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MaryTheres

Psych/Derm.... not sure what's going on.... any advise or co

Hi everyone, :-

I jut got back from a derm appointment. I was getting a glyco peel in an attempt to help my scarring... I had broken out over the past week and my pimples had become sores (like they always have and always do). The doctor said my sores were odd, he thought it was bizarre that my pimples turn into sores (as did my last derm). He told I may want to condsider accutane, as it sems that the antibiotics and spiro aren't working .. he said I should be completely clear and I am not and he can't do much for my scars until I am clear... At the point where we were discussing if my current medicines were working I said, "so you don't think the antibiotics are working?" and he said "well, you have sores all over face..." I then burst into tears....

He then recommended that I see Dr. Koblenzer. She is a dermotogist, a professor of dematology at the University of Penn and a Psychiatrist. I was confused as to why he suggested this but this isn't the first time she has been recemmended to me... my last derm also recommended that I see her.... This derm told me he would call her himself and tell her I need to be seen asap.... I asked why I needed to see her and he said that I should go on accutane but I am already very depressd the accutane may exacerbate the depression nd I'll be very, very badly depressed and he is not trained in controlling the depression aspect. he said she could put me on antidepressants and give me accutane and monitor my psychological state .... He said he cannot help with my scaring until I stop breaking out completely...I left the office in tears....

I looked her upon the web and she is indeed an expert but she is an expert in "how to work with a range of troubled patients whose sometimes severe physical symptoms do not respond to physical remedies alone" She wrote a book called "Psychocutaneous Disease." It looks like it deals "with difficult-to-treat mind-body problems affecting the skin"

I a wondering do they think my acne is psychological???? a psychosomatic disease.... I told him I am so dpressed because of the way my face looks and he said "well, it's the argument what came first the chicken or the egg" So wat .... does he think that my mental sate is causing the acne?????

anyone have any idea what the h*ll is going on???? anyone else have a situation like this???? 8-[

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I must admit I am finding it very difficult to go on and I desperately want to disappear but I can't because my husband needs me and I have a job that I can't afford to lose.... But I want so much to just disappear until I look and feel better...

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I think it's good that your Dermatologist cares about you enough to recommend you to a specialist who he feels might help you even more. I'm sure he's not coming to any conclusions about your situation other than he doesn't know what to do for you himself. Perhaps the fact that you are very emotional about your situation furthered the idea that someone with a Psychological background would be even more beneficial to your situation.

I'm sorry for what you're going through - I understand it all too well myself. I think that it couldn't hurt to see this other Dr. She sounds really qualified in dealing with skin diseases and possibly psychological aspects associated with the diseases as well. If you are at your wit's end, I think it's got to be a step in the right direction. Remember we are here for you to vent to. Hugs to you! :-

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MaryTheres,

I totally understand your pain. I am forty and whenever something stressful occurs in my life, I break out. Some people get stomach problems, but this is our way. Our stress just manifests itself on our faces. This is not to say we don't have legitimate medical concerns and it could be that the doctor isn't sure either, however has a suspicion that your emotional stress could be a trigger.

However, I don't agree with your doctor in saying that you shouldn't pursue scar treatment until you are perfectly clear. Maybe something spot specific like needling, spot TCA, or saline injections depending on what type of scarring you have.

Just remember Mary Theres, you are not alone, we all share your pain and hope to share your success when it comes.

Hugs!

Anna

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have u tried non ablative lasers?

or has anyone suggested it to you.

maybe your derm is not aware

their always busy to catch up with new technology.

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Hello50,

what is non ablative laser? The estician was talking about some kind of laser that was nt really laser ... I think she called it yag laser???.... I had no idea what she was talking about....

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Thanks so much anna and Oursfan. I am very very depressed about it all. I know that you both understand, thank you so much for your kind responses.

