Help - my skin is a mess

[Okaaaay]

If your skin has equally taken a beating, what have you found that helps? I have sun damage spots (thanks to UV exposure when pregnant) and dermatitis - everything is itchy and red / blotchy all of the time. It’s grim. I’ve seen a dermatologist who prescribed trimovate but honestly that barely keeps things a bay. I currently use an SPF 50 intermittently (was consistently but started to find it too heavy) and have Botox. I’m considering tretinoin, micro needling, laser therapy etc but have no idea where to start. My derm wasn’t terribly interested (they were medical rather than aesthetics).

If you’ve had dodgy skin, what have you done that has really helped. Pics for dramatic effect.

Lasers at a dermatologist's office. I had a few large spots (probably the size of a thumbnail) that bothered me and are completely gone as well as some tiny spots that I didn't even notice until they disappeared.

I've done a combination of IPL and Laser Genesis/nd:YAG (probably two rounds of each) and while the costs of lasers weren't cheap, when I think of what I spent on ineffective serums etc, I consider lasers a better deal.

My skin looked like your skin in that first photo, but with more big brown blotches (aka lentigo). I have worn SPF 50 daily for years and do tret, but my skin problems were from childhood and pregnancy and I don't think anything would have resolved it completely other than lasers.

Looks to me like you have rosacea? Makes your skin itchy and blotchy. Prob induced by all the stuff you're throwing at it. Steroid cream the worst and don't do tret as will irritate it more.

Think there's 2 things going on - the pigmentation and the irritation (which may be rosacea) and you need to treat them both without irritating your skin more.

Get on top of the irritation first - cut back to really basic skin care with no actives (Cerave / La Roche Posy - whatever works for you) and try getting some topical treatment from your GP like Soolantra or Metrogel.

Then when you get your skin back to comfortable look into the pigmentation. I'm not a pigmentation expert at all but Dermatica has a treatment that seems to work and / or consult a laser specialist.

IPL should sort the brown spots, and then a prescription from Dermatica will keep it up. Try soolantra if you think it might be rosacea, wont do any harm if its not. Gentle skin barrier repair moisturiser. Vit c in mornings, and some kind of retinal in evenings, but just a couple of times a week as too harsh. Stay out of sun, or wear 50 spf.

I use Dermatica. I had very bad hyperpigmentation and this has cleared it,I was amazed.
You send them photos and explain your issues and they send you a compound cream. Very good service and miles cheaper than seeing a private derm.

I use the Original Source lemon tea tree oil face wash - I can't promise it's brilliant for your situation but it works for me and it is cheap, you pick it up at Boots for £1.50.

Here is my routine that I follow for this:
Morning:
Using water to wash your face,
Sebamed clear face gel,
Garnier spf
Evening:
Vanicream moisturizer,
Tretinoin (0.1) from skinorac
Sebamed clear facial gel

It looks like rosacea to me too. I used Rozex and Soolantra.

Tret.
I started with skin and me then switched up to 0.05% that I get abroad. 3 quid a tube from Thailand

Yep some of this advice is way too harsh - at least while you get it under control.

Complex skincare with tret / retinol not going to calm anything down at this stage.

It's hard as what works for someone won't work for all so things like the Original Source shower gel would send my skin crazy.

Start simple and add stuff in if you have to.

Yes Soolantra is also great for this

I would treat the dermatitis first, as all anti-pigmentation treatments will dry your skin further and might make it worse.
For dermatitis I highly recommend Exomega Allergo by A-Derma. Use it on the dry areas. It is incredibly efficient and a natural origin formula.

Once your skin is repaired (it takes 27 days for the skin to regenerate itself, so use the cream and very important, don't stress!) I would wait at least 3 months before proceeding with a treatment for pigmentation. Melasma can be very hard to get rid of, so you might need more than one treatment.
Best anti pigmentation treatments are the dermamelan peel (for stubborn and dark pigmentation) and the dermamelan cream (for lighter pigmentation). The latter is also used a maintenance cream after the peel.
While therapists will say that it's ok to have the peel during sunny season, I would strongly suggest against it, as your new skin will be even more prone to pigmentation. From your photos, I would suggest the dermamelan peel, then maintenance with the cream. I would only do the peel in October-Feb period to avoid new pigmentation patches.
Use high SPF (50+) from as early as April until as late as September and any other times when it is sunny. A dermatologist would recommend Heliocare or Jan Marini SPF (Heliocare gel, Jan Marini tinted SPF are great, but very expensive) but that is mostly because they retail these (I managed one of London's best dermatology for 3 years). A budget friendly version is the Nivea 50+ spray SPF. I use it and it is very light and doesn't not clog the pores.

Hope this helps.