping for Roaccutane?