Cure for acne - over the counter?

[1FinickyOne]

I have a friend who is a 35 year old lady and has a terrible acne problem. It covers almost her entire face. She has had this problem since she was 17. I have spoken to dermatologists in Chiang Mai who said it is curable though it would not be easy for her to get off work and away from family obligations to get there. 

 

There is one of those mall type stores who said they could cure it for about 60,000 baht - though I think it might be wise to try some over the counter creams first. 

We have a Big C and Tesco nearby. I could imagine that everyone is different but does anyone have any good product that has worked for you or someone you know? 

 

Thank you. 

[Sheryl]

Somebody who has had bad acne for almost 20 years will almost surely not be helped by any over the counter creams. They are more likely to make it worse.

 

Mall teratemnts are best avoided, and  proper care by a dermatologist will not cost anything remotely near 60,000 baht. even at a private hospital, likely under 10K including meds (unless after it is cleared up she needs treatment of scars).

 

Where does she live? this is not rocket science.

[1FinickyOne]

Thanks Sheryl - - nearest private hospital would be a 2 hour drive that I know of, from Tak City.. would be Phitsanulok. Or Chiang Mai would be 3 hours.... how many trips might be needed? typically? I would guess that there will be some scarring there... I have not examined it closely.  

[Sheryl]

Once every 1-2 months until cleared up... the tretaments (see below0 take time, results are not to be expecetd fast. She can also explain that she lives far away and ask for longer intervals. 

 

Has it already been verified that there is no dermatologiost at the Tak provincial hospital? (Or long wait lists - that would not surprise me). If there is a derm on staff, she can probably see him or her through an after hours clinic in the evening, most provincial hospitals these days have one. And has availability of dermatologist  at 2 private hospitals in Maesot been ascertained?

 

Basically there are 2 treatment approaches for chronic acne such as this

 

1 - systemic antibiotics in the tetracycline family (if she has had acne for 20 years likely has already tried this) - sometimes does the trick, sometimes not, and also when it does work the acne often recurs after it is stopped.

 

 

2- treatment with isotretinoin (accutane and equivalent brands).  This is far more sure to work than #1, and results are pretty long lasting,  but also more toxic. it is essential a woman not become pregnant while taking it as it will cause birth defects. It is also necessary to monitor liver function while taking it through blood tests and that is the main reason for repeat visits otherwise could be just one visit and then follow up after she has completed the full course of the drug which is normally 4 months. However the necessary test can be done by any hospital or lab so she might be able to arrange to have that doen locally. It is just AST/ALT. Don't be frightened by the liver business, most healthy people do just fine, but as a precaution it does need to be monitored. there are also some annoying side effects, especially very dry and chapped lips as the drug really dries up oils on the skin.

 

If after the acne resolves she has scarring a course of IPL would be first approach,  around 5 treatments and should not cost more than 2000 baht per session with discount for a package. Mall clinic may have this but need to consider quality, better done by a proper dermatologist specializing in cosmetic dermatology which would be found in Pitsanaoluk or CM. This can be spread out over a long time, there has to be at least 10 days between sessions but longer is no problem, effects are cumulative. 

[mommysboy]

Adult acne is only similar to teenage acne.  There can be an underlying hormonal imbalance which may stop well short of being a clinical problem.  There are some very effective treatments ranging from antibiotics to treatment with roaccutaine (I think it is called).  Both courses can have side effects and it is imperative that they are medically supervised.  A doctor might also prescribe a topical cream like retin A, which prevents the dome of a spot from forming, and has an ability to tackle some scarring issues.

 

Mild cases may respond solely to a better diet, and a good health regimen, which would include stress control, but your friend is another matter. 

 

There is a great deal of hope here for your friend.  With luck the solution could lay with one of the cheapest, oldest and safest teracyclines such as doxycyclin.

 

Good luck, but she probably won't need it with good, standard treatment.

[1FinickyOne]

Thanks Sheryl - I will ask all questions you have raised in town today. She and her husband are poor and raising a couple of kids and probably never considered anything that would cost any money. I don't think there is a dermatologist in Tak hospital. I will double check. Mae Sot is a harrowing 90 minute drive over winding roads - so, that is not an option. 

 

I am wondering if a local doctor, not a dermatologist could take this on ... but I will look for the closest dermatologist though I can imagine the larger issue would be them having time off from work - I am glad to pay the medical costs - the driving back and forth is a bit less convenient, but I guess can be done... 

 

Thanks so much for all the info - - 

[mommysboy]

On 21/11/2017 at 8:19 AM, kenk24 said:

Thanks Sheryl - I will ask all questions you have raised in town today. She and her husband are poor and raising a couple of kids and probably never considered anything that would cost any money. I don't think there is a dermatologist in Tak hospital. I will double check. Mae Sot is a harrowing 90 minute drive over winding roads - so, that is not an option. 

 

I am wondering if a local doctor, not a dermatologist could take this on ... but I will look for the closest dermatologist though I can imagine the larger issue would be them having time off from work - I am glad to pay the medical costs - the driving back and forth is a bit less convenient, but I guess can be done... 

 

Thanks so much for all the info - - 

I'm only guessing but this should fall in to the remit of a public hospital, and depending on treatment the cost may be much lower than anticipated.  The antibiotics used for instance are really quite cheap, and a doctor's consultation  will only be a few hundred baht. It may be that stronger treatment will be necessary in which case I'd guess a few thousand baht tops.

[1FinickyOne]

1 hour ago, mommysboy said:

I'm only guessing but this should fall in to the remit of a public hospital, and depending on treatment the cost may be much lower than anticipated.  The antibiotics used for instance are really quite cheap, and a doctor's consultation  will only be a few hundred baht. It may be that stronger treatment will be necessary in which case I'd guess a few thousand baht tops.

