Up until my twenties, I saw the same dermatologist that burned off warts from the back of my hand when I was a child. He was the same dermatologist that saw my mom and even my dad, on the rare occasions that he would visit a doctor at all, but when I was 20, I was in need of a skin-punch biopsy for a diagnosis of a rare disease. My dermatologist was incredibly busy and couldn’t see me for weeks, which wasn’t ideal when I needed to be able to go the same day that I was having flare-ups, which were unpredictable. So I got a referral from my rheumatologist for a dermatologist he know that would be able to see me the same day, and I was taken immediately on a day I was having a flare-up.
Being as I had seen the same dermatologist my whole life and had generally pretty good skin most of my life, I stared at the documents I had been given to fill out while in the waiting room. I filled out everything, stating I was there for a punch biopsy, and lingered on the last page. At the bottom was the question, “What else would you like to discuss with the doctor today?” I lingered for awhile before finally writing, “the acne on my forehead.”
Like a large number of people, I had had closed comedones on my forehead since I had hit puberty. While they didn’t particularly trouble me enough to drive me into a dermatologist office before, I figured I might as well get the most out of my co-pay and my infrequent dermatologist visits (prior to this visit, I had seen my family dermatologist about a skin tag in my eyelashes at some point when I was 15-17, and eczema/atopic dermatitis when I was 13).
During the visit, I told the doctor about my forehead acne without much detail, and hoped she would know exactly what to do. She looked at me and said, “Yep! A retinoid will clear that right up! I’m gonna write you a prescription for Ziana. Just use this once a day, at night, after you wash your face! Sound good?”
And it did. Fast-forward and I was 6 months deep into a break-out that never ended, with spots that had heads the size of pencil erasers. I had become a hermit, ashamed of my skin, and barely able to sleep on my sides from the pain.
Everywhere I looked online told me it was “just purging,” and it would get better with time, but it never did. I even cried in public at an Ulta while on the phone with my boyfriend, lamenting that my face was ruined forever and there was no end in sight. Of course, like everyone going through an acne breakout, I assumed it was every skin product except the prescription I had been given by a doctor to make my acne better. After all, a doctor helps you, and I trusted the knowledge and nature of a doctor to have my best interest in mind. I believe I called the office once to ask what I should do, and they assured me it would get better in time.
Unfortunately, it turns out that by the time I started to figure out what was actually happening, it was all way too late. To this day, I have light pitted scarring in places from the 8 month moderate-to-severe zit explosion on my face that never ceased. It has taught me a lot and pressed me to learn a lot about how skin actually functions, and that I probably should not have used that tretinoin once a day, that I have very sensitive skin that still struggles to tolerate tretinoin, and that I should not have remained with a doctor who I began to trust less and less.
From this experience, I went on to many others with doctors who made me cry (one looked at my face and said when I woke up “looking like that,” I shouldn’t be using anything on my face because everything was breaking me out) and who I just couldn’t talk to before arriving on a doctor who was wonderful, specializing in people with auto-immune conditions and skin conditions.
Sadly, my experience doesn’t seem to be entirely an uncommon phenomenon, and most people don’t know how to talk to their doctor (dermatologist or otherwise). Being as I’ve seen every type of doctor – from cardiologist to rheumatologist to dermatologist – and on a semi-regular basis (I see a rheumatologist every three months for tests/check-ups), I figured I would help anyone else who is in the same shoes I was in my early 20s navigate the waters a bit.
When to See a Dermatologist the First Time
Many times on Reddit, I see people posting things like:
- “What is this?”
- “What does this look like to you?”
- “What is on my mouth? HELP!”
- “I don’t know what to do anymore”
- “I’ve tried everything and nothing works”
- “What should I try next?”
If you’ve hit the point where you feel like you are at the end of your rope, tried everything, or just can’t identify that weird rash, it is time to see a doctor. I know it is not always in people’s financial reach (particularly those of us in the US…), but there are many resources now for prescription strength topicals and a doctor’s care that don’t even require leaving the house or having insurance (particularly Curology).
If any of the following statements seem to identify with you, it is time to see a doctor:
- Is your acne leaving indented scars?
- Does it interfere with your day to day life on a regular basis (such as not wanting to leave the house or avoiding friends)?
- Does it seem to be linked to your periods or hormonal shifts?
- Did it onset very suddenly, without routine changes?
- Is it spreading? Any skin condition that seems to spread, especially if it spreads rapidly, requires professional medical treatment.
- Have you tried every fancy skincare product, every spot treatment, and dumped hundreds or thousands into skincare with no results?
Picking a Doctor
The worst doctor I ever saw was one my insurance picked out for me while the best was one I picked out for myself.
The first thing I suggest is asking your friends for recommendations. If you’re a redditor, you may be able to ask your local city subreddit for recommendations as well (though this can be tough if you are in a less populated city). Typically, your friends will be honest with you about why they went and their experience, which is what you want.
From there, search for the doctor online. Yelp can be a toss-up for quality of reviews – some people will give restaurants fewer stars for having to ask for extra napkins, for example. You also aren’t receiving the whole picture on why that person went to the doctor in the first place, what their history is, what their skin is like, or what their concerns are. Because of this, I trust Yelp a little less, but it can still be a good place to get a general idea of what people tend to go to this doctor for the most.
You can also search through their Vitals and HealthGrades pages. This is how I found the dermatologist I fell in love with. These pages tend to have better (albeit fewer) reviews and more information. Make sure you look for the doctor’s specialties, if they have any. Many doctors will specialize in one or two things, such as acne, rosacea, or melanoma. Try to find one that specializes what you’re interested in talking about.
