Scared to visit derm :(
EDS Skin Care Forums Forum Index » Skin Care and Makeup Forum

Tue Feb 14, 2012 6:23 am

Hi all,

I am having a few issues with my skin and want to visit a dermatologist but I am fearful of going.

I am 37 year old male and have some redness (thread vains)and brown spots on my cheeks, also my skin is very dry and has fine lines.

The reason I am fearful is that i will find it difficult to have my skin analysed as I am ashamed of it Sad

I should not have these problems at my age, nobody else seems to at my age.

I don't smoke or drink so I don't know what is happening.

It is winter here in the uk and my skin has got so much worse.

Any advice would be great.

free skin care · Tue Feb 14, 2012 7:13 am

Don't be fearful. We all have our own issues. Brown spots and especially redness are very common. You mention your skin is very dry, with proper moisture those fine lines can look less apparent. What are you currently using for skin care?

Tue Feb 14, 2012 7:22 am

Hi thanks for your reply Smile

I currently use Boots No 7 for men face wash and moisturiser, I am pretty sure I am over washing though as my skin feels tight and I get increased cheek redness after showering.

The problem I have though is that my T Zone is oily so it makes me need to wash but my skin is dry and oily it seems?!

I am wondering if I have Rosacea as I have always blushed and I get burning cheeks, one worse than the other more often now. I guess I get stressed about all this which doesn't help Sad

free skin care · Tue Feb 14, 2012 7:48 am

Your skin should not feel dry/tight after washing. What you describe (dry and oily) is classic for using products that are too harsh for your skin type. They dry your skin out and then your skin produces more oil to try to compensate.

I do think its worth a trip to the derm to determine if you have rosacea or other skin issues.

free skin care · Tue Feb 14, 2012 8:02 am

Skin conditions are VERY common - from acne to rosacea to various forms of dermatitis - it's worth reading up on the estimated percentages so you do not feel alone. Wink

As you are in the UK you do not need to pay to see a dermatologist, your GP should be your first port of call. and will refer you to the NHS derms if necessary.

Skincare ... stop using foaming products containing sulphate surfactants as these are known irritants which damage the skin's protective stratus corneum. These are in face washes, shower gels, shampoo, toothpaste and hand wash. For some of us the smallest amount can be a problem, shampoo bubbles running down my arm trigger my eczema! Sulphates can also increase sebum production as the skin tries to protect itself. My current favourite foaming wash is NaturallyThinking sulphate-free extra gentle shower gel (for face and body). Be sure to use a gentle hydrating zinc oxide sunscreen year round because this is protective and calming/ healing (so much so that it is traditionally used in nappy cream). Check whether your shaving products contain any known irritants.

You say you do not drink or smoke but do you meet or exceed all the other recommendations for healthy eating and lifestyle? With skin complaints your intake of sugar, white/ refined carbs, oily fish and other healthy fats are the most important. Also be sure you are getting plenty of vitamin D given the time of year. A balanced diet plus physical activity (10,000 steps each day) are proven to help you manage stress.

IMO do not introduce any other new products until your skin has calmed a little. You should notice a subtle improvement within a week of stopping the harsh surfactants.

Tue Feb 14, 2012 9:10 am

Thank you once again for your replies Smile

I have lost about 10kg due to anxiety and stress over about 6 months, unfortunately the stress is regarding my skin and appearance so it is a vicious circle Sad

I visited my GP and he was fairly unsympathetic. In the uk they don't seem to refer unless it's potentially life threatening!

Is it abnormal to have brown spots at just 37? The redness is triggered by stress as when I think about it, it happens Sad

It seems that the redness has left a kind of brown staining on my cheek from the continuos flushing.

Thank you for all your tips. I have now bought some cream cleanser from La Roshay that is meant to be very mild.

