A kind dermatologist who listens ?

[Christwosheds]

Dd, 19, has just been to see a dermatologist as she has developed a patch of acne on each side of her face. She has always had lovely skin, this started a year ago after a reaction to sunblock/heat/grime , working outside in 38 degree heat and mud (archaeological dig).
The dermatologist was grumpy, very rushed, and gave her lots of information that she couldn’t take in, but didn’t listen. She prescribed six months of antibiotics plus retinoids, as she said dd has deep inflammation and will get scars. Problem is that dd has IBS which makes her skin worse I think, and simply would not cope with long term antibiotics. She is starting her finals this October, she can’t have terrible gut problems, she really won’t cope (Oxbridge, so insanely pressured anyway) .
It cost £300 to have someone be quite dismissive and stroppy with my dd, who then had to come out in tears all alone (I was going to go with her but couldn’t ) .
I wonder if anyone knows any alternatives to antibiotics, and a doctor who is kind and will listen to her and make her feel supported not bullied.
Her skin is very reactive, and fragile, typical delicate Celtic skin, and so she needs someone who will really look at her as a whole person .
Thanks in advance lovely S&B people.

May be a good idea to see a dietician to sort out Ibs as this can affect the skin, and may all be similar issues.

This is a good idea. I think the root cause of her IBS is stress, rather than diet though. She is a sensitive person who’s had a lot of stressful things to deal with, and she’s studying in a very high pressure environment when she is someone who doesn’t need more pressure.
Seeing someone who might help with her IBS is something I should look into though, as her GP has been hopeless.
She has seen the Gp and asked about possible PCOS, and I am organising a scan for her.

If she has suspected PCOS and IBS issues I'd also suggest looking into endometriosis. It's not unusual to have both pcos and endo but often only one will get noticed as the symptoms are so similar. The IBS is usually related to the endo (going on a Fodmap diet under supervision of a dietician works really well for IBS related to endo).

As for the dermatologist (and GP), it's unfortunate that some are like that. I hope the dermatologist didn't prescribe isotretinoin (and rather a different retinoid like adapalene/differin) without taking notice of her sensitive nature as that can have adverse effects to mood.

Try Kanzen skincare. My 20 year old has used it for two years. No spots. She has acne on her back so I know it works. You can utilise the success guarantee too if she doesn't like it. £30 ish cleanse, tone, moisturise. They have insta and tiktok videos. Real people not paid

Gosh that makes me mad. I took my daughter to a top dermatologist once years ago, he looked at me and said, I find usually this is a problem with the mother. What an arse.

my daughter has, and still is, gone, going through a terrible time with her skin. She was on roaccitame for years but the minute she’s off it, it comes back with a vengeance. Just awful

the current regime is working well and keeping that bay. A prescribed antibiotic ointment and a red light little device I bought for her

keep it simple, gently double cleanse, Mario badeaus drying lotion at night

keep talking with the go, if they’re not sympathetic, find another one

as for dermatologists I don't know where you are but Dr Robles at Kings Oak/Cavell Enfield and Miss Siah at One Hatfield hospital are two great lady dermatologists. price similar to £300 IIRC. they listen and give solutions/options to try immediately. they'll also advise whether to start changing diet I have loads of allergies too and have reactive skin

not what you were asking but I find Biokult supplements which are a probiotic have really helped when I have taken them when on antibiotics with gastric symptoms.

I hadn’t thought of endo as she doesn’t get what I think of as endo pain. Her periods aren’t painful, but she will get a more upset gut then. She gets diarrhoea when at all stressed, and after eating. Occasional constipation. It is getting worse I think.
She did have all sorts of tests in the autumn of 2022 as she was really unwell and she was bleeding a lot (bowel) , and they were concerned about IBD or Crohn’s, but the diagnosis was IBS in the end.
I suggested she ask about PCOS because of the spots, plus her PMT had got worse and her cycle slightly irregular, longish cycles. Her hormone levels were ok apparently, the GP then said she should have a scan to just check her ovaries, so I am going to organise that privately just to speed it all up.
Her skin was almost always clear, just the occasional period spot. Then last Summer she came home very spotty, assumed it was sunblock/heat/dirt, but it just didn’t resolve. It it up and down but month by month it has spread and the spots are bigger and more inflamed than they were. She has tried various things, and sometimes they improve for a few days but then get worse again. So I felt it was time to see a dermatologist.

Thanks for this. We are a long way away and rural, but dd can get to London .

This made me angry on your behalf ! “A problem with the mother “ . Where do these awful people come from ? Skin problems can be so upsetting, you would think they would be more understanding and well, kind !

I brought my DD at age 13 to a dermatologist who put her straight on the OCP and treclin -a retinoid. She said we came in the nick of time to avoid scarring
There was me thinking her skin wasn't too bad atall.
Anywsy she advised cerave wash and moisturiser .my DD skin is really clear. Isint acne hormonal ?? It has sorted it.TG

@Riverswims did they do allergy tests on you?

