What so many doctors don’t see (acne)

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Dr. Jetske Ultee

Research Physician in Cosmetic Dermatology
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For years now I have been delving into cosmetics. I believe in the importance of good skincare but, at the same time, I am shocked by the sense and nonsense within the cosmetics world. You can share in my knowledge about skincare via this blog.
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Why do so many doctors stick to the same practices that have been used for decades? Why are so few doctors receptive to new insights? I really don’t want to generalise, but it sometimes frustrates me to see how long it takes for new information to be put into practice. Acne treatment springs immediately to mind. You don’t want to know how many questions I receive on this subject. And time and time again I notice how much misunderstanding, ignorance, bad advice and treatment there is, even though so much can be done for acne.

I spoke, recently, about two studies in the blog for my scientific trust Skinwiser. About how long it takes for people with (severe) acne to receive the right treatment. Doctors are not the only reason for this; it also has a lot to do with ‘Doctor Google’. For those who have missed the articles, you can read them here (Dutch). About mis- information and misunderstandings that so many people face or have experienced with a condition.

Rare doctors

If, after far too long and too much distress, you eventually dare to make an appointment to see a doctor about your complaint (because you had initially read or heard that you will grow out of it), then you will probably receive a prescription for antibiotics. Without the cause of the problem having been sufficiently looked into. Because is the acne actually acne? Or is it possibly connected to a fungus, or an overgrowth of the demodex mites? And how much does a hormone imbalance, an incompatible diet, intestinal problems or the incorrect use of cosmetics play a role? The doctors who look into this are few and far between. While at the same time, recognising the cause of the problem is extremely crucial in the choice and success of the treatment.

Antibiotics and other heavy duty firepower

For people suffering with severe acne, it is not only antibiotics which are prescribed, but often also the ‘horse medicine’ isotretinoin. This vitamin A acid based medicine works very efficiently, but you do need to be aware that there are many nasty side effects. And it has become clear in the last few years, through research, that a fraction of the dose (low dose or ultra low dose isotretinoin) will deliver the same result without all of those awful side effects. Meanwhile, it has even been discovered that a low dose of isotretinoin is also very beneficial for people with less severe acne and rosacea, and therefore provides a good alternative to antibiotics.

Will the ban help coral to survive?

I am, above all, very happy that ingredients in cosmetics (and in sun creams) are so closely scrutinised as well as the effect these have on our health and the environment. I have always been a great advocate of it. I truly hope that the questions we have will be answered through competent studies. But, at the same time, I don’t think we should lose sight of the bigger picture. I honestly wonder if a ban on specific sun creams is the initial solution for protecting our coral. Perhaps it helps a little and all the littles help but there are still a number of other important steps to take (climate change, rising temperatures, our farming). A lot of coral is also lost in places where there are no tourists and that has been the case for decades.

Inquiring questions in the consulting room

It puzzles me why a great deal of doctor have not adopted this. Is it the immense pressure of work? Obviously acne is not life threatening, but the anguish caused by the condition is much more than thought, and sometimes so critical in the development of young people. There is a drawback to self- prescribing, especially as there is so much bad information circulating on the internet. But, I am ultimately still in favour of people reading for themselves about their complaints and staying informed about the latest developments. And if you have a couple of skin care inquiries for the doctor, don’t be afraid to ask, everyone will only gain from it!

Kind regards,



Research Physician Cosmetic Dermatolgy