I am hoping that the cold and indoor heating are causing some of the dehydration of the skin.

free skin care · Tue Feb 14, 2012 9:31 am

Myself wrote:

Thank you once again for your replies Smile

I have lost about 10kg due to anxiety and stress over about 6 months, unfortunately the stress is regarding my skin and appearance so it is a vicious circle Sad

I visited my GP and he was fairly unsympathetic. In the uk they don't seem to refer unless it's potentially life threatening!

Is it abnormal to have brown spots at just 37? The redness is triggered by stress as when I think about it, it happens Sad

It seems that the redness has left a kind of brown staining on my cheek from the continuos flushing.

Thank you for all your tips. I have now bought some cream cleanser from La Roshay that is meant to be very mild.

I am hoping that the cold and indoor heating are causing some of the dehydration of the skin.

I know the US members tend to think of a dermatologist as the first port of call but that really is not necessary. A derm will not diagnose anything different to a decent GP, and the NHS has guidelines for which treatment is to be used first. Very few dermatological conditions are life threatening, you should be referred if you case is complex or unresponsive not necessarily severe. A sympathetic and knowledgeable GP is obviously essential so ask to booked in with someone else in the practice. Reception or the practice manager will know which doctor has an interest in dermatology if you ask - remember they and their families get eczema and rosacea too! A decent pharmacist is knowledgeable on treatments, but you need a firm diagnosis first.

Stress alone does not generally cause significant weight loss, so I assume you are eating less? This may well mean your skin is getting fewer nutrients so as you say a vicious circle. Daily physical activity 'burns off' those fight-or-flight hormones as nature intended and can boost the appetite. The weather and central heating will have some impact but changing your lifestyle and skincare will likely have greater impact. Honestly no prescribed medication can make up for inappropriate skincare or a deficient diet, so in many ways you have more power than any derm. Very Happy

Brown spots could be a number of things, some of which are common and some rarer. Could be post-inflammatory hyperpigmentation, melasma ... again, you need a diagnosis before you can address that. There is plenty that can be done, but treatment can vary depending on the root cause. First and foremost be sure to wear that zinc sunscreen year round, even here in the UK.

Tue Feb 14, 2012 9:43 am

Thank you Firefox Smile

I guess I meant that it is seen as cosmetic, my GP said your face doesn't look too red to me gave me cetometrogol cream. Kind of dismissed my concerns and said 'your skin is probably better than mine'.

My food intake has been poor to be honest, eating too much bread and cheese products when I do. The stress makes me lose my appetite, I know for some it has the reverse effect.

I was reading about whole food powders on another thread and it sounded like a good way of getting nutrients. What are the best foods or supplements to try to take/eat?

My exercise regime has been non existent in the past year, I used to run a lot and I think the sweating helped my skin.

free skin care · Tue Feb 14, 2012 10:33 am

Myself wrote:

Thank you Firefox Smile

I guess I meant that it is seen as cosmetic, my GP said your face doesn't look too red to me gave me cetometrogol cream. Kind of dismissed my concerns and said 'your skin is probably better than mine'.

My food intake has been poor to be honest, eating too much bread and cheese products when I do. The stress makes me lose my appetite, I know for some it has the reverse effect.

I was reading about whole food powders on another thread and it sounded like a good way of getting nutrients. What are the best foods or supplements to try to take/eat?

My exercise regime has been non existent in the past year, I used to run a lot and I think the sweating helped my skin.

One GP may view eczema or rosacea as cosmetic, but I can assure you the NHS does not (I have worked in healthcare for twenty years!). I know from both personal and professional experience what a profound effect healthy diet and regular physical activity has on stress/ anxiety and on skin health. Also on confidence levels: once you start taking charge of your own health again you can feel like you can conquer anything or anyone!!

