You’re Going To Need A Thick Skin To Handle This

(I’m a dermatologist seeing a patient for the first time. She was referred for a chronic skin condition on her face and neck, and her appointment was booked around two months ago. Due to the nature of our work, we advise that patients do not change their skin care routines prior to seeing us, and to come wearing little to no cosmetic product, such as makeup, moisturiser, etc. We also ask for a list of products they use regularly, as well as a description of their skin care routine.)

Nurse Practitioner: “Your 1300… You aren’t going to like this.”

Me: “Okay? Let her in.”

(The woman comes in and I can tell, regardless of how much makeup is on her face, that she is seriously suffering from something her referral did not cover.)

Me: “Hello, I’m [Name]. How have you been?”

Woman: *dismissive* “Fine. How long is this going to take? I have stuff to do.”

Me: “It should take no longer than half an hour. Follow-up appointments may take longer, however.” *picking up a packet of wipes* “Once your face is clear of product, we can begin. I’ll promise to be as fast as I can.”

Woman: “No! I have stuff to do. I need my make up!”

Me: “I can’t do an examination without seeing your skin.”

Woman: “You can see my skin. See?!” *pointing*

Me: “I can see your skin through a layer of makeup, which will only make it difficult to find out what you’re suffering from.”

Woman: *pouting* “But, please. Can you just do it with my makeup on, just this once?”

Me: “There’s little point in us doing anything if you aren’t willing to let me see your skin.”

Woman: “Fine!” *takes wipes*

Me: “We also asked for a list—”

Woman: *smugly* “Here! I take good care of my skin, so I don’t know what could be wrong!”

(She hands me a rather long list and a thorough description of her routine. Judging by most of the products, I can only assume she does it weekly, as it would take four to five hours to do it all. I can already tell why she is suffering from skin complaints. She comes back looking sheepish and I instantly recognise a mild to moderate burn on her left cheek. It’s also bleeding slightly.)

Me: *looking at the list* “How long have you been on [Medication]?”

Woman: “About a month.”

Me: “And is that around the time this—” *gently touching around the burn* “—has been here?”

Woman: *shrugs* “I guess.”

Me: “Okay. Firstly, I need to warn you that if you continue with this routine, you are seriously going to damage your skin. Even weekly exposure to this much—”

Woman: “Daily.”

Me: “…daily?”

Woman: “Daily! That’s daily!”

(I stare at her wide-eyed for a moment before regaining my composure.)

Me: “Okay. All of this needs to stop. Weekly is bad enough, but daily… you’re putting yourself at serious risk. Your skin is an organ that can care for itself most of the time. You don’t need all this. Every time you clean or exfoliate your face, you are removing secretions from your skin which help to maintain it. Every time you wipe them away, your skin works harder to restore the balance.”

Woman: “But that’s why I use all that. It does the same; better, in fact.”

Me: “No, it doesn’t. Not when your skin functions perfectly well on its own.”

Woman: “So, what does all this mean then? What will happen if I don’t stop? Is it serious?”

Me: “You’re 22, correct?”

Woman: “Yes.”

Me: *looking over her face* “From your face alone, I would have guessed mid-30s.”

Woman: “What?!“

Me: “The damage you’re doing is causing your skin to age faster than it should. You’re also at risk of developing skin cancer, lesions, eczema, and—” *gesturing to the burn* “—burns.”

Woman: *completely unfazed* “But isn’t all that supposed to help?”

Me: “Not with the way you’re using it. I would rather you do nothing than abuse your skin like this. Most of these products are designed for occasional use, not daily. Now for that burn.” *I turn back to her list* “When did you have acne? Your records don’t mention it.”

Woman: “I didn’t have it.”

Me: *turning to her* “You said you have been using [Medication] for a month. Did you follow instructions?”

Woman: “Umm… I—”

Me: “I don’t see any signs of scarring. Why were you prescribed [Medication]?”

Woman: “I wasn’t.”

Me: “It isn’t an over-the-counter medication. You need a prescription.”

Woman: “A friend gets it for me.”

Me: *pinching my nose* “How often do you use it?”

Woman: “Everyday, for about an hour.”

Me: *closing my eyes* “Was it for a spot?”

Woman: “YES!”

Me: *opening my eyes to her* “This medication is to reduce acne scars. It contains a mild acid which can break down scar tissue. It’s only meant to be used at bi-weekly or monthly intervals, keeping it on the skin for five to ten minutes or until your skin starts to tingle, whichever comes first. I’m not equipped here to handle the damage it could cause.”

Woman: “But, b-b-but… this is meant to help me!”

Me: “I can refer you to a specialist. She’ll be able to accurately assess the damage and risk of scarring. You’re lucky it’s only been a—”

(The woman fled from my room in tears. We contacted her family and made them aware of the referral and asked her to call us. She never did. I sincerely hope she is doing well.)