[ariel]

I finally go to a dermatologist for the persistent, painful, deep-under-the-surface cysts Iâ€2122ve been getting on my chin right before every period.

The doctor inspects my face, says that the cystic blemishes are severe. Then she proceeds to tell me itâ€2122s rosacea. Um, what? My nose was a little red from extracting some blackheads, but other than that, I donâ€2122t have any of the typical rosacea symptoms.

She prescribes Retin-A & Doxycycline, but tells me theyâ€2122re expensive if I get them at a pharmacy, and suggests I buy then from her. Weird, but ok, I guess.
She also throws in a bottle of “AHA oily skin solution 8†by Dermatologic Cosmetic Laboratories, whatever that is.

Then she gives all my cysts an injection at $10 each, telling me sheâ€2122s giving me a good deal, she usually charges more, etc.

At home, I look at my prescriptions: the Retin-A is in a plain white tub with just a computer printed label
[RETIN-A & T.A.C. / APPLY AT NIGHT ONLY!].
No other info.
Doesnâ€2122t Retin-A come in different strengths? And what is T.A.C.??

Same with the Doxy: plain prescription bottle with a label
[Doxycycline Hyclate 100mg]. No instructions, nothing.

I would really appreciate any feedback you can offer, especially regarding the rosacea diagnosis.
And does anyone know what T.A.C. is?
I should go see a different doc, shouldnâ€2122t I?

 

[Mari]

I finally go to a dermatologist for the persistent, painful, deep-under-the-surface cysts Iâ€2122ve been getting on my chin right before every period.

The doctor inspects my face, says that the cystic blemishes are severe. Then she proceeds to tell me itâ€2122s rosacea. Um, what? My nose was a little red from extracting some blackheads, but other than that, I donâ€2122t have any of the typical rosacea symptoms.

She prescribes Retin-A & Doxycycline, but tells me theyâ€2122re expensive if I get them at a pharmacy, and suggests I buy then from her. Weird, but ok, I guess.
She also throws in a bottle of “AHA oily skin solution 8†by Dermatologic Cosmetic Laboratories, whatever that is.

Then she gives all my cysts an injection at $10 each, telling me sheâ€2122s giving me a good deal, she usually charges more, etc.

At home, I look at my prescriptions: the Retin-A is in a plain white tub with just a computer printed label
[RETIN-A & T.A.C. / APPLY AT NIGHT ONLY!].
No other info.
Doesnâ€2122t Retin-A come in different strengths? And what is T.A.C.??

Same with the Doxy: plain prescription bottle with a label
[Doxycycline Hyclate 100mg]. No instructions, nothing.

I would really appreciate any feedback you can offer, especially regarding the rosacea diagnosis.
And does anyone know what T.A.C. is?
I should go see a different doc, shouldnâ€2122t I?

A lot of this sounds very strange. I don't like the idea of her selling her own products -- I never heard of a doctor doing that before. Also did she tell you what she was injecting into your cysts? This doesn't sound like rosasea to me. I'd stay away from her and get another opinion.

 

[Freddy]

Wow...that's why I have little faith in dermatologists. Sometimes I really think they got their Ph D.s at the bottom of the cereal box.

 

[Freddy]

http://www.skincaretalk.com/basic-sk...care-blog.html

Read that, it will help.

 

[mireckca]

I believe that doctors can dispense medications from their office supplies and are not bound by the same rules that a pharmacy is. That opens the door for alot of problems, in my opinion. They often mix up their own preparations for use by their patients. He/she should at least have given you some written literature - on how to use the preps, and what precautions to take, and so on.

If I were going to make a bet, it would be that the cream is a combination of Retin-A and a steroid. I don't know if this is commercially available, but by the description of the labelling, he/she might have prepared it him/herself. The T.A.C. - might, might, might, might be "triamcinolone acetonide cream" - a steroid cream for topical use. I suspect that he/she is using it to cut down on the irritation that can result from the Retin-A.

The confusing thing is that the benefits of using Retin-A are seen over the long term, and this is a powerful steroid which typically should not be used on the face for extended periods of time (it thins the skin). So the combination of the two in a single product is unconventional and surprising to me.

So - I may be wrong, but I cannot think of what else it could be. Or there is more to the story than you have been able to tell us here based on what you know.

In any case, I think that it is irresponsible of this doctor to dispense medications without fully instructing you as the patient. You are entitled to understand what you are putting on your person. I personally think that you should go back and ask some questions so that you understand what is going on. This is a situation where if you are not satisfied, then you can find another doctor and he/she has lost a patient - not a thing for you, but also an economic loss for the doctor.

 

[Freddy]

TCA stands for Trichloroacetic Acid which is a very powerful peel. I'd stay away from that unless you're skin is really bad.

 

[mireckca]

TCA stands for Trichloroacetic Acid which is a very powerful peel. I'd stay away from that unless you're skin is really bad.

Thanks Freddy. That makes better sense!

But still a dangerous combination especially given that the patient was given no instructions or precautions.

 

[ariel]

Thanks for all the feedback. I really appreciate it!

The label says TAC, not TCA- would that make a difference?

Anyway, an update: My skin peeled & flaked like crazy from the Retin-a cream she gave me. It's awful, but I've read skin needs time to adjust to Retin-a.
The cysts are decreased in inflamation and tenderness, but super irritated and red from the cream. Yay. The question is, do I keep following this course of treatment?

