Dermatologists are trained in diseases, not skin care.
It seemed so obvious at the time. My whole family is oily and acne prone. My siblings were both on Accutane. Dermatologists are seen as the first stop for acne problems. It was covered by insurance. After the Proactiv failure, it seemed like the next logical step.
What actually happened was a series of disappointing appointments. In each five to ten minute session, after hours in the waiting room, I was asked what skin care I was using (Blackhead Eliminating Scrub, nothing else), given a few expensive prescriptions, and sent to the pharmacist. When I told them I was getting cystic acne, they didn't believe me because it was never present at the time of the appointments. I was never asked about my diet. I was never asked about my usual sun exposure, just vaguely told that the medications could make me more sun sensitive. I never had a proper skin analysis. I was never told what my skin type was (combination dry, not oily). I wasn't asked how often I washed my pillowcase (not enough). I wasn't asked whether I picked (I do).
At this point, I don't even remember all of the different expensive medications they gave me over the years. I remember Benzoyl Peroxide, Differen, Tazorac, Retin-A, Cetaphil, and some sort of liquid blotter in a bottle. I know there were more. My skin only got worse when using any of them. I saw no decrease in acne and a sharp increase in redness, peeling, and shininess. I was mocked incessantly about how shiny my face was by the other students in elementary school. They were right- my giant forehead (fivehead) reflected like a mirror and was even more prominent than usual, something I was very self conscious about. .
The shine was a combination of raw skin and product buildup. The top layer of my forehead skin had peeled off early on and never seemed to grow back. I kept using the products, constantly hearing, "It has to get worse before it gets better." Except it never got better. It got worse and worse and worse. My horrible tendency to pick at the flaking skin did not help at all, and I now have plenty of post inflammatory hyperpigmentation. This wasn't at all helped by the 30 minutes of sun exposure at prime sun hours during recess every school day and full days on weekends. I was told to "avoid excess sun exposure," which in my 11 year old brain meant "don't lay out in the sun" which I didn't do anyway. They did not make it clear to me that any sun exposure on my glow in the dark complexion was both counterproductive to my acne and would make every inflammation problem I was having far worse. Eventually I stopped using all of the prescriptions and just let them sit in a drawer untouched.
Years later, when I went to college at Aveda's Institute of Beauty and Wellness for Esthiology, several instructors told us that Dermatologists get two weeks of basic skin care. The rest of the Dermatology course- years of study- are focused on diseases, cancer, disorders, and medications. I have searched everything trying to find proof of this online. Even without finding proof of this being correct or incorrect, I believe it's close. Western medicine is all about treating diseases with drugs. My esthetics course included 600 hours of skin care, how important skin analysis and detailed history is to success, how the difference between adding one or two products to a regimen is striking.
As I progressed through my program, I realized how poorly I was treating my skin. Scrubbing daily, never using moisturizer, and never using sunscreen was wreaking havoc on my skin. My skin was both oily and dry, severely dehydrated, inflamed, stretched tight and raw. I had a ridiculous amount of blackheads, cystic acne along my jawline, pustules and papules on my cheeks. It felt like every pore on my face was clogged.
Turns out, every pore on my face was clogged. Despite my daily scrubbing, my skin was not responding. The first product I bought was Aveda's Outer Peace Cleanser. Even after using it once, I could tell the difference in my skin. It was less tight, it actually felt clean, it wasn't raw. I started using a jar of Dr. Brandt moisturizer I was given for Christmas and didn't think I had needed because I was "so oily."
For the first time, my face didn't hurt. I hadn't realized how much my face had hurt until it stopped hurting. I realized that my lipid barrier, the layer that protects skin from damage, had been completely destroyed. After a series of student treatments while learning on each other, my skin finally started to improve. I slowly started adding new products to my new routine. I learned how dairy can be a trigger for jawline cysts and cut down my intake dramatically, noticing a huge difference. I started washing my pillowcases often. I started wearing sunscreen every day, realizing my half an hour in the car to get to school definitely counted as sun exposure. I started eating healthier and carrying a bottle of water with me everywhere.
Once I started working in the field, I heard other stories of what I will can only describe as ridiculous failures by doctors and dermatologists.
A client with severe pustular acne was given Retin-A and told to go tanning to help her acne. Retin-A makes skin extremely sun sensitive, and the slight antibacterial effect of UV rays is not worth the extra inflammation that makes acne worse.
A client was told that her acne "was just bacteria" and told to use Bacitracin as a moisturizer.
A dentist- dentist!- had prescribed his own son Accutane "to keep him from getting acne." Even people who don't have any connection to this industry know that Accutane (Isotretinoin) is a very serious drug used in only extreme cases of existing cystic acne and has serious side effects. Teen girls, even sexually inactive, are given monthly pregnancy tests because the risks of birth defects are so high. Blood tests are taken regularly to make sure that vitamin A levels do not become high enough to be toxic.
A rosacea client was given six months of oral antibiotics (rosacea is not bacterial), steroid creams, and a face mask for her severe rosacea, with no results. After a month of starting my in-depth regimen of calming, cooling, protective products, her skin dramatically improved. She stopped using her prescriptions of her own volition (and my silent relief).
Don't get me wrong- there are plenty of cases where dermatologists have helped dramatically. There are many that I'm sure do thorough consultations, many who truly help acne and rosacea cases. Accutane was very effective treating the deep cystic acne of my siblings. I have personally told many clients to see a dermatologist for suspicious spots, at least two of which have been diagnosed as skin cancer (basal cell and squamous cell carcinoma). Dermatologists help with diseases and cancer. They are indispensable.
However, as a nurse practitioner puts it, "Their product toolboxes are too small." Beautification of skin is the entirety of what an Esthetician does. Appointments are generally an hour or more. A good Esthetician will ask in depth questions about a client's routines, lifestyle, history and issues. Skin care routines will be recommended, adjusted, perfected. Treatments are done not only to beautify the skin but to calm the mind and body. The stress cycle will be explained and discussed. Exfoliation, extractions, and hydrating masks can be done to speed up the improvement of a new skin care routine.
One of my esthetician friends Eva Hendrick was visited by a new client who turned out to be a Dermatologist, "I honestly don't know a lot about skin care and treating the issues I want to treat with the correct products, and wanted a little expertise from someone with that knowledge." This is how I wish every Dermatologist viewed us! In an ideal world, we would constantly be referring clients and patients to each other when our scope of practice wasn't appropriate for that person's specific needs.
I still break out- my skin is definitely still acne prone, and always will be. I still get cysts on my jaw line when I give in to my ice cream cravings. I still get a lot of clogged pores, but it's usually when I've been lazy with my own routine. I'm still fighting my compulsions to pick, now realizing that acne excoriee (compulsive picking resulting in scars and worsening acne) can be a form of obsessive compulsive disorder and can be worsened by anxiety.
In an ideal world, the first professional to see about acne concerns should be an Esthetician that specializes in acne, who will make a referral to a dermatologist if it is needed. The field of Esthetics is still new, and many people still don't understand what we do. Eventually, I sincerely hope that acne sufferers will realize that there are other options besides prescription drugs that often make the problem worse.
Have you visited a dermatologist? What was your experience?