Don't wait to be hungry to eat, it is best for health to eat little and often always breakfast. If you struggle to eat solid food you can trick your body with soft or liquid foods - homemade smoothies, glass of milk, thick soups, yoghurt and fruit topped with a handful of crunchy oat cereal and so on. Unfortunately no supplements can make up for poor diet, real food is what we process best. Our bodies have evolved to deal with feast and famine, not for Tesco to be down the road! So deficiencies in individual nutrients or in overall calories will mean the body prioritises essential repairs and maintenance (eg. heart) over non essential ones (eg. skin). Sad

Basically look to be eating seven to nine portions of brightly coloured fruit and veg a day (dried, frozen, canned are included), three portions of dairy products per day, at least two portions of oily fish per week, small portion of complete protein (meat, fish, eggs, dairy) combined with wholegrains or pulses at each meal, 100g+ a day of healthy fats (olive oil, avocados, nuts, seeds, creamed coconut, peanut butter, dark chocolate). If you are focussed in the supermarket once a week, you don't have to be disciplined every time you enter the kitchen! If you are not a massive fruit and veg fan or not a great chef try fruit salads, homemade soups, lentil and coconut curry, stir fries, pasta with tomato/ vegetable sauce, baked beans in baked sweet potato, cheesy broccoli and red onion bake, roasted mediterranean veg, stuffed mushrooms and peppers, root veg casserole ... Batch cook so you can just bung something tasty in the microwave the following day. Wink

Oily fish is a big one because long chain omega-3s are powerful anti-inflammatories, help the skin retain water and be an effective barrier generally, are incorporated into various hormones so help with mood and stress. Canned pink salmon or pilchards (not tuna) are easy and inexpensive, but most of my clients choose to supplement double or triple concentrated fish body oil capsules (not cod liver). This is really the only supplement I recommend to almost all my clients: look to take in 2-3g of combined DPA and EHA per day. Other healthy fats already mentioned are equally important because research suggests the ratios of one to another are critical.

Do not run too much until you are eating a little better because running is tough on the muscles and joints - exercise breaks them down and rest/ food builds them back up. You cannot build a showhome with broken bricks! There are some great *free* walk-to-run plans set to music on iTunes and elsewhere if you have a smartphone. Hopefully you already got fitted for proper running shoes? Keep reading and posting; I hope you feel a little more positive already. Very Happy

Tue Feb 14, 2012 12:44 pm

Thank you Firefox Smile

I could do with someone like you as a mentor Smile

Amazing advice thank you Smile

free skin care · Tue Feb 14, 2012 1:35 pm

Myself wrote:

Thank you Firefox Smile

I could do with someone like you as a mentor Smile

Amazing advice thank you Smile

You are welcome! I am here and on Skincaretalk most days, and there are many other helpful and knowledgeable regulars who do the same. Do let us know how you get on, once you get sorted you can pass on the benefit of your experience to someone else. Wink

free skin care · Tue Feb 14, 2012 2:03 pm

I am not sure how it in UK, but here the medicine is very narrowly specialized and I would not trust any GP with non-trivial skin issues - only the properly trained derm can differentiate between age spots and melanomas; between rosacea and ...;and so on so for. Also, for some of the problems I would only trust derm's recommendations and prescriptions (some of the severe peeling they do for sun damage, etc.).

The condition of the skin should not stop anyone, since you are seeking help from the doctor not a date, and imho it would actually be better to show the skin at it's worst.

Best of luck!

free skin care · Tue Feb 14, 2012 3:27 pm

sigma wrote:

I am not sure how it in UK, but here the medicine is very narrowly specialized and I would not trust any GP with non-trivial skin issues - only the properly trained derm can differentiate between age spots and melanomas; between rosacea and ...;and so on so for. Also, for some of the problems I would only trust derm's recommendations and prescriptions (some of the severe peeling they do for sun damage, etc.).

The condition of the skin should not stop anyone, since you are seeking help from the doctor not a date, and imho it would actually be better to show the skin at it's worst.

Best of luck!

Just for general info because I struggle to get my head around your healthcare system too. The following may sound like being defensive, but I'd actually like to see a system that was some way between what I imagine you have and what we have - the best of both!