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MaryTheres,

She was probably talking about the Erbium:YAG laser which is an ablative laser and unfortunately I can NOT recommend it. Non ablative lasers are safer:

"Non-ablative lasers have gained immense popularity in the past two years because they require little to no healing time. They work by by-passing the surface of the skin and treating the layers underneath, known as the papillary dermis. This allows the skin to respond as if it was repairing a wound and regenerates the skin. With this technique, the epidermis is generally not removed. Because they are less intense than ablative lasers, non-ablative procedures pose minimal downtime and recovery. However, non-ablative treatments require multiple sessions, and may take several weeks for the optimal results of treatment to be seen after the last session. "

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I'm not sure whether or not you are on an anti-depressant or not right now but before you go on an SSRI, you should most definately be educated about the risks.

Dr. Blake Tracy has written a book about Prozac and SSRI's, and before going on Prozac, Paxil, Zoloft, etc....you really should be aware of the risks. The side effects can be horrible.

Combining an SSRI with accutane could spell major trouble for your liver, which is what is trying to detox your system anyway, making your acne way worse.

Have you tried Vitamin B5 and cutting out sugar and dairy? Those couple of things alone could help you tremendously. Doing peels also can get your acne under control, and very quickly. There are things online that are incredibly safe and effective, and much cheaper than getting a peel in a doctor's office.

Personally, I believe that the more people research things for themselves and become very pro-active in their own recovery and ignore dermatologists, the better off they are. Derms are inconceivably uneducated about the root causes of acne and inconsistant in their approaches to controlling acne. When YOU are the one making decisions about your life instead of leaving it to the fate of derms and doctors, then you are more prone to success. I don't listen to derms and docs too much. I never got clear under them and I was with them for 12 years. Now, I only look to my derm for my Retin A micro prescription and that's it.

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Hi MaryTheres---I am SO sympathetic to what you are going through because it sounds so similar to what I went through for 30 years. The acne would turn into sores and get infected; there were countless times when I wanted to just end it all because it was so humiliating and frustrating. After trying virtually everything available, my derms didn't know what else to do. I agree with Denise on what she is saying; I had to totally revise my diet--no sugars, no dairy, eat lots of fresh fruits and veggies, etc. I also found that regular aerobic type exercise helped alot. I had read that keeping your cells well oxygenated would inhibit bacterial growth. All of this helped to a degree, but when I was doing some internet research on the subject, I came across something called Wilson's Thyroid Syndrome. One of the symptoms was persistent acne that doesn't respond well to treatment. It said that if your body temps are too low, you can't fight off bacteria and can cause many types of infections. I had been tested several times for low thyroid and nothing came up. I found a doc on the Wilson's site and visited him. He has been a literal lifesaver for me. Once I began the treatment he prescribed, the acne has disappeared, along with other health issues I was experiencing. I wanted to go back and punch all those other docs in the nose!! Anyway, now I'm dealing with the scarring as a result of the acne; I had just had my first needling session a week ago and I'm just now starting to see some improvment---YESSSS!!! Anyway, hope this can be of some help to you--I certainly do understand what you're going through!

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OMG Ebby - sounds like you really went through something similar to what I am going through!!!! Your acne turned into sores too??? Mine does even when I don't pick at them ... in fact, I pick at them because they become sores... if they were just bumps I actually wouyldn't mind them as bumps are not all that hard to conceal - sores that weep and bleed are!!!! The derms think that I am picking at my skin and that's why they are sores they don't believe that they almost always turn into sores no matter what!

Also, what you say about it being related to the thyroid makes sense as I am very underweight and am finiding it close to improssible to gain weight. Everytime I mention this I get no sympathy (in fact people think I am bragging) and as much as I love being thin I think there is definately a problem 'cause I eat and eat and do not gain weight... and of course again everyone thinks I am anorexic or blumic. Seems like everyone is sooo quick to tell me I am mentally and emotionally ill ---- no one believes that I am not making myself this thin just like none of the derms believe that I am NOT picking my acne to make them into sores....

As for diet, I have tried everything - I already have a good diet as I LOVE fish, fresh veggies and fruit. I do eat sugar and I like sugar but in attempt to help my skin I gave up sugar entirely, it didn't help. I gave up carbs entirely, it didn't help. I gave up wheat, dairy, I gave up proceesed foods entirely (talk about difficult - that was really hard as almost everything is processed or has something processed in it) - none of worked and, in fact, made my weight drop even more which wasn't good and is probably what made me start to scar...

