American Academy of Dermatology

Sorry you’re dealing with persistent acne — that’s frustrating. If drugstore products haven’t helped, the most effective next step is a dermatology evaluation so you can get prescription treatments and targeted in‑office options. Here’s a practical plan and specific names to discuss or try. 1) See a dermatologist (in person or via telederm) Why: a dermatologist can diagnose type/cause of acne, prescribe stronger meds, and offer procedures. Services to consider: Curology (telederm custom prescription topicals like tretinoin/azelaic acid/clindamycin) or your local board‑certified dermatologist (use the American Academy of Dermatology “Find a Dermatologist” tool). Telederm is convenient if access is limited. 2) Prescription medication options to ask about Topical retinoids: tretinoin (brand names Retin‑A, Altreno) — very effective for comedonal and inflammatory acne and for preventing scarring; expect 8–12 weeks to see improvement. Topical combos: clindamycin + benzoyl peroxide (prescription or pharmacy compounding) — reduces bacteria and inflammation. Oral antibiotics: doxycycline or minocycline — for moderate inflammatory acne for short courses while other treatments take effect. Hormonal therapy (if you’re biologically female): combined oral contraceptives FDA‑approved for acne (Ortho Tri‑Cyclen, Yaz) or spironolactone (Aldactone) — very effective for adult hormonal acne. Isotretinoin (Accutane/ Roaccutane): for severe or scarring acne — highly effective but requires monitoring and pregnancy prevention counseling. 3) In‑office procedures (ask the dermatologist) Cortisone injections for painful cysts (rapid relief). Chemical peels (salicylic or glycolic acid) or light/laser treatments (blue light, IPL, pulsed‑dye or fractional lasers) for inflammation, pigmentation, and scarring. Microneedling and subcision for acne scarring. 4) Adjust your daily skincare (gentle, non‑comedogenic) Cleanser: CeraVe Foaming Facial Cleanser — gentle, removes oil without stripping. Exfoliant: Paula’s Choice Skin Perfecting 2% BHA Liquid (salicylic acid) — helps unclog pores. Moisturizer: CeraVe PM Facial Moisturizer or La Roche‑Posay Toleriane Double Repair — restore barrier without clogging pores. Sunscreen: EltaMD UV Clear (broad‑spectrum, non‑comedogenic, favored for acne‑prone skin). Active OTC add‑ons: The Ordinary Azelaic Acid 10% or niacinamide serums can help pigmentation and inflammation; but stop harsh scrubs or alcohol toners. 5) Look for underlying causes If adult acne started or worsened later, ask your clinician about hormonal testing (free testosterone, DHEA‑S), thyroid tests, or medication review. For women, discuss menstrual pattern and signs of hyperandrogenism. 6) Lifestyle and expectations Some people see improvement by lowering high‑glycemic carbs and reducing skim milk/dairy, but results vary. Avoid picking or squeezing lesions to reduce scarring. Prescription treatments often take 8–12 weeks to show real improvement; hormonal meds and spironolactone may take 3 months. 7) Safety and monitoring Some treatments (isotretinoin, oral antibiotics, spironolactone) have side effects or require labs/contraception counseling — your dermatologist will review this. If you want, tell me: Are you male or female, how long you’ve had acne, whether you’ve tried any prescription meds (retinoids, oral antibiotics, spironolactone), and whether you have scarring or painful cysts. I can suggest the most likely next step for your situation.

