Do I need to see a derm?
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free skin care · Mon Mar 05, 2007 11:04 pm

I'm feeling sort of bad right now because my parents made a comment about my skin during dinner. I got 3-4 new cysts the past 2 days as it's my TOTM week (and just when I thought I was 90% clear and marks have started to fade a bit!). I did pick at them so they did get red and inflammated but right now are flat and at the healing stage already, they don't hurt anymore either. So right now my skin isn't in the best shape due to the cysts but my acne heals quite quickly now and I can imagine the cysts would have completely healed in another 3-4 days max. I feel I have a good routine and all but my parents insist that my skin is really bad (and they know it's hormonal). They're asking me to go to a derm but I'm relunctant.

I have talked to my GP about my acne before and topical antibiotics either didn't work or left me red, hurting and peeling. I also do not have any hormonal "disorders".

In my mind a derm is most likely going to prescribe the usuals - topical antibiotics, a Vit A product like tazorac or retin-a, accutane or a course of antibiotics. I'm currently on Alesse so I don't see the derm prescribing a course of hormonal drugs for me (alesse has not had any effect on my skin good or bad). Now honestly I don't see how this will help my skin and I've never had good results with Vit A - I don't think my skin likes it, either that or I'm just sensitive to it. I'm pretty against using accutane due to the side effects and because I think I'd rather be stuck with bad skin than screw with my health. I need something more of a preventative rather than something to get rid of existing acne because my current routine does it pretty well imo.

So do you all think seeing a derm would help me?
I've learned so much on EDS about my skin that I'm not sure whether a derm would be able to provide me with something new.

free skin care · Mon Mar 05, 2007 11:24 pm

what about switching from Alesse to something with an androgen blocker, such as Diane (prevents hormonal acne)? Or trying a pure androgen blocker like Adelactone? If you show a strong preference for a certain type of treatment (as in not a retinoid, etc) a good doctor should try and work with you within your request.

free skin care · Tue Mar 06, 2007 12:04 am

no i dont think a derm would help.. i am in the exact same position as you

i saw a derm 2 weeks ago and she is suppost to be one of the 'best' in vancouver.. dr michelle something from north burnaby on hastings/boundary.. it was a total waste of time!

she didnt even listen to what i had to say she just said yeah its 'typical acne' and prescribed me antibiotics and differin although i told her i used both in the past with no success.. i also brought all my products and she was very disrespectful just chucking them like they were junk (expensive cosmetics!!!)

i suggested that may be my acne is due to using the wrong products/ingredients and if she could suggest better stuff for my skintype.. she just thought i was undermining her and insisted on antibiotics

i asked if theres any medical facial treatments she can do to speed up clear skin and she said no its going to be at least a 6-12 month process

it really soured me on derms.. they are all the same.. i saw one like 3 years ago and same kind of reaction

to me its like.. they dont even care about ur individuality or needs or skintype even.. they just want to put u on longerm prescriptions so they can rack up the $$$$

unless you have very good luck finding a derm that actually listens and respects what u have to say... if so.. hook me up Very Happy

free skin care · Tue Mar 06, 2007 12:18 am

That's actually a good idea waffle, I think maybe I'll ask my GP next time I go in for a new prescription, I'm due for one soon.

I did mention whether it would help if I switched to another brand of BC but he really recommends sticking with Alesse because it's a lighter BC and also with minimal side effects but I'll definitely talk to him again about that.

smqueen - that's exactly what I am worried about, I don't want to waste my time because I'd need to get a referral from my GP so I'll end up having to see my GP before seeing a derm. Well in the past my GP only prescribed the topicals out of my mom's request and more like "do you think you need them", he never really thought I had serious acne though. If you think your acne is due to using wrong products/ingredients perhaps your own research might be better than a derm. I personally think that derms are more intuned with the inner workings of the skin as they were trained in med school and not as familiar with cosmeceuticals. I learned a lot from EDS and through trial and error I found a good routine that I really like but I can't do much about the damn hormonal cysts every month.

free skin care · Tue Mar 06, 2007 12:19 am

I think you should see your GP more than a derm. Alesse gave me bad breakouts that took 2 months after quitting to calm down. I've also read several studies that shows that users of the pill may be deficient in zinc and vitamin b-complex. Here's one of them http://www.empowermentzone.com/oral.txt. I take zinc/b-complex/multivitamin on a daily basis and I find that I get more cystic acne at my TOTM if i get lazy and stop taking them for a few weeks. I believe that good skincare is only the tip of the iceberg when it comes to acne. You may have to take an internal approach. Do keep us updated!