Can I look this guy up on the web????

Ebby I am very close to Philly is your doctor anywhere near there... I would love to go see him.. feel free to PM me or I will you I need more info on this.... I finally feel like maybe I am getting some where Thank you Thank you!!!

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Mary, if your thyroid checks out o.k., you really should try vitamin B5. It ha worked very well for a lot of people.

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Denise, thanks but B5 was a nightmare for me ... I took it over the winter - it didn't help and I think it made things worse (not sure) I have heard it helps for some but I stuck it out for as long as I could (months) and it just was not good for me. Thanks anyway though.

Ebby has pm'ed me with more infor and I looked the wilson thyroid condition up on the web I have alot of the symptoms! I had no idea they were all related to a thyroid problem. I got a list of drs. in my area I can't wait to see one....

Thans so much everyone for your kind words - Y'all are so great... I feel so much better! I have some hope! and I don't have to go on antidepressants or accutane (I am petrified of both) [-o< I pray this is the answer to my problems...

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MaryTheres,

I think if I were you I would go to see this derm/psych. I thnk that she could be helpful not just with the external scars but with the internal ones as well. I have read about docs who do both in order to help with self-image and I think it's great. if only I could find one. I have a tendency to touch places where i am scarred frequently and this just make the skin irritated. It's something I do compulsively and anti-depressants help me to control it. Yes, anti-depressants do have side effects, but for me being able to leave my house without being too freaked out and having moments of peace are worth the potential risks of the SSRIs.

Deborah

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MarysThere, Just something I want to mention so you can have it in mind. I have puffiness under my eyes (not bags or dark circles) and have been having trouble getting results to reduce them. I resently bought a book called Your Body's Many Cries For Water hoping it might somehow help with eye area. It's written my an M.D and he puts forth a strong argument that so many things are caused by not getting quite enough water into the body. The book shows a website on the cover ----www.watercure.com I'm still reading the book and haven't been to the website yet. Anyway, he pushes for drinking 8 to 10 glasses of water a day and says many sicknesses are better or even gone (if they haven't progressed too far)if a person will try that first before going on some medications. He argues that the medical establishment blocks him because they can't make money off of people drinking water. Don't know for sure if this is of use to you but thought that I should throw it in.

I just went to the website and see that he is giving advise there but is also selling books and cds. I don't want to give the impression of spamming so just let me say that in his book I'm reading he connects not drinking enough water to being able to cause depression and stress among many other things. The problem I would see with you drinking a lot of water is that it helps to lose weight and you don't need to do that. I think having your thyroid checked first before you do anything else is a smart and logical move by you. Good Luck.

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Thanks catlover and Daltgilb,

Daltgilb, you're right... I am still going to see the psych/derm - she is very renowed in her field apparently . maybe she can help me. The depression is very bad lately... very bad. My husband is even worried... many mornings I just burst into tears while we are driving to work... I guess she couldn't really due any harm..

Catlover... I can't say I have always drank enough water but the past several months I have been drinking tons of it! I never drink soda or fruit drinks or anything... I drink ALOT of water, all day. I saw a special once on TV on how water is so essential and this woman (I believe she was a cancer victim) was sayign how we get sick because we are not getting enough water and all of our aft drinks are caffineated...ect.. so I have been extra cautious about making sure I get plenty of water... so I dn't thin that's the problem. But it was good of you to throw it out there... and it is good to keep that in mind

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MarysThere,I edited my post and added another paragraph saying I went to the website. You posted just about the time I was editing so I don't know if you saw it or not. Anyway, I think you're on the right tracks.