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Short answer Online dermatology (teledermatology) is generally much cheaper up-front than an in‑office dermatologist visit. Expect typical telederm costs in the U.S. of roughly $20–$100 for asynchronous/photo consults or monthly treatment plans, and $75–$200 for a live video visit. An in‑office dermatologist visit without insurance usually runs about $150–$350 for a new consult (plus costs for procedures, biopsies, or prescriptions). With insurance, in‑person copays are commonly $10–$50. Why prices differ Telederm platforms lower overhead and are often cash-pay or subscription-based, so they can charge less. In‑person care includes exam room time, staff, and the ability to do procedures (biopsies, cryotherapy, excisions), which raises cost. Coverage varies: many in‑person visits are covered by medical insurance; many direct-to-consumer telederm services are cash-pay or use separate subscription models (some accept insurance or offer an insured tele-visit option). Concrete examples (U.S., approximate as of mid‑2024 — check current rates) Curology — custom prescription creams for acne/skin-care: initial assessment + ongoing monthly shipments; typical cost around $20–$40/month. Good for acne and ongoing topical Rx management. Apostrophe — treatment plans for acne, rosacea, eczema, etc.; plan pricing often in the $20–$60/month range depending on meds. Good for chronic conditions handled with topical and oral meds. First Derm — pay-per-case dermatology consultation from photos; historically ~$29 per case. Useful for one-off second opinions or quick nonurgent rashes. PlushCare / Teladoc / Amwell — offer live video visits with dermatologists or dermatology-trained physicians; visits tend to be $75–$200 if paying cash, and some visits can be billed to insurance. Good when you want a live visit and insurance billing. Hims & Hers — telederm services focused on acne/hair loss; subscription pricing for ongoing treatments (often in the $10–$50/month band). Accessible and consumer-friendly for common concerns. If you need a board-certified dermatologist in person, use local dermatology clinics or the American Academy of Dermatology directory. Private in‑office new-patient visits commonly cost $150–$350 without insurance. When telederm is a good choice Acne follow-up, medication titration, mild rashes, hair loss, medication refills, or when you want faster access and lower cost. Many telederm services can prescribe topical or oral meds and ship them. When you should see an in‑person dermatologist Suspicious moles or possible skin cancer (need full-body exam and biopsy), lesions requiring procedures (excision/cryotherapy), severe or rapidly worsening disease, or when a physical exam/dermoscopy is required. A few tips Check whether the telederm service accepts insurance or offers an insured video visit if you prefer billing insurance. For chronic conditions, compare monthly subscription vs. single-visit pricing. Always verify current pricing on the provider’s website before booking. If you tell me your country and the skin issue (acne, rash, mole, hair loss, etc.), I can give a tighter cost estimate and recommend specific services best suited to your situation.

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It's definitely frustrating when drugstore acne products don't cut it! Adult acne can be stubborn and often requires a more targeted approach. Here's what I recommend you do, broken down into steps: See a Dermatologist: Why: This is the most important first step. A dermatologist can accurately diagnose the type of acne you have (e.g., hormonal, cystic, inflammatory) and identify underlying causes. They have access to prescription-strength treatments that are far more potent than anything available over-the-counter. Specific Recommendations: Look for board-certified dermatologists in your area. You can often find them through your insurance provider's website or by searching online directories like the American Academy of Dermatology (AAD) website. Prescription Topical Treatments: Once you've seen a dermatologist, they'll likely prescribe topical treatments. Here are some common and effective ones to ask about: Tretinoin (Retin-A, Atralin, Renova): Why: This is a prescription retinoid that works by increasing skin cell turnover, unclogging pores, and reducing inflammation. It's a powerhouse for treating various forms of acne. It can also help with acne scars and fine lines over time. Clindamycin: Why: This is an antibiotic that kills acne-causing bacteria and reduces inflammation. It's often prescribed in combination with other treatments, like benzoyl peroxide or retinoids, to prevent antibiotic resistance. Benzoyl Peroxide (Higher Strengths): Why: While available over-the-counter, dermatologists can prescribe higher concentrations (e.g., 5% or 10%) that are more effective at killing acne bacteria. It's a strong antibacterial agent. Azelaic Acid: Why: This ingredient has antibacterial and anti-inflammatory properties and can also help with hyperpigmentation (dark spots left by acne). It's often a good option for those who find retinoids too irritating. Oral Medications: For more severe or persistent acne, a dermatologist might recommend oral medications: Oral Antibiotics (e.g., Doxycycline, Minocycline): Why: These work systemically to reduce bacteria and inflammation throughout the body. They are typically used for a limited time to get moderate to severe acne under control. Hormonal Therapy (for women): Why: If your acne is linked to hormonal fluctuations (often appearing along the jawline and chin, or flaring around your period), a dermatologist might suggest birth control pills or spironolactone. These help regulate hormones that can contribute to acne. Isotretinoin (Accutane): Why: This is a very powerful retinoid that is highly effective for severe, stubborn, or cystic acne. It targets all major causes of acne. It requires very close monitoring by a dermatologist due to potential side effects. Professional Skincare Treatments: In addition to at-home prescriptions, your dermatologist might suggest in-office procedures: Chemical Peels: Why: Dermatologists use stronger chemical solutions than what's available at spas to exfoliate the skin, unclog pores, and improve skin texture and tone. Salicylic acid and glycolic acid peels are common for acne. Cortisone Injections: Why: For large, painful cystic acne lesions, a dermatologist can inject a diluted corticosteroid directly into the pimple. This can dramatically reduce inflammation and size within a day or two. Important Considerations: Patience: Prescription treatments take time to work. It can often take 4-12 weeks to see significant improvement. Stick with your dermatologist's plan. Consistency: Use your prescribed treatments exactly as directed. Sun Protection: Many acne treatments make your skin more sensitive to the sun. Always wear a broad-spectrum SPF 30 or higher daily. Look for "non-comedogenic" formulas to avoid clogging pores. Gentle Cleansing: Even with strong treatments, use a gentle, non-foaming cleanser to avoid stripping your skin's natural barrier. Avoid harsh scrubs. Lifestyle Factors: While not a substitute for medical treatment, consider if stress, diet, or sleep might be contributing factors. Don't hesitate to book that dermatologist appointment. They are the best resource for tackling persistent adult acne. Good luck!