free skin care · Tue Mar 06, 2007 12:26 am

oh i totally 2nd dollbird on its more about internally

i decided yesterday to totally cut out sugar from my diet im pretty sure thats what causes flareups anyway :/

free skin care · Tue Mar 06, 2007 1:19 am

Thanks, I guess that's the route to go then. I'm going to try to make an appointment this week since I'm doing Alesse 21 this is my no pill week so if I can try out another BCP now would be perfect timing.

free skin care · Tue Mar 06, 2007 8:16 am

Hi sormuimui, believe you me, I feel your pain! When I would get broken out I was really sensitive about it, so if my parents even innocently asked about it I would get all worked up---- I mean I was like, I know better than anyone that I'm broken out, so I don't need to be reminded of it, right? However, now that I finally have got a tight leash on my acne, I can tell you that 3-4 cysts at one time is a lot, and you shouldn't have to go through that, so maybe at the very least you might talk to you GP. I think that changing your BC or trying a different hormonal pill (I take aldactone and LOVE it) could help a lot. Also, even though you say you don't think your skin likes vitamin A you might try Differin (the lightest, gentlest one) and see if it helps. I tried Differin for a few weeks, maybe a month, and it didn't TOUCH my acne so I had to move up to Taz, but if you're sensitive Differin might be a good option. Another one to look at is Finacea, which is an Azelaic Acid cream. It doesn't cause the same kind of drying and peeling that Vit. A creams do, and it's AMAZING at getting rid of any inflammation, either in a current breakout, or in one you just extracted. Last but not least, keep your head up. I know what you're going through and it sucks, but you're a gorgeous girl, with or without acne. Keep us updated!

Liz XO

free skin care · Tue Mar 06, 2007 8:39 am

I suggest talking with a good esthetician. I was dealing with breakouts into my 30's. It seemed the older I got, the more problems I had with acne. Then, after seeing such huge improvement in a friend's complexion, I asked what her secret was. She went for monthly facials and changed her skin products. So I gave it a try and for started going for facials every few weeks and started using Dr Renauld's Intervention products. I guess the products I was using were too harsh for my skin, causing breakouts. I started to see results in about 2 months, with no medications. That was about 18 months ago and now I go for a facial every 4-5 months and it has been months since I had a pimple. My skin hasn't looked this good in years.

free skin care · Tue Mar 06, 2007 9:04 am

I'm going to weigh in as a minority of one, but I really think it is worth it to see a good dermatologist. If you explain your concerns, and make clear that, by now, you know your skin and have some idea of what will NOT work, I think it's likely that, between the two of you, you'll come up with a course of treatment that you're happy with.

We here DO know alot about skincare, but the fact is that when it comes to something like cystic acne, I don't think you want to settle for a hit or miss approach.

Also, establishing a relationship with a good dermatologist now will also be a great benefit as you get older.

Good luck with whatever you decide. And, when you do get a break out, DO NOT PICK!

free skin care · Tue Mar 06, 2007 9:48 am

first of all -- sending you strokes. parents are without a doubt *the* worst when it comes to skin. i'm antique and they can still make me feel like i'm thirteen all over again!

i highly recommend you changing your pill since there are so many out there that *will* help your acne. typically, that's actually better discussed with a derm (who will be more savvy about what's likely to work in that regard) than your GP. it's also not a bad idea trying to find a good derm anyways, if you can. i've had a derm i've gone to for years. a lot of things did *not* work for me (including two, count them, two courses of accutane). one of the few things that did help was the pill (not allowed to be on it now). having her around also saved my skin from being far worse than it could have been. i was able to have my cysts injected once i found her and have far less scarring than from when i "treated" them myself and picked -- those left me with craters! derms are not completely useless....

and don't beat yourself up over four cysts. hell, at your age that would have thrilled me! seriously. some of us are just prone to it genetically. i am more than twice your age (yikes!) and am dealing with two cysts from using shea on my face. they are not going away fast at all. it's rare nowadays, mind you, but i still get them. i'm not nearly as self-conscious as i used to be (decades of practice), but i still have some when i don't want to be seen.... and, as i said, i wish i'd had a derm around a lot sooner to keep away the ugly scarring i now have to deal with when my skin is actually clear.

and you should definitely look into aldactone as manslayerliz said. i've not tried it but have heard wonderful things about it for hormonal acne. (i'm actually going to see if i can try this myself.) and you can usually get samples at a derm so you don't have to spend $$$ to try them.

go and see a derm. make your parents happy. and hopefully you can make yourself happy too.

free skin care · Tue Mar 06, 2007 11:47 am

sormuimui wrote:

Thanks, I guess that's the route to go then. I'm going to try to make an appointment this week since I'm doing Alesse 21 this is my no pill week so if I can try out another BCP now would be perfect timing.

