1 day ago
Advice for Discussing Skin Conditions with a Dermatologist
I meet with my dermatologist on Thursday to talk about next steps in treating erythematotelangiectatic (vascular) rosacea. Logging my skin days here and seeing the progress -- and the limits of progress -- has made me realize the emotional relationship I have to this condition. The progress feels amazing. At the same time, it's hard to accept I will never have even skin tone, for example, especially when my skin is too fragile to cover it with cosmetics and use harsher cleansers. Even on my best skin days I don't feel like I could ever choose "Glowing."
Her availability is very limited, so I want to use my time well.
I will ask her:
- what treatments are available
- what she thinks are good first steps
- what a realistic outcome will be for my skin even with treatments
Even if you don't have rosacea, but do work with a dermatologist regularly, what are some good questions I should ask that I may not be thinking of?
Thanks!
p.s. Crunch says wear sunscreen!
Comments (7)
I’ve never worked with a dermatologist before, I don’t even get facials or anything, but I’m curious to hear how a dermatologist can help if I ever decide to try. I’m here to learn and to say that Crunch has valuable wisdom!
Crunch is a very smart crustacean.
@hazelmoss I completely relate to that emotional fatigue. My vascular reactivity is likely milder than yours, but I share that exact feeling: I never select 'glowing' because there will always be a visible broken capillary, background redness, or enlarged pores. You are already doing everything right topically to keep the barrier calm, but wanting to improve that baseline medically is completely valid—it makes an enormous difference to daily quality of life! I see my dermatologist annually for regular skin checks (monitoring nevi/moles, cherry angiomas, and skin tags/acrochordons)... I have so many! 😭 A few specific, practical questions I would add if I was you: - Ask if she considers you a candidate for vascular lasers to physically seal those vessels, and what kind of downtime or post-laser swelling to expect with your fragile barrier. - Ask which part of her suggested plan targets the fixed, structural redness versus the sudden heat flares. - Dermatologists often prescribe vasoconstrictors but there is a risk of rebound erythema. If she is proposing that, ask her direct clinical opinion and whether she advises for or against them for your specific skin type. - Ask: 'If we get this under control, what does the realistic maintenance schedule look like 1–2 years down the line?' You've got this! 🦞
@hazelmoss You know, piecing together little clues you’ve dropped across different threads... Tell me if I remember wrong: rural Midwest, being near lakes, funky tap/well water, and cycling between AC and heating? Makes me wonder how much of your baseline redness is an environmental uphill battle rather than a failure of your routine! That exact combination is notoriously harsh on neurovascular barriers, worth mention to the dermatologist. Something you were discussing, like a shower filter or taking hard tap water completely out of the face-cleansing equation could do more for baseline redness than adding another topical ever could.
@Mariacasino Yes, all of those factors are correct. The majority of municipalities around me rely on wells fed by aquifers. The water hardness is 30-35 gpg. In fact, one of the wells in my village has been decommissioned due to forever chemicals. That may have occurred before I moved. My skin did better when I lived in a village that had Lake Michigan water. The environmental factors definitely make it an uphill battle. It means that my skin is always one mishap away from lobster jail. I also just learned about the connection to neurovascular hyper-reactivity, which adds an even more complex layer to treatment beyond environmental factors and known triggers. Some phenotypes of rosacea like flushing and background redness are neurological rather than microbial (papules, pustules - I don't have these). Neurovascular Hyper-Reactivity Presentation: ✅ Migraines ✅ Sensitive skin, rosacea ✅ Autonomic Dysregulation: Autism, C-PTSD, chronic stress/anxiety SSRIs are sometimes prescribed to treat redness and flushing related to neurovascular hyper-reactivity. It's interesting because my migraines have sharply dropped off after starting SSRIs two years ago. But it may also require a a beta-blocker to help relax the blood vessels because that hasn't seemed to improve. This is a whole new layer to the condition that I didn't reckon on. It's a bit overwhelming. I'm not sure how I'm going to cover a quarter of the information I need to in the 15 minutes I will get with the dermatologist. 😖
Ingredients, external environmental triggers, diet that work for or against you. Success stories they have seen in other patients and what they did beyond the in-clinic treatment and prescription medicine. Building trust with the right (competent, honest) doctor is important too because some of them stick to the correct answers that won't get them into trouble, and only start to share more when trust is established. Occasionally, conduct your own independent research. And don't lose hope!
Ah, asking about success stories is a good one I hadn't thought about either. Fortunately, I have a good relationship with my derm. She's helped me significantly with my psoriasis. It's just expensive to go, so I don't see her as often as I should. Thak you!