Is my derm an idiot (SKINCELS GTFIH)

[prince_]

Please High IQ people that are able to read i need your help with what i should do
My main questions are bolded but please read the whole thread

In March i went to a dermatologist and she put me on a routine and this is how it went:

LRP effaclar cleanser (PM/AM)
Azelaic acid cream 20% (AM)
Adapalene 0.1% (PM)
Doxycicline antibiotics (1 pill per day)

I saw great improvements with this and i almost had no active acne (probably bc of antibiotic)

In may she took me of the antibiotic bc i've been on it for 6 weeks and completely changed my routine

Benzoyl peroxide cleanser 4% (AM/PM)
Clindamycin 1% solution
Azelaic acid 20% PM one night
Tretinoin 0.1% PM the other night (and the just changing everyday between the 2 to get used to Tret)

In the first week i purged like crazy i got like 10 new inflamed active pimples but then it got better but i still continued to purge and i thought it was normal bc of the Tret purging stage that lasts 2-6 weeks but after 6 weeks i still continued to get acne every few days but not as bad

Yesterday i had an appointment and because my progress is not too good (it doesnt look good i have a ton of hyperpigmentation on my whole left cheek and few actives on my right side on skin where upper maxilla is)

She told me that i might have to use accutane before she touched my face and realised most of it was hyperpigmentation but my sebaceous glands are in overwork because of puberty and hormones and i still constantly get acne
I made peace with the fact that i might need to take accutane although i wouldn't like it

But here is the part thats bothering me
In a few weeks im going on vacation to Greece and i'll stay there for 3 weeks
She told me that under no circumstances i should use Tretinoin while im there bc UV rays are too strong and i could burn my skin which i understand
But wouldn't that reset the progress after i stop a retinoid and after i start again i would have to go trough a purging phase once again?

Here is the most important part: she told me until my vacation to use Tretinoin 0.1% AM and PM and i've never heard of such thing, its normal to use PM but AM before going out seems mad to me because it makes your skin sensitive to the sun (ofc i use SPF 50) but it still seems dangerous

I don't know if she is a good derm bc in this 4 months i haven't seen much progress as i think i should have, my main problem is that my skin constantly breaks out even tho i do everything i can to stop it

Before you say fix your diet stuff, my diet is great i eat a lot of meat, vegetables and i avoid diary maximally
Also i don't eat any sugary stuff no sweets no sweet drinks or stuff like that

My shit skin is stopping me from living a happy HTN life its so over.

 

[Shkreliii]

tldr dont go to greece

 

[appealmaxed]

don’t do skincarw

 

[prince_]

don’t do skincarw

and what should i do instead

 

[appealmaxed]

and what should i do instead

eat well drink water

skin care is cope
the moment i stopped skin care my skin cleared

 

[Itsjoeverlol]

eat well drink water

skin care is cope
the moment i stopped skin care my skin cleared

cope

 

[Itsjoeverlol]

just get on accutane or use a hydrating/gentle cleanser with tret 0.025% at night and an insane moisturizer + spf in morning

 

[appealmaxed]

cope

over for your genes then if u have to do skincare boyo.

 

[prince_]

eat well drink water

skin care is cope
the moment i stopped skin care my skin cleared

Before you say fix your diet stuff, my diet is great i eat a lot of meat, vegetables and i avoid diary maximally
Also i don't eat any sugary stuff no sweets no sweet drinks or stuff like that

i wish it was that easy

 

[appealmaxed]

i wish it was that easy

then stop the skincare and it will clear. try it for a bit. i doubt it will get worse

 

[Itsjoeverlol]

over for your genes then if u have to do skincare boyo.

over for ur genes if u can’t handle slop

 

[prince_]

then stop the skincare and it will clear. try it for a bit. i doubt it will get worse

tbh i will try that while im on a vacation i will just wash my face and use SPF to see if it gets better bc she said i could use azelaic acid and benzoyl peroxide but that doesn't do shit without retinoid so maybe its better to give my skin rest from all that shit
was your acne severe?