Alesse and those other low dose pills don't tend to help with acne -- they may not exacerbate it, but they don't tend to help. Look into Diane (only Canadian one I know that works) or equivalents of american brands like demulen, desogen, yasmin, ortho-cyclen (imo works better than tri-cyclen), etc.
No reason IMO to take the lose dose pills unles you have problems with side effects from the pill.

free skin care · Tue Mar 06, 2007 11:51 am

also, to be fair to dermatologists that constantly prescribe retinoids to people that don't think they work -- apparently huge numbers of retinoid users use it incorrectly (too much, as a spot treatment, inconsistently, quit before results can show), and my derm says when used correctly they really do work for most people, so they keep prescribing them hoping people will really stick with it.

free skin care · Tue Mar 06, 2007 6:04 pm

Thanks for all your opinions!

May I ask the difference between the various BCPs and how do they work? For example if one doesn't work or I'm plagued with too many side effects, then perhaps I can try another one that works differently.

I made an appointment to see my GP for Thursday, I'll also ask him to recommend a derm as well in case I decide to go that route.

free skin care · Tue Mar 06, 2007 6:36 pm

sormuimui wrote:

Thanks for all your opinions!

May I ask the difference between the various BCPs and how do they work? For example if one doesn't work or I'm plagued with too many side effects, then perhaps I can try another one that works differently.

I made an appointment to see my GP for Thursday, I'll also ask him to recommend a derm as well in case I decide to go that route.

ok, so as you probably know, BCP is a combo of progestin and estrogen. They work together. Some progestins have high androgenic activity (meaning they cause hair growth, acne). Bascially what you want to avoid is a progestin with high androgenic activity and together with low estrogen -- which means avoid Alesse, Estrostep, loestrin, etc if you have acne. They have lower side effects (weight gain, mood swings, etc) because of their low estrogen content, but have the most androgenic activity.
To avoid acne, you want higher estrogen content and lower androgen potency in your pill. Higher estrogen and some progestins such as in Ortho evra (the patch) has been thought to lead to a higher risk of blot clots, so you shouldn't go this route if you have family history or smoke (DISCLAIMER I AM NOT A DOCTOR PLEASE TALK TO YOUR DOCTOR).
These pills are recommended for helping acne:
Yasmin, Demulen 1/50 or 1/35, Othro-Tri Cyclen, Ortho-Cyclen, Yasmin, Brevicon, Modicon, Necon, Ortho Evra
I have found ortho cyclen better than ortho tri cyclen personally. Diane is not on this list because it's Canadian, but I know it's equivalent is sold in the US under the generic Solia. Desogen 35 is also good supposedly.
There is a site called women's diagnostic cyber that can help, although it is a bit technical.

free skin care · Tue Mar 06, 2007 6:40 pm

I have also had better luck with single phase pills rather than the tri-phasic for hormonal acne , probably because it's more of a steady level of hormones in the body.

free skin care · Tue Mar 06, 2007 9:24 pm

I agree with Dollbird. Good skin care can only do so much. I was eating healthy for a while and then slacked off over the holidays...and into the new year. My skin really showed it. The acne was flaring up again like there was no tomorrow. Over the last two weeks, I started to go back to the way I was eating before and my skin has calmed down. I don't recommend using birth control pills for acne (speaking from experience).

I don't like derms. My last derm spent less than 2 minutes looking at my skin and recommended Accutane or Spironolactone (spelling?). I got charged $25 for the appointment (the remainder was supposed to be covered for OHIP). I later found out that it was suppose for the injections and I didn't even receive any. What a rip off. I did go on Spironolactone for a month and didn't renew the prescription after that. I had a lot more success with my Naturopathic Doctor than any of the prescriptions. Thank god, my benefits at work covered $500 of the services per year.

free skin care · Tue Mar 06, 2007 10:20 pm

I don't think I'll ever be the eating super healthy type of person regardless of how my skin looks, I love food too much Laughing

I'm not using BCP for acne, I'm using it for contraception purposes, been on Alesse for 2.5 years now, my skin just started getting really bad about a year ago out of the blue, my GP told me it was hormonal. So I was thinking perhaps a BCP that would help my skin would be the way to go rather than topicals or other hormonal measures, if not for contraception purposes I would doubt I'd use BCP just for skincare.