Finally, don’t forget their own page. Some doctors will have their own Instagrams. This can be a good way to get an idea of what most people see them for, and what they prefer to talk about or specialize in. Keep in mind that doctors are just like anyone else, and will post the things they feel the most positively about.
Once you’ve combed through the exhaustive list of resources online, narrow it down to the doctor you feel the most sure about, and set up an appointment.
Your First Visit
Before your first visit, as things occur to you throughout the day, write down everything you’d like to discuss onto two sheets. Frequently, we forget everything we want to talk about or feel anxious about asking a “stupid question.” When the doctor asks, “Is there anything else?” I’ll admit that I’ve said, “Oh, no, that’s it!” when in reality, I have a burning question that I am just too ashamed to ask. When your doctor comes into the room, after introductions, hand them one of the sheets of questions, and let them know that you’d like to discuss what is on the list. This way, you have your list of questions in front of you in case you get anxious or forgetful, and they have your questions in front of them so you cannot dodge out of a question from shame last minute.
Make sure you include any relevant details you can think of. Habits, previous records (such as allergy records, GI records, etc. – bring your other doctor’s information in case your dermatologist’s office needs to request documents be faxed over), family history (cancer, autoimmune, skin conditions), and a thorough history of your medications and supplements. This means prescription drugs (topical and oral) as well as supplements like fish oil, turmeric, cranberry pills, lysine, etc. Include dosage, frequency, and what you’re taking them for. Write your current routine down and what hasn’t worked and why (couldn’t use this product because it was too drying or made my skin burn, for example).
Take pictures of your skin in a well-lit condition on its worst days. This can be a huge help to your doctor when determining what the correct diagnosis is. Also, this helps to establish a pattern, which is crucial. Note what you were using or what changes may have taken place around the time of the photos.
Before they leave, make sure you ask how to apply the prescription topicals they recommend or if you should take any oral medications that are prescribed with or without food (and if you can take it with fruit juices like grapefruit juice, which causes issues for some oral medications). If you forget, ask your pharmacist! They are specialists in drug usage and interaction, potentially even more so than your doctor, and are required by law to ask if you have any questions about the medication.
Remember that you are paying to be there and the doctor wants to help answer your questions. After all, they went through years of medical school to help people.
Bullet pointed list for ease:
- Write down all concerns onto two sheets. One for your doctor and one for you.
- Write down habits.
- Gather any relevant previous medical records (especially for any endocrine disorders, allergies, PCOS, or other hormonal conditions). If you no longer have the records (ex. diagnosis at a young age), then just make sure you note it and about at what age you were diagnosed.
- Gather any other doctor’s information (name and phone number) in case your dermatologist needs documents faxed to their office.
- Gather your family history on both sides (usually most doctors are just looking for direct relatives, like parents and siblings). Autoimmune, cancer, skin conditions, etc.
- Write down all oral medications, dosage, frequency, and why you’re taking them.
- Write down all supplements, dosage, and frequency.
- Write down current routine.
- Write down what you have tried and what hasn’t worked as well as why (skin sensitizing, burning, dryness, etc.)
- Ask them how to use the topicals they prescribe.
- Ask them if you should take any oral prescriptions with food and if it is safe to take with fruit juices, if you consume fruit or fruit juices, particularly grapefruit.
One last tip is to not wear makeup! They need to see your bare skin. Wearing sunscreen and moisturizer is fine, but make sure they can see your skin clearly.
Follow up with your doctor frequently and if you have any concerns. Make the follow-up appointments in the office, while you’re there, and put the appointment in your phone calendar so you don’t forget. Take a card so you have their current phone number in case you have any questions.
Don’t be afraid or ashamed to follow-up, either. Perhaps the worst part of any skin condition is the shame aspect that is frequently attached. Many people with skin conditions report avoiding interactions with people, and feeling an extremely low sense of self-esteem. This can impact not only how we see ourselves in the mirror, but our inclination to be an advocate for ourselves.
If you’re feeling at all like your skin (or maybe not even your skin – something else that has happened to you) has severely impacted your life and your self-esteem, consider talking to a therapist.
While not specifically acne-related, I went through abuse in my childhood and trauma in my teen years. This left me with CPTSD (complex post-traumatic stress disorder), panic disorders, generalized anxiety, and a propensity to tunnel down into the deepest, darkest holes of depression. I had always known that seeing a therapist (and psychiatrist) would be good for me, but I didn’t even go to my first visit until I was 26. I was petrified of opening up to a stranger, having them “analyze” me, feeling like a specimen or a spectacle, and isolated.
My first visit to my therapist was maybe a little awkward because of that. I talked openly about my life, but I didn’t really dig deep into the things I felt were troubling me the most. I continued like this for maybe six months, seeing my doctor every other Friday, talking about life and getting his perspective on things I was dealing with in my day-to-day.
But then one session, I brought up some of the feelings that had been bothering me all week, and it just started to flow out of me like a broken dam. It was life-changing. I walked out exhausted from the tears, but feeling brave, safe, and honestly, not at all as “crazy” as I once perceived myself to be. Finally having a diagnosis for the mental pain I was suffering was possibly one of the most re-assuring and comforting experiences of my entire life, and allowed me to step away from the pain and see it more objectively.
Therapy isn’t cheap, and I understand that better than anyone, but it shouldn’t be something you are afraid of. If you want to try talking to a therapist, but you aren’t able to afford office visits (check with your insurance – some insurance providers will reimburse you the cost with a receipt + a reimbursement claims form) or feel too nervous to sit down with a doctor outside of your own comfort zone, there is online therapy. One of the ones I see recommended the most is betterhelp (though I have never used it myself).
Please, do not be afraid. It can change your life and liberate you in ways you may not have even thought possible.