Alrighty, here it goes. Bare with me.

TLDR version: What key words do I say to get the VA Derm clinic to prescribe oral isotretinoin when they want to refuse to, and when they incompetently won't look at my past medical record? I can't switch doctors, so I'm stuck inside this system.

I'm 32. My healthcare is through the US Veterans Affairs. I hate it. The waitlists are one thing, but the short attention span of doctors who refuse to listen, and refuse to look at my medical file for the past failed treatments, and refuse to communicate with other clinics, it gets old and frustrating fast.

My skin is tied DIRECTLY to my mental health. I'm sure many here can relate. I suffer from OCD and ADHD which I can handle most days, and fall apart others. It's hard to keep things together and think in positive ways when my skin is not healing for months on end. I end up getting into behaviors and routines, and losing focus on normal aspects of life, becoming a neurotic mess.

I have been suicidal and been treated for that in the past too (all thanks to my skin as the major trigger). So obviously, they want to avoid giving me something that can push me over the edge, and their solution is to keep me at the edge untreated. Not exactly logical or intelligent--like I said, my skin is tied to my mental health, and I'm already at the point again that my depression is getting beyond my control WITH medications and counseling....

Derm clinic finally saw me after trying for over three months. Redtape. They are REPEATING the failed antibiotic treatments (minocycline this time) along with topical tretinoin 0.1% cream (I been on 0.05% for a year now). They want to "wait and see".

In the past, my skin will clear up, but the antibiotics cause me to get sick with colds, flus, and digestive issues. Long term antibiotics are NOT a solution. I'm already 32 and this skin breakout has been happening for OVER twenty years. Plus, they interfere with my mental health meds. I feel detached from myself in a way I can't describe. Best possible description is like watching myself on auto-pilot and feeling like I'm no longer "me".

The topical cream makes my skin clear on the surface but also allows bacteria to get deeper into my base skin layers, so I clear up overall, but get HUGE welts/cysts/abscesses as a trade off. The cream is not treating the skin deep enough to cause permanent change. Instead, it simply clears the whiteheads, blackheads, and other skin issues, softening the top layers, and everything underneath is able to push forth. This also allows the bacteria to feed deeper on the stuff coming out. Typically, after 6 months, my skin is still erupting, still getting deep infections, and I'm so dry that my skin tears easily.

I'd rather deal with 6 months of harsh oral isotretinoin and be done for good, than deal with years and years of harsh antibiotics, creams, and still having problem skin plus my depression riding on a balancing act.

I'm losing patience. I fake being normal, which is exactly how no one saw my previous mental issues. I put on the act for others' benefit and laugh at life. I'll do that to an early grave apparently.

So, with all that embarrassing stuff out of the way, and with a new Derm followup in 2 months for the usual 15 min appointment, what can I say concisely to make them move along the tier treatments toward oral isotretinoin? Especially since they are always "happy" with my skin?

My skin is scarred by lots and lots of discoloration and uneven texture, but I lack the pockmarks they "love" to see, and the 50 or so active acne marks on by entire body are not a concern for them, even if they never go away. I have "normal" acne for life. This VA hospital has "doctors" that look 22 years old, so I'm very sure they are following the textbook definitions and have no critical thinking skills.

I figure my only option is to play up that the antibiotic is incompatible with me, the side effects too severe, and that my skin needs to be treated from the base layers out since it never heals. Anyone with more experience at knowing what to say to get other treatment options thrown out leaving only oral isotretinoin?