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*Treatment results may vary
Comprehensive Review of my Consultation for Acne Tretatment at Bobby Buka
- Appointment was made easily (plus)
- insurance did not cover this treatment, which I found out 20 minutes before my appointment was to start. Wtf. Still decided to keep the appointment, and pay out of pocket. Rushed to make this appointment.
- I was not informed beforehand that I would be seeing a PA. I have a Curology subscription for the past 4 years so I’ve talked to lots of PAs, I’ve already done that and it’s not working. That’s why I’m here to see a real dermatologist.
- I insisted on seeing an MD. There was no MD at that location, and I had to make the trip to their office at 220 Front St. That’s a 30min train ride from Brooklyn to Manhattan.
- I met with Dr. Dina Began. Finally, an MD. I understand wanting to look at things with a beginner’s mindset, but when a patient is telling you they’ve had acne for 18 years, and they’ve tried everything except Accutane, you might wanna take them seriously??? I’m not an idiot. I have a PhD in molecular biology, I’m the person who researches this stuff that pharma companies then produce and doctors prescribe. I have diligently studied the primary literature and I’m current with it.
- Did not clarify treatment expectations and goals with me.
- She asked me about spironolactone and doxycycline use. I was just on a doxycycline course for a week. In her opinion, doxycycline takes a month to work. I have not read this anywhere. She wanted to put me on doxycycline for a month!
I’ve been on 100mg, 2x a day, 7 days; and no improvement. Spironolactone 50mg daily and it’s been 4 months now. Again, no improvement. Which again was in my history.
- She asked me about PCOS, depression, etc. She didn’t read my file, because she would see it all in the notes that I’m being treated for depression. I don’t have a PCOS diagnosis.
- My BMI and Hb1Ac is normal, I weigh 120lbs and I’m 5’4”. Again in my file, and didn’t use HIPAA to pull my records, otherwise we would have seen that number.
- I have eliminated dairy, eggs, soy, meat because of increased breakouts. I limit my carbohydrate and simple sugar intake to no more than 50g.
- Wanted to put me on Bactrim, which is a hard NO when on spironolactone because they both increase blood potassium levels. That’s dangerous.
- Kept prescribing me things but did not narrow down the underlying reasons behind my hormonal acne. Obviously something’s not going right. The suggested treatments would not get to the root of the problem, so the acne is just going to keep on happening. What is the point fixing a leak in the system when you don’t know where it’s leaking?
- Recommended Epiduo Forte, which is a problem for me as it increases scaliness and dryness, and it’s the wintertime, so more broken skin. It’s bad enough with 2.5% benzoyl peroxide and 0.012% tretinoin individually, how much worse is it going to get with a combination of the two??? (Adapalene is a third generation derivative of tretinoin). That increases the risk of secondary infection, and more acne.
- Gave me a pamphlet on Epiduo Forte. Pretty pictures from 3 people, but no statistics! C’mon Galderma (manufacturer of Epiduo Forte), you have to do a better job. I cracked open Pubmed, started looking for primary literature on Epiduo Forte. Dryness, itching, scaling reported in over a third of the population. Confirmed what I already knew would happen, because this happens to me all the time when I use a harsh treatment. Can’t get rid of the flakiness by moisturizing, can’t wear foundation over it either.
- Just said it was different from Differin, but didn’t say how. Why would I want to spend $500 on Epiduo Forte if I can buy Differin for $15-25? It has the same ingredients as Epiduo Forte. She gave me a tiny sample of it to see if it is being tolerated.
- asked her for fourth-generation retinoids, such as Seleinoid G. They’ve been around since 2005. Clinical trial data shows faster treatment, plus significant advantages over Adapalene for the same concerns I listed above. She didn’t say anything about that.
- suggested Altreno but no samples to try for the next two weeks or more till the medical rep visits because they were all out of samples. She said it had alitretinoin, but it doesn’t. It has tretinoin, again, at 0.05%. If I couldn’t handle tretinoin at 0.012%, how can I do so at 0.05%?
I was happy to see an MD after all the running around from Williamsburg, but she was dismissive of my experience with acne over 18 years with my own face and the products I had tried. She was insensitive about my depression, and I felt that she couldn’t understand where I was coming from. That was triggering, and I just broke down into tears in her office. She had barely inspected my face, and didn’t take any pictures. I had to ask her repeatedly if she was going to come back and take a look at certain areas. At the end of my appointment, she said “well, we have other patients to treat” . And walked out. No formal diagnosis in hand. A day and 250 dollars wasted. My acne is old enough to vote, and at this rate it’s going to be old enough to drink.