Op my dd is similar, younger and has issues with spots and gut.

Can you complain about that treatment?

What is OCP ? I will ask DD what the retinoid is that she has been prescribed.

@Radyward

-sorry op)

My dd has spots and I'm worried about scarring but the gp wouldn't refer us in until we have tried stuff but in the mean time I'm worried her skin will scar.

We use ceravee to clear it but what moisture for the face?

You should definitely complain about your consultation and you will probably get another one gratis. No one should come out of a consultation crying due to not being listened to. The clinical director needs to know about this. So;

Check that nothing she is using on her face contains pore blockers or irritants. La Roche Posay, CeraVe very good. Check make up. Don't use make up brushes or sponges (bacteria)

Retinoid topicals are very good and likely will work but build tolerance slowly. Aim to be using it over night up to every night, but start off with just an hour or two. Then twice a week overnight, increase as tolerated. Only use it on a night, apply good bland non pore blocking moisturiser 20 mins later. Retinoid makes skin photosensitive so she must wear a non pore blocking sunscreen (LRP very good)

Encourage her to drink plenty of water every day
Reduce inflammatory food
No exfoliation, treatments etc
Add in azaelic acid if nec, and/or niacinamide
If skin feels irritated stop the retinoid for a couple days, stick to non actives until better then start again

Six months is a long time for antibiotics, so much for antibacterial governance, may be useful as she starts the retinoid if she gets a little purge

Main thing is to be patient

Dr Ien Chan at the London Dermotology centre has been good for me. The chap that runs it (Roberto something) is quite renowned I think.

Things like PCOS deffo worth checking out and get a second Derm opinion - but it may well be that she does need antibiotics. They are often quite low dose for Derm conditions so may not be as big an issue as you think, and you can shore up your gut health at the same time. (I say this as someone with PCOS, fairly regular skin problems and off and on colitis, so I do get the fear.)

Sunblock is a huge issue for her as she either reacts to it badly (v sensitive skin, I’m also intolerant to a lot of sunblocks) or it causes spots. She can’t use any of the LRP ones, she has tried them all. She is milk white and so needs sunblock so it is a big problem.
I can’t read the doc’s writing easily but it looks as though the antibiotic is Lymecycline ? Lyrecycline ? Can’t tell ! Plus azeleic acid. Which I thought wasn’t a retinoid but she told dd it was like a weak retinoid .

The antibiotic dose is 408mg ?? Then it says 3/12 .
doc told her it would affect her gut. Maybe she didn’t listen to how bad dd’s gut is.
I am obviously very worried about scarring, but I know that dd is struggling a lot with her IBS all the time she is away in college, and that this coming year will be extremely stressful.

Oral contraceptive pill.
Cerave moisturiser.
It's mad . My DD wasn't bothered at age 13 but us now at age 15.5 and is happy that her skin isint a problem. My skin was pretty bad as a teen and I hated it. It made for a bad self image. There was no way DD was going to have contend with that in life !! I do think reading here that pcos / ibs may be tricky when treating acne .

Cerave hydrating cleanser and moisturising milk

Dr marsland is Manchester way

Disclaimer that I haven't seen him for acne but he was amazing on the NHS for my severe life affecting urticaria. I sobbed down the phone at him and he was very much "I know. Right let's get this sorted then"
I knew my local hospital wouldn't do the injections I needed and I had seen him 10 years before so I sneakily bypassed my local and went via right to choose!

theskindoctor.co.uk

It sounds quite odd that the doc would say that - he couldn’t know in advance if it would impact on her gut in a way that she would notice or not - and if it did, there would be different options to try.

It sounds like it was a pretty awful consultation, but also that your daughter may have found it so difficult that she was adding her own layers later, likely as an expression of distress.

Anyway, get a second opinion, and I would only say don’t dismiss antibiotics out of hand. It sounds like it’s important you go with her.

I am sorry that you and your DD had such a rushed experienced with the dermatologist.

With the antibiotics prescribed, you can often take probiotics either alongside or separated by 2 hours from the antibiotic, or in some cases post-antibiotic use. This is dependent upon the brand of probiotics and their manufacture (such as encapsulation technology). The importance of taking a probiotic is because broad-spectrum antibiotics can wipe out beneficial gut bacteria for up to 2 years post-antibiotic use, as well as having standalone therapeutic use. Talking to a natural therapist in conjunction with seeking out an approachable dermatologist would be beneficial as several strains of probiotic would be specific to your DD's conditions (such as L. plantarum 299V for IBS and L. salivarius LS03 for acne) and may be indicated.

Dianette contraception pill. Works a treat and clears it all up.

The acne will be hormonal so needs a hormone approach