Advice Needed for Mid Suffering With Acne

O

Ollie3

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Aug 8, 2020
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16
Please do not respond with judgement or criticism - it isn't needed or wanted! If you have personally suffered or have a loved one who has dealt with the emotional and physical issues with severe acne, then you will have compassion. My daughter had typical mild (VERY mild) pimples here and there upon entry and through her plebe summer and first year, more flare ups. We all thought with better self care and changes in diet, rest, and hormone balance things would self resolve. They have not. Things have spread and worsened. She's fortunate that some of it she can now "cover up", but the emotional toll and physical (some of the nodular ones she gets really are very painful) have affected her a great deal. On one visit last year to the BMU she tested the waters and asked if isotretinoin would ever be considered, but seemed to hear it was unlikely. I think it's in the formulary, but not 100% sure of that. Yes - she's tried topicals and retinoids and about every product under the sun and bc pills all to no avail. She wants the emotional and physical freedom from this prior to commissioning and finds it all so embarrassing. To her credit she has kept a positive attitude for the most part, but I really see the toll. When home she had a slight improvement, but it clearly is the type of acne (deep under the skin) that is only going to really get clear with a course of isotretinoin. She is NOT one to do anything out of process and I just don't know if any of you have any advice or positive comments that BMU WOULD prescribe this? Again, please don't judge and dismiss this or berate me for the post - whether male or female this stuff affects a young adult. Thank you in advance.
 
There’s absolutely nothing wrong with this. It’s a fact of life. BMU’s job is to help, though they do have a reputation for being stubborn and bureaucratic at times. Yes they are going to want to prescribe more conservative remedies at first but I wouldn’t lose hope. I know that they do perscribe tretinoin as a first line of treatment, which is another vitamin A derivative but not as powerful as isotretinoin. If that doesn’t work after a couple of months, they may be willing to try something more intense.

My main advice is that your daughter is going to have to stick up for herself and be willing to make a fuss. BMU has a lot on their plate but like I said, it’s their job to help. First step is she should make an appointment with a doctor and explain that she’s tried many conservative remedies to no avail and the problem is significantly interfering with her quality of life. She needs to be blunt and truthful here. It might not be a comfortable conversation for her, but as leaders it’s our job to have those uncomfortable conversations.
 
@Ollie3 tried to pm you but your profile is restricted.
 
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Kierkegaard said:
There’s absolutely nothing wrong with this. It’s a fact of life. BMU’s job is to help, though they do have a reputation for being stubborn and bureaucratic at times. Yes they are going to want to prescribe more conservative remedies at first but I wouldn’t lose hope. I know that they do perscribe tretinoin as a first line of treatment, which is another vitamin A derivative but not as powerful as isotretinoin. If that doesn’t work after a couple of months, they may be willing to try something more intense.

My main advice is that your daughter is going to have to stick up for herself and be willing to make a fuss. BMU has a lot on their plate but like I said, it’s their job to help. First step is she should make an appointment with a doctor and explain that she’s tried many conservative remedies to no avail and the problem is significantly interfering with her quality of life. She needs to be blunt and truthful here. It might not be a comfortable conversation for her, but as leaders it’s our job to have those uncomfortable conversations.
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This advice from a fellow mid is spot on. Military medicine does try the most conservative approach first. I don’t know whether a WRNMMC derm doc is still coming over at regular intervals, but an appointment with a derm should be the goal, and a discussion of options and the impact on QOL.

The advice about self-advocacy is priceless. This is a life skill. I struggled with this myself long ago, as many young women do, not wanting to make a fuss. If it was a matter about one of my sailors, I was fearless and relentless in getting him or her what they needed. I got over this, learned how to overcome the pressure to conform and the light bulb came on about my own self-worth and going after what I needed.
 
Capt MJ said:
This advice from a fellow mid is spot on. Military medicine does try the most conservative approach first. I don’t know whether a WRNMMC derm doc is still coming over at regular intervals, but an appointment with a derm should be the goal, and a discussion of options and the impact on QOL.

The advice about self-advocacy is priceless. This is a life skill. I struggled with this myself long ago, as many young women do, not wanting to make a fuss. If it was a matter about one of my sailors, I was fearless and relentless in getting him or her what they needed. I got over this, learned how to overcome the pressure to conform and the light bulb came on about my own self-worth and going after what I needed.
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Thank you very much, Capt. MJ. I appreciate the words and how perfectly you phrased it. I will absolutely do my best to try to impart that. Somehow moms get the blame for everything ... it was never an issue (or so I thought) through high school and late teens. The climate change, hormones, physical activity, diet, stress has all taken a toll. She got a pretty negative reaction when it was brought up as an "aside" in a prior BMU appt., so she's been loathe to readdress it. Timing is terrible now I realize, but having been down the path myself I 100% have empathy and it's affecting self confidence as only the parent can recognize.
 
@Kierkegaard are you sure you are a Midshipman? That's a compliment.

@Ollie3 great advice by all above. Capt MJ mentioned the dermatologist. My wife is a long time patient at Walter Reed Derm clinic and they are trying to catch up with appointments and procedures from when they slowed down at the start of the pandemic. Also, I know a thing or two because I've seen a thing or two, and one thing I never hesitated with unless the patient had an obvious fungus or other easily diagnosed condition is their skin.

She should go to BMU once again and if not satisfied with the plan for her diagnosis, request to have a dermatology consult written.
 
I checked the settings. I don't see where or how I restricted receiving messages. What did I miss!? I'm not very good at this.
 
Ollie3 said:
I checked the settings. I don't see where or how I restricted receiving messages. What did I miss!? I'm not very good at this.
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Five posts, a week of forum membership, system refresh.
 
Ollie3 said:
I checked the settings. I don't see where or how I restricted receiving messages. What did I miss!? I'm not very good at this.
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Ill try you later! Great advice already...
 
Temple17 said:
I would recommend asking BMU for a Clindamycin and Benzoyl Peroxide Topical Gel. I used to have really bad acne and it went away in a couple weeks after using the gel. Haven't had any issues in over a year. I wish you the best.
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Did you have cystic acne? It sounds like OP's daughter has cystic acne AKA nodular acne.

Accutane is the go-to medication and it is on the formulary. I'm reaching out to colleague who would know if BMU would prescribe it or would they want a dermatologist to do it. The OP apparently thinks I didn't give good advice so I will check for my own knowledge.
 
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