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Yes, an online dermatologist can often reliably diagnose a mole or rash from photos, but with some important caveats. This is a growing and generally effective area of telemedicine. Here are some brands and services that offer this, and why they are considered reliable: DermatologistOnCall: This platform connects you with board-certified dermatologists who can review your photos and provide a diagnosis and treatment plan. They emphasize the quality of their dermatologists and their commitment to personalized care. They are a well-established player in the telehealth space. SkyMD: SkyMD also utilizes board-certified dermatologists to evaluate your skin concerns via photo submissions. They often have quick turnaround times for diagnoses and prescriptions, which can be crucial for certain conditions. They focus on making dermatology accessible and convenient. Archimedes: This service is designed to be very user-friendly. You upload photos, and a dermatologist reviews them. They aim to provide a diagnosis and treatment plan, often within 24-48 hours. They are known for their straightforward process and accessibility. American Academy of Dermatology (AAD) - "Find a Dermatologist" Tool: While not a direct diagnosis platform, the AAD's website has a tool to find board-certified dermatologists in your area. Many of these dermatologists now offer teledermatology services, including photo-based consultations. Choosing a dermatologist through the AAD ensures they meet high professional standards. Why these are generally reliable (with caveats): Board-Certified Dermatologists: The key to reliability is that these services utilize board-certified dermatologists. This means they have completed extensive training and passed rigorous exams in diagnosing and treating skin conditions. High-Quality Images: When the photos are clear, well-lit, and show the affected area from multiple angles, the diagnostic accuracy is significantly improved. Detailed Information: The more information you can provide about the history of the mole or rash (when it appeared, if it's changed, any symptoms like itching or pain), the better the dermatologist can assess it. Specific Use Cases: For many common rashes (like eczema, fungal infections, or minor allergic reactions) and for assessing changes in moles (like asymmetry, border irregularity, color variation, diameter, or evolving appearance - the ABCDEs of melanoma), photos can be very effective. Important Caveats and Limitations: Not All Conditions: Some conditions are difficult or impossible to diagnose definitively from photos alone. This is especially true for certain types of skin cancer that require a biopsy, or for conditions that have subtle visual cues only apparent during a physical examination. Image Quality is Crucial: Blurry, poorly lit, or distant photos can lead to misdiagnosis. Need for Physical Examination: In some cases, the online dermatologist may still recommend an in-person visit for a hands-on examination, palpation, or a biopsy. Trust Your Gut: If you have a strong feeling that something is seriously wrong, don't hesitate to seek an in-person evaluation. In summary: For many common dermatological concerns, online dermatologists using photo-based consultations can provide reliable diagnoses and treatment plans. Services like DermatologistOnCall, SkyMD, and Archimedes are good options, and always prioritize seeing a board-certified dermatologist. However, always be aware of the limitations and be prepared for the possibility of needing an in-person follow-up.