- insurance did not cover this treatment, which I found out 20 minutes before my appointment was to start. Wtf. Still decided to keep the appointment, and pay out of pocket. Rushed to make this appointment.
- I was not informed beforehand that I would be seeing a PA. I have a Curology subscription for the past 4 years so I’ve talked to lots of PAs, I’ve already done that and it’s not working. That’s why I’m here to see a real dermatologist.
- I insisted on seeing an MD. There was no MD at that location, and I had to make the trip to their office at 220 Front St. That’s a 30min train ride from Brooklyn to Manhattan.
- I met with Dr. Dina Began. Finally, an MD. I understand wanting to look at things with a beginner’s mindset, but when a patient is telling you they’ve had acne for 18 years, and they’ve tried everything except Accutane, you might wanna take them seriously??? I’m not an idiot. I have a PhD in molecular biology, I’m the person who researches this stuff that pharma companies then produce and doctors prescribe. I have diligently studied the primary literature and I’m current with it.
- Did not clarify treatment expectations and goals with me.
- She asked me about spironolactone and doxycycline use. I was just on a doxycycline course for a week. In her opinion, doxycycline takes a month to work. I have not read this anywhere. She wanted to put me on doxycycline for a month!
I’ve been on 100mg, 2x a day, 7 days; and no improvement. Spironolactone 50mg daily and it’s been 4 months now. Again, no improvement. Which again was in my history.
- She asked me about PCOS, depression, etc. She didn’t read my file, because she would see it all in the notes that I’m being treated for depression. I don’t have a PCOS diagnosis.
- My BMI and Hb1Ac is normal, I weigh 120lbs and I’m 5’4”. Again in my file, and didn’t use HIPAA to pull my records, otherwise we would have seen that number.
- I have eliminated dairy, eggs, soy, meat because of increased breakouts. I limit my carbohydrate and simple sugar intake to no more than 50g.
- Wanted to put me on Bactrim, which is a hard NO when on spironolactone because they both increase blood potassium levels. That’s dangerous.
- Kept prescribing me things but did not narrow down the underlying reasons behind my hormonal acne. Obviously something’s not going right. The suggested treatments would not get to the root of the problem, so the acne is just going to keep on happening. What is the point fixing a leak in the system when you don’t know where it’s leaking?
- Recommended Epiduo Forte, which is a problem for me as it increases scaliness and dryness, and it’s the wintertime, so more broken skin. It’s bad enough with 2.5% benzoyl peroxide and 0.012% tretinoin individually, how much worse is it going to get with a combination of the two??? (Adapalene is a third generation derivative of tretinoin). That increases the risk of secondary infection, and more acne.
- Gave me a pamphlet on Epiduo Forte. Pretty pictures from 3 people, but no statistics! C’mon Galderma (manufacturer of Epiduo Forte), you have to do a better job. I cracked open Pubmed, started looking for primary literature on Epiduo Forte. Dryness, itching, scaling reported in over a third of the population. Confirmed what I already knew would happen, because this happens to me all the time when I use a harsh treatment. Can’t get rid of the flakiness by moisturizing, can’t wear foundation over it either.
- Just said it was different from Differin, but didn’t say how. Why would I want to spend $500 on Epiduo Forte if I can buy Differin for $15-25? It has the same ingredients as Epiduo Forte. She gave me a tiny sample of it to see if it is being tolerated.
- asked her for fourth-generation retinoids, such as Seleinoid G. They’ve been around since 2005. Clinical trial data shows faster treatment, plus significant advantages over Adapalene for the same concerns I listed above. She didn’t say anything about that.
- suggested Altreno but no samples to try for the next two weeks or more till the medical rep visits because they were all out of samples. She said it had alitretinoin, but it doesn’t. It has tretinoin, again, at 0.05%. If I couldn’t handle tretinoin at 0.012%, how can I do so at 0.05%?
I was happy to see an MD after all the running around from Williamsburg, but she was dismissive of my experience with acne over 18 years with my own face and the products I had tried. She was insensitive about my depression, and I felt that she couldn’t understand where I was coming from. That was triggering, and I just broke down into tears in her office. She had barely inspected my face, and didn’t take any pictures. I had to ask her repeatedly if she was going to come back and take a look at certain areas. At the end of my appointment, she said “well, we have other patients to treat” . And walked out. No formal diagnosis in hand. A day and 250 dollars wasted. My acne is old enough to vote, and at this rate it’s going to be old enough to drink.
Provider Review