 

[appealmaxed]

tbh i will try that while im on a vacation i will just wash my face and use SPF to see if it gets better bc she said i could use azelaic acid and benzoyl peroxide but that doesn't do shit without retinoid so maybe its better to give my skin rest from all that shit
was your acne severe?

yes don’t even use clenser, just water. at most use moisturiser

 

[prince_]

yes don’t even use clenser, just water. at most use moisturiser

ok thanks i will update did it get better or worse also i heard salt water from the sea might help

 

[RealNinja]

Skincel here. Inaccurate to expect tretinoin purging to end after 2-6 weeks. For many people it takes months. I think I saw real improvements from Tret after the 4-5 month mark.

Tret 0.1% is the strongest version. Absolutely do not use it twice a day; only at night. Dont know why she would tell you to do that. BP cleanser, Tret 0.1 and 20% azelaic at the same time is a lot for most people’s skin to handle.

Its good that you’re switching on and off between AA and Tret to decrease irritation, but you need to focus on keeping your skin barrier intact. Moisturize heavily, use a moisturizer including ceramides. If you start noticing broken skin barrier symptoms (red face, burning/stinging, flaking, tightness) the first thing I’d do is stop using the BP wash. Take a 1-2 nights off tretinoin to sleep with your face covered in Vaseline.

You mentioned hyperpigmentation from the purging outbreaks. Tretinoin 0.1 and prescription azelaic acid are the best things you can use for PIH/PIE. So you’re on the right track. Both of these things combined should get rid of all scarring and hyperpigmentation quickly. If you’re still getting acne it’s important to focus on calming the inflammation and not picking/popping them to prevent further scarring.

The most important thing is keeping your skin barrier intact, keeping skin hydrated and moisturized.

 

[DavidLaidMaxxing]

The tret definitely broke you out. People recommend tret way too much here and 90% of the time it's not needed unless your old and want to smoothen your skin.

Personally, tret gave me and made my PIH/PIE worse, azelaic acid works though.

 

[prince_]

Skincel here. Inaccurate to expect tretinoin purging to end after 2-6 weeks. For many people it takes months. I think I saw real improvements from Tret after the 4-5 month mark.

Tret 0.1% is the strongest version.
BP cleanser, Tret 0.1 and 20% azelaic at the same time is a lot for most people’s skin to handle.

Its good that you’re switching on and off between AA and Tret to decrease irritation, but you need to focus on keeping your skin barrier intact. Moisturize heavily, use a moisturizer including ceramides. If you start noticing broken skin barrier symptoms (red face, burning/stinging, flaking, tightness) the first thing I’d do is stop using the BP wash. Take a 1-2 nights off tretinoin to sleep with your face covered in Vaseline.

You mentioned hyperpigmentation from the purging outbreaks. Tretinoin 0.1 and prescription azelaic acid are the best things you can use for PIH/PIE.
So you’re on the right track. Both of these things combined should get rid of all scarring and hyperpigmentation quickly. If you’re still getting acne it’s important to focus on calming the inflammation and not picking/popping them to prevent further scarring.

The most important thing is keeping your skin barrier intact, keeping skin hydrated and moisturized.

First of all thank you for this amazing response!

Moisturize heavily, use a moisturizer including ceramides.

I use this moisturizer i think its good thats what she told me use

flaking, tightness)

my skin peels a bit the day after using Azelaic acid but day after using Tret it doesn't and about tightness i barely feel it after washing my face bc cleanser dries it out

Tretinoin 0.1 and prescription azelaic acid are the best things you can use for PIH/PIE.

I don't know why but i just doesn't do anything my left side is almost active acne free but full of hyperpigmentation and on the places where i didn't get acne for months there are still marks and they are not fading away...

calming the inflammation and not picking/popping them to prevent further scarring.

how do i do calm the inflammation, i don't pop my pimples anymore i've learnt that the hard way

Absolutely do not use it twice a day; only at night. Dont know why she would tell you to do that.

Thank you i knew it seemed absolutely crazy to me to use such strong retinoid twice a day, should i use something else AM or just moisturize the skin?

give this guy a rep for this great response really helpful

 

[RealNinja]

First of all thank you for this amazing response!