Anything vaguely, possibly any form of skin cancer-ish is referred to an NHS dermatologist. Two speeds of being seen: fast track/ urgent and regular (within six weeks up until recently). In 2012 I was referred for what both my GP and the practice nurse believed was seborrhoeic keratosis. This was confirmed by the hospital dermatologist and their student doctor, and I have been discharged. Around twenty years ago (before the system was in its present form) my mother's basal cell carcinoma was missed by her GP. Eventually the practice removed the mole because it was annoying her, and sent it away for analysis. Lab analysis was and remains standard practice for everything, that is not left down to one doctor's opinion. My mother later had another mole removed which came back all clear from the labs. Follow up checks again with dermatologists were clear and she was discharged.

Sun damage generally is not covered by the NHS and a GP should never recommend and would never perform a deep peel. If the issue is purely cosmetic no action is taken by the NHS, if any changes are possibly pre-cancerous you are called back at regular intervals for a check up by the hospital dermatology department. So had my diagnosis been actinic keratosis I would not have been discharged. Cosmetic sun damage and peels would be addressed by a private dermatologist only.

What can be prescribed by GPs or by hospitals and charged to the NHS is controlled; each Trust (governing body for a health district) has a panel of experts set the 'formulary' which lists first line, second line treatment for each condition. Unless things has changed recently, Roaccutane (isotretinoin) for acne or more severe rosacea would be prescribed and monitored only by a hospital dermatologist due to the side effects and risks. Not sure whether you can get Retin-A at all on the NHS, but if you can it will be for acne not ageing. GPs know what they can and cannot prescribe, community pharmacies know what they can and cannot dispense against an NHS prescription.

IMO if GPs can diagnose life threatening conditions such as diabetes then they should be trusted as a group to diagnose rosacea or eczema correctly. It is highly likely they are seeing such common conditions on a daily basis because most citizens use the NHS, and private healthcare is uncommon. Hope that helps! Wink

http://www.iow.nhs.uk/index.asp?record=1673

free skin care · Tue Feb 14, 2012 7:51 pm

Firefox,

in general in the ideal situation that should work the way you described.

Unfortunately, in real life things are quite different. My own skin cancer was actually missed by a derm for a year and a half - he claimed it to be just a "sun spot", but it turned out to be a melanoma albeit atypical one.

That is why I am quite passionate about seeing a derm and a good one at that. Since mole removing is nowadays a good business practice you also do not want to end with tons removed unnecessarily (also happen to a close relative). Many good teaching hospitals run free clinics when one can be checked for skin cancer for free.

HTH

free skin care · Wed Feb 15, 2012 10:13 am

sigma wrote:

Firefox,
in general in the ideal situation that should work the way you described.

Unfortunately, in real life things are quite different. My own skin cancer was actually missed by a derm for a year and a half - he claimed it to be just a "sun spot", but it turned out to be a melanoma albeit atypical one.

That is why I am quite passionate about seeing a derm and a good one at that. Since mole removing is nowadays a good business practice you also do not want to end with tons removed unnecessarily (also happen to a close relative). Many good teaching hospitals run free clinics when one can be checked for skin cancer for free.

HTH

But I thought you are not in the UK? Are you saying teaching hospitals here or in the US run such clinics or both? As I said my mother's basal cell carcinoma was missed too, despite being a classic case BUT this was at a time when referral was at the GP's discretion. AFAIK nevi are no longer excised in primary care here in the UK, they are removed in the hospital environment and the decision as to which are removed is a derms. IMO rather than paying for a series of appointments with a private dermatologist - which most cannot afford - UK residents should familiarise themselves with the NHS guidelines for their symptoms all of which are posted up online.

