Help – my 17 1/2 y.o. daughter is having acne and other skin problems!

Hi Dr I, so glad I stumbled upon your website. You are the most informative and helpful dermatologist I've found from reading the other blogs. My question is in regards to my 17 1/2 yr old daughter. We have been battling. Mila was put on Retin-A and Solodyn last year and has had surgery with the dermatologist cleaning her out. She is still on Retin-A and developed an allergic reaction to the Solodyn along with lots of other allergies this past year. She was recently put on a gluten-free diet because of severe stomach pains (digestive problems)...and has recently started breaking out and has never had this..the derm continued her on her cream and now put her on erythromycin 2x day for 3wks. There has been no change, maybe a bit worse- gyno put her generess fe . We are starting (although read it causes acne.) We will be on a month to possibly start Acutane. My son was on this and 6monthe later started to break out again. Is it wise for my daughter to go on this or would she be better off with spirnolactone to help ease the oil surgeries? Which one is safer? Please let me know if ortho tyrcline lo is better for acne. Thank you for all your help.

Thank you!    I’m very glad you wrote because you bring up an important point and while your daughter’s problem is way too complicated to presume to do a good job in a blog, I have some advice for you I’m hoping will be helpful.  We know there is sometimes a connection between the gut and the skin, but science on this is still developing. 

First, remember that the diagnosis of a problem is the most important first step.  If the diagnosis is correct, treatment is often much more effective.   It sounds to me as if it’s still not clear exactly what the problems are.  And, are her doctor’s coordinating with each other – also very important!  For example, for someone with a GI problem, oral antibiotics could make that work.  Does your daughter truly have celiac disease (there is a blood test for this now), or just the more vague  gluten intolerance. Does she have ulcerative colitis, Crohn’s or just irritable bowel?  It is a giarrdia infection from a camping trip?  Do you see where I’m going? 

Also, she has allergies –  have those been tested for with both the tests allergists do (tiny injections in the skin), and with at least the True Test which is usually done by a dermatologist ( tests for common allergies to skin products).   Sometimes “breakouts” are actually allergic reactions that can be subtle.

As a mother, it’s really hard to watch your beautiful daughter struggle with this but sometimes the long term outcome is faster and better by going back to her Gyn, her Derm, her GI doc and her allergist and getting them to coordinate with each other.  Sometimes a great family practice doctor is very helpful in coordinating all this.  Make sure that all labs drawn and notes for visits are sent to all the doctors so they all have the same information.  Hope this helps!  Dr. I 

Dr. Brandith Irwin, MD

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