However I do know a few friends who had REALLY bad bacne since puberty and took hormonal pills (which I now know are actually BCP) during their teens for a while and gradually got rid of all the bacne. One of them used Diane so I think maybe I'll look into that. It's odd how they ONLY had bacne and are not acne-prone on their face at all, but now my friend does not wear halters or those types of shirts due to the pigmentation/scars on her back.

free skin care · Tue Mar 06, 2007 10:24 pm

sormuimui wrote:

I don't think I'll ever be the eating super healthy type of person regardless of how my skin looks, I love food too much Laughing

I'm not using BCP for acne, I'm using it for contraception purposes, been on Alesse for 2.5 years now, my skin just started getting really bad about a year ago out of the blue, my GP told me it was hormonal. So I was thinking perhaps a BCP that would help my skin would be the way to go rather than topicals or other hormonal measures, if not for contraception purposes I would doubt I'd use BCP just for skincare.

bring it on, sister. I'm just trying to not get knocked up with as few zits along the way as possible...also FYI after a few years you can develop new side effects to your BCP as your hormones change, so it could be you're just growing out of the alesse.

free skin care · Thu Mar 08, 2007 6:25 pm

Wanted to update:
I went to see my GP today and expressed my concerns for acne and asked him about the various BCPs. He recommends Diane 35 (as expected) and told me it's similar to Alesse but at a higher dosage. He also told me that if I wanted something just for skin I could go on Accutane which has a higher chance of being a "cure" but he says since I need to be on contraception I cannot take Accutane. He also says that usually people would prescribe a course of antibiotics first to reduce the recurrence of the acne-causing bacteria prior to prescribing something hormonal but he says that those are also not advised to take while you're on contraception as they produce another fungal bacteria in your body (I never knew that!). He was SO patient with all my questions and even went to double check on all the info on Diane to let me know all possible side effects. Did you know that Diane is not recommend to those in their mid-thirties?
He also said that I should see a dermatologist if I'm worried about my skin just to make sure since he's not an expert in the area being a GP. I expressed my concerns regarding dermatologists and he listened and recommended one that he says would probably have the time and patience to listen to all my concerns and individual needs and told me to call his receptionist the next day so she can help me make an appointment. smqueen - I'll pass on the info on the derm in a few days once I get the full name/address. My GP also said the wait to see the derm may be around 3 months or so which is good as I only got 3 months of Diane so it'll be great to talk to the derm about it whether Diane works or not.

Man I LOVE my GP, he is the greatest and I have no doubt the dermatologist he recommended would be a wonderful doctor as I've always been more than satisfied with every specialist he has referred me to thus far. He's a bit reluctant in giving me other types of BCP though as he doesn't want to increase the chance of side effects (due to the higher dosages in the others) which is understandable if I was only using for contraception purposes.

free skin care · Thu Mar 08, 2007 6:50 pm

oh, yay! good doctors are the best. I hope the Diane works for you -- I know so many people where it's the only thing that helped their acne!
as for the antibiotics thing -- it sounds like your doctor was trying to nicely say that BCP plus antibiotics will give you a yeast infection Laughing

Which is true for a lot of people.
anyways,good luck and keep us updated.

free skin care · Thu Mar 08, 2007 7:12 pm

Question (I hope someone answers this soon):
I got my Diane, now it says to start on the first day of TOTM as with most other BCPs. However this is a 21 day BCP same with my Alesse so should I follow my old Alesse schedule or go with the first day directions? Because if I follow the first day it'll be today, and would subsequently change the date of my TOTM for next month since I'm taking it a few days earlier than with my old Alesse schedule. I'm not sure, the pharmacist said to follow the directions but she didn't seem to be 100% sure.

If anyone has experience please advise, if not I guess I'll follow the directions and start taking it today.

TIA

free skin care · Thu Mar 08, 2007 7:28 pm

Maybe you should start today, unless the next TOTM clashes with a trip to the Bahamas or something. Better start earlier than later, just to be safe. You may experience some spotting but that's about it. Hope Diane works out better for you than Alesse.

free skin care · Thu Mar 08, 2007 7:48 pm

I think if you decide to follow your old schedule, just use a backup method for at least 7 days once you start. Last time I switched my doctor told me to just follow my old schedule, but I certainly wouldn't want to take any risks.

free skin care · Thu Mar 08, 2007 9:19 pm

Thanks, I started today. Hopefully it'll be okay. Really appreciate your advice Very Happy

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