I can imagine our system sounds worrying to an 'outsider' but actually referrals to NHS specialists are very common. Within my close family we have hearing problems x 2, depression/ insomnia x 2, an enlarged prostate, one with two concurrent eye infections, type 2 diabetes, angina, mild dermatitis x 2, suspect 'moles' x 2 ... All but two of these have been addressed by a hospital consultant not simply the GP. That is about as real life as it gets IMO. Which is all off topic, given that the OP is more likely to have rosacea than any of these complaints! Laughing

free skin care · Wed Feb 15, 2012 10:21 am

Firefox,

I am in USA, NYC/NJ area.

Many teaching hospitals here do that so people with no income or no insurance can get examined. Doctors donate their time and at the same time it gives bigger exposure to the students who accompany them.

My main point is that a good skilled professional should examine the issue first. If nothing serious is found - then skincare/diet/exercise/life style changes can be addressed. Also sometimes skin issues are symptoms of underlying internal problems and it is better if they are recognized and addressed.

HTH

free skin care · Wed Feb 15, 2012 10:41 am

sigma wrote:

Firefox,

I am in USA, NYC/NJ area.

Many teaching hospitals here do that so people with no income or no insurance can get examined. Doctors donate their time and at the same time it gives bigger exposure to the students who accompany them.

My main point is that a good skilled professional should examine the issue first. If nothing serious is found - then skincare/diet/exercise/life style changes can be addressed. Also sometimes skin issues are symptoms of underlying internal problems and it is better if they are recognized and addressed.

HTH

I think we are talking at cross purposes, I was explaining the UK healthcare system but you are referring to the US system. Unfortunately AFAIK we don't have those walk-in clinics here so we have to work within the healthcare system we have. Our medical students sit in on scheduled hospital clinic appointments and participate in ward rounds to gain practical experience. Agree wholeheartedly US citizens should take full advantage of that fantastic *free* service. Smile

Also agree wholeheartedly that, if there is ANY possibility of a skin complaint being life threatening now or in the future, the patient should see a dermatologist. Thankfully the NHS concurs and the algorithms for referral are clear - hence I was referred to dermatology despite the GP suspecting seborrhoeic keratosis. It is not down to the GP to assume that a lesion is 'just' a sun spot, it is only down to them to decide whether to 'fast track' a referral (under two weeks) or 'standard' referral (up to six weeks, mine was four). Of course there can be health issues underlying 'minor' skin complaints, but again it is for the GP to do blood, urine or stool tests based on NHS guidelines and his wealth of experience.

Most UK citizens simply cannot afford to see a private dermatologist, GPs are the gateway or facilitators to this service. It's certainly not a perfect system, as I said earlier I'd welcome something that incorporates the best of your system and the best of ours. But frightening the public into questioning their GP's competency for diagnosing atopic eczema or mild rosacea doesn't move us forward. I don't understand what you are suggesting UK citizens on a regular income do, realistically?

free skin care · Wed Feb 15, 2012 9:32 pm

Frankly, my one and only concerned was for a person who has brown spots to have them checked by a professional. Trusting GP or even a mediocre derm is a too cavalier of an approach imho.

I am quite familiar with medical field (having most of my family working in it) and healthcare system in US and can give recommendations if asked.

I have no time nor interest to debate or learn more about Health Care system in UK, sorry.

I was just trying to help "Myself".

free skin care · Thu Feb 16, 2012 2:21 am

Sulfates are also in mens shaving creams. Check the can for sodium lauryl sulfate in particular. It will damage your skin terribly. Barbasol brand shaving cream in the US has it as an ingredient.

Sun Feb 19, 2012 7:56 am

are we ever going to get back to the subject?? spider veins and age spots?? Question

Automatic Message

If this is your first visit to the EDS Forums please take the time to register. Registration is required for you to post on the forums. Registration will also give you the ability to track messages of interest, send private messages to other users, participate in Gift Certificates draws and enjoy automatic discounts for shopping at our online store. Registration is free and takes just a few seconds to complete.

Click Here to join our community.

If you are already a registered member on the forums, please login to gain full access to the site.