I'm definitely following up w/ a different doc, did not like her approach with selling her own meds.

Freddy: I thought all derms were MDs, no?

 

[mireckca]

The label says TAC, not TCA- would that make a difference?

Hi Ariel - that's why I supposed that it was the steroid cream - it kind of makes sense and kind of does not, as I said. I know medicines, but Freddy has first hand knowledge of skin care, so his view is invaluable. It could be either of our components, or something different altogether.

In any case, I think that you are wise to move on. He sounds like a witch-doctor to me. All the best to you.

 

[fawnie]

HI Ariel,

The whole thing sounds kinda shady to me! I don't think it's illegal for Drs to dispense drugs from their offices, but whether it's ethical or not depends on the circumstances. Usually the Drs buy meds they prescribe frequently in bulk and then can pass the savings on to the patient, so sometimes it's a good thing. Not telling a patient what they are injecting into her face is a big red flag to me.

I worked with Drs who used TAC (tetracaine - adrenaline - cocaine) as a topical anesthetic, but it's an antiquated formula and not in much use any longer, since there are better topical anesthetics now. I'm not sure if this is what was in that Retin-A concoction you were given - it doesn't jive....????

Cystic acne on the chin is usually hormonal acne. Sometimes just the right Birth Control Pill or spironolactone can clear it up pronto!

Yeah, I'd take a pass on this Dr. She gets a big "F" in patient communication skills, no matter how good her diagnostic and treatment skills are!!!

 

[Freddy]

No no, I made the mistake. I read really fast and thought it was TCA, TAC is different.

 

[ariel]

Yeah, I'd take a pass on this Dr. She gets a big "F" in patient communication skills, no matter how good her diagnostic and treatment skills are!!!

100% agree. She did say she was saving me $ by selling me the meds directly, but her bedside manner was seriously lacking.

Hmmm. So TAC's either a steroid cream or an antiquated topical anesthetic.
I'm hesitant to call and ask b/c I'm sure I won't be able to get ahold of her that easily.

I know birth control may be the answer, but I'm scared of the mood changes, weight changes. Hormonal bc has always made me puffy and depressed.
Then again, I'm already depressed because my face is a mess.

I'm really hoping the combo of retin-a and antibiotics will work

.
How much time do you think I should stick with it before chucking it & seeking out birth control?

 

[mireckca]

I'm hesitant to call and ask b/c I'm sure I won't be able to get ahold of her that easily.

You are her patient and entitled to understand what she is giving to you. The doctor may be difficult to get ahold of, but you should call the office and ask the nurse - she/he can check your chart and tell you what the abbreviation stands for. The doctor is probably using this same potion on lots of her patients. You really don't need to speak to the doctor directly to get this kind of info.

 

[ariel]

OK, I'll call the derm's office & try to find out what TAC stands for. I'll let you all know what I find out.

Still, if you were in my shoes, how long would you keep using the retin-a, considering all the horrendous peeling and irritation? (I'm embarassed to go to work).

 

[mireckca]

OK, I'll call the derm's office & try to find out what TAC stands for. I'll let you all know what I find out.

Still, if you were in my shoes, how long would you keep using the retin-a, considering all the horrendous peeling and irritation? (I'm embarassed to go to work).

I would call the doctor's office right away and tell them that you are having a harsh reaction to the cream. Some irritation is normal and passes with time, but in other cases the doctor may tell you to use the cream less frequently, or may reduce the strength of the medications in the cream. And while you are on the phone with them, you should ask them exactly what is in the cream that you are using.

It still bothers me that they gave you these medications without proper instructions. The pharmacist is trained to do these things - that is why drugs are typically dispensed from a pharmacy. In my opinion, if the doctor is "too busy" to do so, then he/she should not be handing out drugs.

All the best to you. And yes, please let us know how it turns out. I think we are all curious and concerned for you about this.

 

[mireckca]

Quote: Originally Posted by kateokate

I take great offence to what Mirecka said about her being a witch-doctor.That's very judgemental. I am hurt by those comments.
I wish you well. I have experienced problems like this but never say or put-down someone and say they are a WitchDoctor. That's very hurtful.
MIrecka, I am very hurt by what you said.


Oh really? Then I'll repeat it again just for you. This and any doctor that mixes up drugs and hands them to patients without properly instructing them as to their identity, proper usage, and precautions - is a Witchdoctor - and should not be dispensing drugs.

 

[mireckca]

I thought that this "kateokate" had a strangeness to her. It was our little friend Jessica back again, gone again.

 

[Mari]

I thought that this "kateokate" had a strangeness to her. It was our little friend Jessica back again, gone again.

 

[mireckca]

Yeah - and I was her victim this time. Sniff, sniff, sniff.

 

[ariel]

Hi all:
mirecka, it's exactly as you said: TAC stands for Triamcinolone, to reduce irritatioin.
I didn't mention my reaction, b/c everything I've read states scaling and redness is a normal side effect of retin-a. However, one site read it should be used every 3rd or 2nd night initially to allow the skin to adjust. Again, total lack of instruction & what to expect from this doc.

Anyway, obviously, the TAC isn't working at all!
I've only been using retin-a on my chin now. After applying it nightly, my entire chin is red, bumpy, & peeling. It seems to be triggering more bumps. I'm going to discontiue it for a couple days to give my chin some relief & see what happens.
It still floors me that her cream doesn't indicate what strength the retin-a is.
She sucks.