"Two recent experiences of dermatology"

Three years ago I attended the nurse led clinic at Crosshouse for a course of Isotretinoin for severe cystic acne which I have suffered from for around twenty two years. I was given a dose based on my weight and within a week I had very red, bloodshot and itchy eyes. The Isotretinoin was stopped with no discussion of reducing the dose or alternative treatment - it felt like the nurses weren't able to deal with anything other than prescribing a standard dosage and didn't seem to know about lesser known side effects. At the time I felt disappointed with the lack of support and inflexibility of the nurse led clinic but I was too concerned about my eyes to do anything about it. I had waited months for the treatment and was left with sore eyes, continuing acne flare ups and no support.

Several months later I visited a private dermatologist for advice and he suggested that a lower dose of Isotretinoin over a longer period may be better for me. Based on his observations of my skin and the length of time I have suffered from acne, he also recommended I be seen by a consultant in future rather than via the nurse led clinic. He wrote a letter to my GP advising them of this.

Earlier this year, I went to my GP with ongoing cystic acne and I was referred to a consultant at Crosshouse. Today after waiting around fifteen weeks for an appointment, I saw a consultant and was so upset with the way I was treated. The consultant didn't say hello or introduce themself and just started talking about my skin straight away. I explained that I had tried lots of antibiotics over the years and they tend to upset my stomach, and I felt they were more of a short-term solution. The consultant bluntly said there is no cure for acne and what did I want them to do if I didn't want antibiotics or Isotretinoin. I started to get upset as I am quite sensitive about my skin. The consultant then asked if I was on antidepressants. When I said no, I was asked if I normally get teary like that. I tried to explain that when you have been suffering with skin problems for over twenty years it can be quite upsetting. I couldn't believe the insensitivity. How can you become a consultant dermatologist without having an appreciation of the emotional impact skin complaints have on patients.

I said I wasn't against trying Isotretinoin again and mentioned the possibility of a lower dose. The consultant quite bluntly said that's what I was given before and when I disagreed, gestured at the letter from the private consultant to my GP. When I pointed out that the letter was a recommendation, not my previous dose, the consultant dismissively told me that I could still get side effects on a lower dose - very helpful! I was so disappointed with the way I was spoken to. I had waited so long for an appointment and was looking forward to getting some advice and suitable treatment. I wasn't expecting the consultant to ask me what I wanted them to do, not once but a couple of times. Surely that's their job! The consultant didn't touch my skin or show any interest in the history of my acne.

In the end I just agreed to the lower dose of Isotretinoin so that I could get out. The consultant then told me I would be seen by the nurses in future. When I queried what would happen if I had side effects again, I was just dismissed. Basically the nurse led clinic is my only option again, despite my GP requesting a consultant clinic. I appreciate acne is not a life threatening condition and is probably not high on a consultant's agenda but I expected to at least be treated with a bit of respect and offered some advice. I left the hospital in tears and am not sure that I will even bother with my treatment after my two recent experiences of dermatology at Crosshouse.