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Mary Theres,

I have also burst into tears for 'no reason'--usually when i catch sight of myself in a mirror somewhere where I wasn't expecting to. I have been diagnosed with Body dysmorphic dysfunction and will have to live with it forever probably, but drugs have helped and I plan to start group therapy soon. In my case, I do not self-mutilate in a traditional sense. Rather, I perceive things to be much worse with regards to my skin than they really are--maybe and I let the derms do the damage. Anyway, this condition often goes unrecognized by derms and plastic surgeons, doctors that people with my condition first seek out before seeing a psych. Recently, there have been a lot of articles calling for derms to be responsible and recognize these symptoms in people, so that they don't perform some crazy potentially more emotionally devastating procedure on patients. I copied an article on this dr. koblenzer which you may have already seen--thought I'd post it anyway. I think I understand what you are feeling.

The Psychoanalytic Approach to Psychosomatics and Eating Disorders

The Newsletter of the Psychosomatic Discussion Group of the American Psychoanalytic Association.

Book Review

Psychocutaneous Disease

by Caroline S. Koblenzer, M.D.

New York: Grune & Stratton, 1987

The physicianly goal to treat the whole patient is rarely achieved. Although this may soon change dramatically, most physicians still specialize in part of the body, Journals compete for well established "facts" and "new research findings".

Caroline Koblenzer's book Psychocutaneous Disease is a welcome antidote to this narrow, costly medical vision which blankets health care. A Professor of Dermatology at the University of Pennsylvania and a psychoanalyst, Dr. Koblenzer has written a concise practical manual primarily for the dermatology resident and practicing dermatologist. While in need of a neurobiological update (the text was written 8 years ago), this is a volume rich with clinical examples on how to work with a range of troubled patients whose sometimes severe physical symptoms do not respond to physical remedies alone.

In Section 1, General Principles, Dr. Koblenzer reviews the history and classification of psychosomatic disease. Drawing from studies of matemal deprivation and the loss and bereavement literature, she suggests how overwhelmingly painful memories first "perceived" by the skin might reappear later as "physical disease". Hysterical conversion based on repression of an unacceptable idea, somatization, and secondary gain are other partial explanatory hypotheses for such disorders as alopecia areata, atopic dermatitis, and psychogenic purpura.

In a gem of a chapter on general principles of evaluation and treatment, Dr. Koblenzer's clinical wisdom brightly illuminates what might otherwise appear dry and mechanical. With an absence of jargon, she discusses how during history taking, the patient's behavior toward the physician can give useful information about his or her reaction to future care. She demonstrates the value of understanding that a patient's effort to demean or control the physician can be a defense against anxiety. There is also an excellent section helping physicians to recognize and manage their own feelings of anger, guilt, or failure when unable to reach their therapeutic goals.

The larger part of the book, Section 2, describes clinical syndromes grouped according to whether they are known psychiatric conditions manifest in skin disease, conditions where strong psychogenic factors are likely, and conditions whose outcome is often dependent on emotional factors.

In this section, Dr. Koblenzer discusses a number of the most unusual, puzzling, and difficult-to-treat mind-body problems affecting the skin; self-mutilating skin lesions of abused borderline children, Munchausen by proxy, inflictions perpetrated by parents on their children, monosymptomatic delusions of the dysmorphic syndrome, and the obsessive-bug infestation preoccupations in patients with parasitosis. Most of these disorders are given a clear clinical description followed by demographic data, discussions of etiology, pathophysiology, psychopathology, differential diagnosis, laboratory or biopsy findings, management, and prognosis.

The author is at her best when she writes "...we must have the courage to diagnose nondisease..." There are many fine clinical vignettes from Dr. Koblenzer's own practice illustrating how, with attention to timing and the strengths and weaknesses of the particular patient, she will confront them with the possibility that unseen, unfelt, and unspoken issues are contributing to their symptoms. Depending on how the patient reacts to her probing, she will follow up with further treatment recommendations. An example was a lonely, frightened woman with severe skin lesions and repetitive thoughts and behaviors she couldn't control. She had little capacity for psychological understanding and would have felt rejected if Dr. Koblenzer tried to refer her to a psychiatrist. Dr. Koblenzer willingness to listen to her story, help her to better locate her pain, and to offer understanding and comfort seemed exactly what this patient was able to use at the time.