I use this moisturizer i think its good thats what she told me use
View attachment 3012377

my skin peels a bit the day after using Azelaic acid but day after using Tret it doesn't and about tightness i barely feel it after washing my face bc cleanser dries it out


I don't know why but i just doesn't do anything my left side is almost active acne free but full of hyperpigmentation and on the places where i didn't get acne for months there are still marks and they are not fading away...


how do i do calm the inflammation, i don't pop my pimples anymore i've learnt that the hard way


Thank you i knew it seemed absolutely crazy to me to use such strong retinoid twice a day, should i use something else AM or just moisturize the skin?

give this guy a rep for this great response really helpful

I don’t know what this moisturizer is, we are from different countries. But you want one with ceramides specifically to maintain skin barrier- I use “vanicream daily facial moisturizer” with hyaluronic acid and ceramides. Find an equivalent of that in your country.

Hyperpigmentation can take a long time to fade. It shouldn’t take extremely long once you get adjusted to Tret and azelaic acid, though. It’s also very important to use sunscreen because UV will make your scars look more red.

You can calm inflammation by hydrating your skin with something like the moisturizer I mentioned. Putting Vaseline or petroleum on your face at night after you moisturize also helps. Just don’t do this after you use Tret.

Generally people use azelaic acid in the morning and tretinoin at night, although I would continue doing alternating days until you know your skin is adjusted to it. Yes, in the morning you can just wash your face and use moisturizer + SPF.

 

[prince_]

It shouldn’t take extremely long once you get adjusted to Tret and azelaic acid, though.

How long did it take for your hyperpigmentation to go away

 

[oooto]

why not just hop on Accutane? been to about 8 dermatologists nothing helped, tried isotretinoin and after finishing it after 1 year, my acne never breaks out again and it has been 3 years, well i do get one or two pimple once in a while, but thats because i eat shit food sometimes.

 

[AySab]

Please High IQ people that are able to read i need your help with what i should do
My main questions are bolded but please read the whole thread

In March i went to a dermatologist and she put me on a routine and this is how it went:

LRP effaclar cleanser (PM/AM)
Azelaic acid cream 20% (AM)
Adapalene 0.1% (PM)
Doxycicline antibiotics (1 pill per day)

I saw great improvements with this and i almost had no active acne (probably bc of antibiotic)

In may she took me of the antibiotic bc i've been on it for 6 weeks and completely changed my routine

Benzoyl peroxide cleanser 4% (AM/PM)
Clindamycin 1% solution
Azelaic acid 20% PM one night
Tretinoin 0.1% PM the other night (and the just changing everyday between the 2 to get used to Tret)

In the first week i purged like crazy i got like 10 new inflamed active pimples but then it got better but i still continued to purge and i thought it was normal bc of the Tret purging stage that lasts 2-6 weeks but after 6 weeks i still continued to get acne every few days but not as bad

Yesterday i had an appointment and because my progress is not too good (it doesnt look good i have a ton of hyperpigmentation on my whole left cheek and few actives on my right side on skin where upper maxilla is)

She told me that i might have to use accutane before she touched my face and realised most of it was hyperpigmentation but my sebaceous glands are in overwork because of puberty and hormones and i still constantly get acne
I made peace with the fact that i might need to take accutane although i wouldn't like it

But here is the part thats bothering me
In a few weeks im going on vacation to Greece and i'll stay there for 3 weeks
She told me that under no circumstances i should use Tretinoin while im there bc UV rays are too strong and i could burn my skin which i understand
But wouldn't that reset the progress after i stop a retinoid and after i start again i would have to go trough a purging phase once again?