 

On November 20, 2560 BE at 10:26 PM, Sheryl said:

Once every 1-2 months until cleared up... the tretaments (see below0 take time, results are not to be expecetd fast. She can also explain that she lives far away and ask for longer intervals. 

 

Hi Sheryl and MB - I thank you both and passed along the info today and I can see that she was noticeably grateful. She wears a mask every day at work. She is poor and they are raising 2 kids and money is enough of an issue for her that she has probably never even purchased a cream. 

 

Getting away is not easy for them either. Is it in any way credible that I could have the meds sent to a local doctor with a clinic and have it administered that way? Or am I being too creative and naive? I do not mind paying for this even to the point of helping them if they get docked some salary at work. 

[mommysboy]

15 minutes ago, kenk24 said:

 

 

Hi Sheryl and MB - I thank you both and passed along the info today and I can see that she was noticeably grateful. She wears a mask every day at work. She is poor and they are raising 2 kids and money is enough of an issue for her that she has probably never even purchased a cream. 

 

Getting away is not easy for them either. Is it in any way credible that I could have the meds sent to a local doctor with a clinic and have it administered that way? Or am I being too creative and naive? I do not mind paying for this even to the point of helping them if they get docked some salary at work. 

 

Only Sheryl can comment on the availability of said drugs, and, probably more importantly, Thailands policy on treating acne.  Since the drugs can have side effects, and acne sufferers are not suffering from a disease then some doctors may be reluctant to prescribe I suppose. 

 

However, the antibiotics in question will undoubtedly be available just about anywhere including the local pharmacy since they are used in a wide range of diseases and infections.

[Sheryl]

I doubt given how long she has had this, that they will try abx, I suspect they will go directly to accutane.

 

Any doctor can obtain the medication from the drug distributor, no need for it to be sent from another hospital, the question is whether a local doctor would (1) be willing/comfortable to oversee this sort of treatment which is usually given by dermatologists and (2) would be skilled at doing so. Medical care in Thailand is very specialized and unless there is an uncommonly bright GP with a lot of initiative in your area you are unlikely ti get very far in finding anyone willing to treat this. It will either be "mai dai" or she will be fobbed of with something ineffective,

 

As mentioned she can get the lab work (ALT/AST) done locally  as long as results are normal. So looking at as little as 2 dermatologist visits 4 months apart.

 

The whole thing can be done free under the government health system. If the provincial hospital does nto have a dermatologist she should ask for a letter of referral to one, probably they will refer her to the government hospital in Pitsanoluk which is a 900 bed regional facility. BUT going this route will involve more time, waits etc and likely more trips, first back and forth to the Tak hospital and then to the hospital she is referred to. I don't know what sort of work they do/hours they have, but care in govt hospitals is strictly Mon-Friday whereas private hospital specialists are available on Saturdays and Sundays, in case that matters.

 

If she is given isotretinoin , I can't stress enough that she must not become pregnant. She has to be sure she is on totally reliable birth control. She will be made to sign a consent form to this effect.

 

 

 

[1FinickyOne]

42 minutes ago, mommysboy said:

 

Only Sheryl can comment on the availability of said drugs, and, probably more importantly, Thailands policy on treating acne.  Since the drugs can have side effects, and acne sufferers are not suffering from a disease then some doctors may be reluctant to prescribe I suppose. 

 

However, the antibiotics in question will undoubtedly be available just about anywhere including the local pharmacy since they are used in a wide range of diseases and infections.

 

21 minutes ago, Sheryl said:

I doubt given how long she has had this, that they will try abx, I suspect they will go directly to accutane.

 

Any doctor can obtain the medication from the drug distributor, no need for it to be sent from another hospital, the question is whether a local doctor would (1) be willing/comfortable to oversee this sort of treatment which is usually given by dermatologists and (2) would be skilled at doing so. Medical care in Thailand is very specialized and unless there is an uncommonly bright GP with a lot of initiative in your area you are unlikely ti get very far in finding anyone willing to treat this. It will either be "mai dai" or she will be fobbed of with something ineffective,

 

As mentioned she can get the lab work (ALT/AST) done locally  as long as results are normal. So looking at as little as 2 dermatologist visits 4 months apart.

 

The whole thing can be done free under the government health system. If the provincial hospital does nto have a dermatologist she should ask for a letter of referral to one, probably they will refer her to the government hospital in Pitsanoluk which is a 900 bed regional facility. BUT going this route will involve more time, waits etc and likely more trips, first back and forth to the Tak hospital and then to the hospital she is referred to. I don't know what sort of work they do/hours they have, but care in govt hospitals is strictly Mon-Friday whereas private hospital specialists are available on Saturdays and Sundays, in case that matters.

 

If she is given isotretinoin , I can't stress enough that she must not become pregnant. She has to be sure she is on totally reliable birth control. She will be made to sign a consent form to this effect.

 

 

 

Again, thank you both and I will pursue the wise course of finding a competent dermatologist. I think the accutane is the obvious course for her as well. She quickly shook off the pregnancy question but I will tell her to insist on a test - why not?  

 

After that, really, it will be up to her and her husband to make the time. I can pay. I can drive them. But I can't go for them. I will gladly share with you any good news. 

[Sheryl]

Test us not the only issue it is making sure she foes not become pregnant any time thereafter while taking this mefication.

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[1FinickyOne]

28 minutes ago, Sheryl said:

Test us not the only issue it is making sure she foes not become pregnant any time thereafter while taking this mefication.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

ok - got it - will make double sure the doctor informs her... good reason to have the husband along too.