Today's medical residents will have an increasing credibility problem with Dr. Koblenzer's description of the "neurosis" and its subdivisions since our medical/psychiatric colleagues have all but done away with such terminology in current data bases and the DSM IV. In fact a second of the four psychiatric categories Dr. Koblenzer uses, Organic Brain Syndrome, has also been discarded in an effort to reach a more unitary mind/brain classification system. Hopefully, discussions generated by Dr., Koblenzer's astute clinical observations could help refine those psychoanalytic concepts which continue to contribute to the doctor's understanding of the patient.

Dr. Koblenzer's book Psychocutaneous Disease is important and valuable and deserves a wide medical audience. It is a scholarly book about out the people undemeath their skin disease. It also demonstrates how a well trained and sensitive clinician can offer the best in psychological medicine to patients who deserve no less.

John L. Frank, M.D

. (Philadelphia)

GO TO:

CyberPsych Index Page

Psychosomatics Index Page

On-line Discussion of issues in Psychosomatics and Eating Disorders.

For further information, Contact Harvey Schwartz, M.D.

CyberPsych -http://www.cyberpsych.org/

Original posting November 17, 1997

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Daltgilb,

So do you think that perhaps this derm that recommended I see Dr. Caroline Koblenzer thinks I have something similar to what you have?? That maybe I see the scarring and the acne worse than it is? I'm confused :-s

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MaryTheres,

I'm not sure why the derm recommended that you see Dr. Koblenzer. It could just be that he is concerned about the way accutane might affect you. Also, since we have never met in person, I don't know if your scarring is something that you perceive to be worse than it really is. What really matters is how you see yourself and how the scarring affects your happiness. I can only speak about my personal experience and say that when I read about people who want to lock themselves up in the house as a result of the scarring--not you, but other posters who have mentioned that their obsession with scarring severely impacts their ability to function--I cannot help but wonder if counseling and medication could help. I know people who, despite very severe acne scarring, manage to enjoy their lives and to bring joy to others. This makes me feel bad, as sometimes I have been so obsessed with scarring that I neglect everyone around me and basically make them feel as sh*tty as I do. My battle is by no means 'won,' but I'll keep exploring other avenues beyond just fixing the scars. I may actually go to see Dr. Koblenzer as well since she is not too far from me. I am in NYC. Please let me know what you think of her if you decide to go and feel free to email me privately if you like.

Deborah

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Daltgilb,

Well, my scarring and acne definately are debilitating (emotionally and mentally). And my husband has even suggested that I let it get to me so much more than is warranted. I could certainly use therapy. also, I do come from an abusive background. Perhaps something, unresolved ssues maybe, from my past is manifesting itself as acne. So I have decided to do a two prong approach - see the doctor for treatment of wilson's thyroid syndrome and see Dr. Koblenzer as well. I have been taking my temperature and it has been consistently under 98.6. In fact, most of the time it never even seems to break 98.0. This is one of the major symptoms of wilson's thyroid syndrome... no wonder I feel so damn awful....

Dr. Koblenzer is in Moorestown, NJ and that isn't too far from NYC (though it is far enough). I will pm you and let you know how it goes...also maybe she can recommend someone in NYC. I will ask her if you like... or maybe you could even call her and talk to her over the phone. Anyway, I will pm you and feel free to pm me also. Thank so much Daltgilb!

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I just want to thank everyone who came to this thread and helped me. You all have helped me immensely. I hope I can return the favor someday. I feel like I may very well be on the road to good health just what? 24 hours after I felt so completely hopeless. Words cannot express my gratitude - y'all are wonderful... =D>

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I went to see my doctor for referrals to see some dermatologists and she will only do it on condition that I go on antidepressants and see a psych team for assesment :)

I feel really woozy and sleepy since going on the antidepressants but I really need those referrals so I guess I'll have to struggle on.

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--> AntzinPantz

NO ONE can force you to go on antidepressants if you don't want to. They can have some side effects and it can be hard to stop taking them eventually, but if YOU feel you need them then it's ok. But it almost sounded like your doctor forced you to take them...(?)

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