Here is the most important part: she told me until my vacation to use Tretinoin 0.1% AM and PM and i've never heard of such thing, its normal to use PM but AM before going out seems mad to me because it makes your skin sensitive to the sun (ofc i use SPF 50) but it still seems dangerous

I don't know if she is a good derm bc in this 4 months i haven't seen much progress as i think i should have, my main problem is that my skin constantly breaks out even tho i do everything i can to stop it

Before you say fix your diet stuff, my diet is great i eat a lot of meat, vegetables and i avoid diary maximally
Also i don't eat any sugary stuff no sweets no sweet drinks or stuff like that

My shit skin is stopping me from living a happy HTN life its so over.

alright so, first things first.

the reason the dermatologist put you off the antibiotic is because the antibiotic isn’t an selective agent that kills p.acnes. no, it affects all bacteria via its spectrum (including the good gut bacteria which is why you can’t be placed on life).

now you can still use tret even at your vacation, just make sure to use sunscreen and reapply it multiple times throughout the day.

yes, tretinoin will cause purging as it increases cell turnover and don’t expect it to work immediately as it takes 6months of tretinoin 0.1 use, everyday to show clinical results.
Don’t use tretinoin in the AM please, not even when your dermatologist says so.

isotretinoin is fine, i dont know why you’re scared of it. it also can help with hyperpigmentation as it increases cell turnover.

 

[prince_]

why not just hop on Accutane? been to about 8 dermatologists nothing helped, tried isotretinoin and after finishing it after 1 year, my acne never breaks out again and it has been 3 years, well i do get one or two pimple once in a while, but thats because i eat shit food sometimes.

i know thats the easiest way out but there are a lot of side effects of accutane and possibly it can close the growth plates and i feel like i can grow at least an inch or half an inch more

 

[prince_]

now you can still use tret even at your vacation, just make sure to use sunscreen and reapply it multiple times throughout the day.

and what if i stop for those 3 weeks will i purge again?

isotretinoin is fine, i dont know why you’re scared of it.

i know thats the easiest way out but there are a lot of side effects of accutane and possibly it can close the growth plates and i feel like i can grow at least an inch or half an inch more

 

[AySab]

and what if i stop for those 3 weeks will i purge again?

possibly.

 

[Zain202]

Please High IQ people that are able to read i need your help with what i should do
My main questions are bolded but please read the whole thread

In March i went to a dermatologist and she put me on a routine and this is how it went:

LRP effaclar cleanser (PM/AM)
Azelaic acid cream 20% (AM)
Adapalene 0.1% (PM)
Doxycicline antibiotics (1 pill per day)

I saw great improvements with this and i almost had no active acne (probably bc of antibiotic)

In may she took me of the antibiotic bc i've been on it for 6 weeks and completely changed my routine

Benzoyl peroxide cleanser 4% (AM/PM)
Clindamycin 1% solution
Azelaic acid 20% PM one night
Tretinoin 0.1% PM the other night (and the just changing everyday between the 2 to get used to Tret)

In the first week i purged like crazy i got like 10 new inflamed active pimples but then it got better but i still continued to purge and i thought it was normal bc of the Tret purging stage that lasts 2-6 weeks but after 6 weeks i still continued to get acne every few days but not as bad

Yesterday i had an appointment and because my progress is not too good (it doesnt look good i have a ton of hyperpigmentation on my whole left cheek and few actives on my right side on skin where upper maxilla is)

She told me that i might have to use accutane before she touched my face and realised most of it was hyperpigmentation but my sebaceous glands are in overwork because of puberty and hormones and i still constantly get acne
I made peace with the fact that i might need to take accutane although i wouldn't like it

But here is the part thats bothering me
In a few weeks im going on vacation to Greece and i'll stay there for 3 weeks
She told me that under no circumstances i should use Tretinoin while im there bc UV rays are too strong and i could burn my skin which i understand
But wouldn't that reset the progress after i stop a retinoid and after i start again i would have to go trough a purging phase once again?

Here is the most important part: she told me until my vacation to use Tretinoin 0.1% AM and PM and i've never heard of such thing, its normal to use PM but AM before going out seems mad to me because it makes your skin sensitive to the sun (ofc i use SPF 50) but it still seems dangerous

I don't know if she is a good derm bc in this 4 months i haven't seen much progress as i think i should have, my main problem is that my skin constantly breaks out even tho i do everything i can to stop it

Before you say fix your diet stuff, my diet is great i eat a lot of meat, vegetables and i avoid diary maximally
Also i don't eat any sugary stuff no sweets no sweet drinks or stuff like that

My shit skin is stopping me from living a happy HTN life its so over.

Bro I use tret 0.1% from skinorac for a long time now to maintain my gay glow so you can use it till your vacation