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Hubris

Getting a referral from GP to dermatologist?

Hi guys,

I've had acne since I was 12, I'm now nearly 21. During that time, I've never had clear skin - it's varied between mild/moderate and even slightly severe at times. Right now it's mildish - I have about 20ish red spots varying size and maybe 5-10 very small unnoticable ones. I've had it much worse on my back since I was 14 - and it's generally covered with light acne and about 5-10 big red spots.

It has ruined university for me - I feel so embarassed when I break out badly, I just hide in my room for days on end, even missing lectures and seminars. I hate going swimming because of my back and always drape a towel over my shoulders till I reach the pool if I do. It has seriously effected my self confidence...what little I have.

I started going to the doctor when I was 18 - before then I tried everything else - BP in different concentrations, all the brand stuff like Oxy, Clearisil, Clean and Clear, Witch Hazel etc etc etc, natural remedies like honey masks and apple cyder vinegar etc, even shelling out on light therapy to no avail.

Another reason I didn't go to the doctor was because I heard you become resistant to antibiotics after a while and it can come back worse than ever when you do. My friends had experienced little results on them until referred to a dermatologist and taking rocaccutane. In England, only a GP can refer you to one after trying you out on treatments. First I was put on Zineryt by a GP, which kept it mild for months and then it stopped working and I started having massive breakouts. I kept getting prescribed the Zineryt and nothing was happening...so I just left it alone for 6 months when it was mild and would flare up to moderate. Then I was prescribed Duac, though I told the doc that I had been resistant to BP - did nothing - came back after 6 weeks like he said and the new doc said no, I had to let Duac work for at least 12 weeks??!! Nothing changed. When I came back I decided I was fed up and wanted to see a dermatologist - it can take weeks to months to get seen on the NHS even when referred.

But the GP said I needed to take minocycline for at least 2-3 months before she could refer me because she said all a derm could do is prescribe me roaccutane. The problem I have with this is that the oral antibiotic may not work - thereby 3 months of time gone, or if they do work they will reduce the acne slightly and she'll say that's grounds for not referring me - and then I'll have to wait until it stops working and I'll get massive flare ups before Valentine' Day or something. Even when I get referred to a derm and get off the waiting list of potentially months, there is no guarantee he will prescribe roaccutane anyway - he might want to try me out on something else first so I'll end up going another year in misery. Even if I get prescribed roaccutane - it'll take 4 months for my skin to clear but meanwhile I'll have dry lips/skin...Basically do you think I'm being unreasonable or should I press my GP for a referral?

I apologise for the essay...and really appreciate anybody who took the time to read all of this.

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Hi Hubris, I'm sorry that you are having difficulty with your unsympathetic GP. I can totally empathise with your situation regarding acne as an adult - I'm 32 years old, UK based and I am currently beginning my 3rd month of Isotretinoin (roaccutane)

Without drowning on about my story/situation I would advise the following: Press your GP for a referral - your GP (and any dermatologist) should take into consideration your scarring both physically from acne AND emotionally/psychologically.

If all else fails you could self refer privately, though it will depend on wether or not you can afford it. One option would be to get an initial appointment via a private consultation and begin treatment privately and then return to your GP saying you referred privately due to his/her dismissive attitude and that you have now begun treatment and wish to go on the NHS waiting list and swap over when you can.

Sorry this is a brief reply but I'm at work right now, if you want any further support please feel free to PM me.

Love and hugs, Rosie x

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Hi, another English based Isotretinoin user here. I've just started my 2nd month of the course.

Im 6yrs older than you Hubris, and have suffered since about 11. It was only mild flaring to moderate, until I came off the Dianette pill age 19 and then cystic severe breakouts started. Going back on Dianette, follwed by the various antibiotics, which only work for so long, kept it moderate...this year I decided I'd had enough, I didnt even KNOW about Accutane at this point, but anti b's, topicals etc were doing nothing.

So I went back, saw a different doctor, didnt even have to ask to be referred to a derm, doc agreed at my age, I need a (hopefully) permanent fix, because it was really getting me down too.

You can ASK to be referred, however they will only do it once youve tried the things they have to offer, but if you cant wait...you can pay for it, think its about £150 for a private consultation, and I was told by my derm that a course of Accutane would cost £500 if not on the NHS (based on 50mg a day for 4 months.)

If your GP does refer you, well like you rightly said, you will be waiting a good while for an appt, I waited 9 weeks, which is considered GOOD! At that point I didnt even know you had to be on contraception to start the drug, so when I saw my derm I had to wait ANOTHER month before starting :(

I started at the end of July on half dose, 25mg a day, had a V v bad IB, worse than my skin has EVER been its still pretty bad now, Im now on normal dose fo my weight 50mg a day, and hoping my IB is almost over, think its going to take a good while for all the red marks to fade though.

My derm thinks I will start clearing this month, hoping to be pretty clear by the end of next month, it is a lengthy process, but as my derm said, there comes a point when you have to accept you arent just going to 'grow out of it.'

The only real advice I can give is, if your GP wont refer you, see another one, and see every one in your practice if thats what it takes to get a referral, unfortunately some dont realise the impact skin has on our lives.

If you dont want to wait, then there is always the private option :)

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