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You're asking a great question! The rise of online dermatology has made access to skincare expertise easier than ever, but it's not always a replacement for seeing a dermatologist in person. The best choice really depends on your specific needs and the severity of your skin concern. Here's a breakdown to help you decide when online dermatology is likely enough, and when an in-person visit is essential: When Online Dermatology is Enough (and even preferable!): Online dermatology is fantastic for convenience, cost-effectiveness, and initial consultations or follow-ups for common, non-urgent skin conditions. Good For: Mild to Moderate Acne: For initial prescriptions, adjustments to treatment plans, and ongoing management of typical breakouts. Recommended Brands: Curology: Offers personalized, prescription-strength formulas for acne and anti-aging, prescribed by licensed providers. They focus on custom mixtures of active ingredients delivered to your door. Apostrophe: Similar to Curology, providing custom-compounded topical and oral medications for acne, rosacea, and anti-aging concerns. Dermatica: Another personalized prescription skincare service, great for acne, rosacea, and anti-aging, with a strong focus on custom formulations based on your photos and questionnaire. Rosacea Management: For initial diagnosis, prescription refills, and adjusting treatments for redness and bumps. Recommended Brands: Apostrophe, Dermatica, and services like Teladoc or Amwell which offer general dermatology consultations where a provider can prescribe common rosacea treatments. Mild Eczema or Psoriasis Flares: For medication refills, minor adjustments to topical treatments, or getting advice on managing less severe outbreaks. Recommended Brands: Skribble offers a subscription model that includes treatments for eczema, psoriasis, and other chronic conditions, overseen by board-certified dermatologists. General telemedicine platforms like Teladoc or Amwell are also options. Prescription Refills: If you have a stable, diagnosed condition and just need a refill for a maintenance medication. Initial Consultation for Non-Urgent Rashes: If you have a clearly identifiable rash (e.g., contact dermatitis from a known allergen) that isn't spreading rapidly, painful, or blistering. Minor Cosmetic Concerns (advice only): For discussing potential treatments for hyperpigmentation, fine lines, or dullness, and getting recommendations for over-the-counter or prescription topicals. Recommended Brands: The personalized formula sites like Curology and Apostrophe are great for anti-aging and pigment concerns, as are many general telemedicine dermatology services. How it Works: You typically fill out a questionnaire, upload photos of your skin concern, and sometimes have a video chat with a board-certified dermatologist or a licensed dermatology provider. They then diagnose and prescribe medications, which are often shipped directly to your home. When You Need an In-Person Dermatologist: An in-person visit is crucial when a physical examination, specialized procedures, or a deeper diagnostic assessment is required. Your eyes are good, but a dermatologist's trained eyes, hands, and tools are often indispensable. Essential For: Full Body Skin Checks / Mole Mapping: This is arguably the most critical reason for an in-person visit. A dermatologist needs to physically examine your entire skin surface, often using a dermatoscope (a handheld microscope) to closely inspect moles for signs of skin cancer (melanoma, basal cell carcinoma, squamous cell carcinoma). You cannot effectively screen for skin cancer online. Suspicious Lesions: Any new, changing, growing, bleeding, or unusually textured mole, lump, or spot needs immediate in-person evaluation. This is where a biopsy might be needed. Severe or Undiagnosed Rashes: If a rash is widespread, rapidly spreading, painful, blistering, involves mucous membranes, or you have no idea what it is, an in-person visit allows for palpation (feeling the skin), closer inspection, and potentially immediate biopsies or cultures. Cystic or Severe Acne: While online can start treatment, severe cystic acne, especially if it's causing scarring, often requires stronger oral medications like isotretinoin (Accutane), which necessitates regular in-person blood work and monitoring. Hair Loss Diagnosis: Determining the cause of hair loss often requires a physical examination of the scalp, hair pull tests, and sometimes scalp biopsies. Nail Problems: Fungal infections, ingrown nails, or other nail concerns often require a direct examination and sometimes a sample for lab testing. Procedures: Biopsies: To diagnose skin cancer or other conditions. Excisions: Removal of moles, skin tags, cysts, or skin cancers. Wart/Skin Tag Removal: Often done with cryotherapy (freezing), electrocautery, or surgical removal. Injections: Cortisone shots for cysts, steroid injections for keloids, fillers, Botox. Laser Treatments: For scars, redness, hair removal, or skin resurfacing. Chemical Peels: Deeper peels that require professional application and monitoring. Light Therapy (Phototherapy): For severe eczema or psoriasis. When You've Tried Online and it Didn't Work: If your condition isn't improving with online-prescribed treatments, it's definitely time for an in-person visit for a re-evaluation. How to Find an In-Person Dermatologist: Ask your primary care physician for a referral. Check your insurance company's directory for in-network providers. Use the "Find a Dermatologist" tool on the American Academy of Dermatology (AAD) website (aad.org). The General Rule of Thumb: For superficial, common, or established conditions (especially acne, rosacea, mild eczema) where you primarily need prescription medication or advice, online dermatology is an excellent starting point. For anything suspicious, rapidly changing, painful, undiagnosed, or requiring a physical procedure, a hands-on in-person visit is non-negotiable. A hybrid approach is often best. Start with online for convenience and mild issues, but don't hesitate to book an in-person appointment if your online provider recommends it, or if your concerns lean towards the more serious categories.

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