Hi,
I am an 18yr old female and I have had a very serious cystic acne problem on my forehead since the age of 10. It has caused scarring on this skin and much discomfort, embarresment and pain to myself. Since I am now entering adulthood I would like to fix this problem, to help my confidence as I still get huge very ugly, painful cystic bumps on my face. Sometimes I cry when I look in the mirror :( Unfortunatley I have not visited a dermatologist because I do not have health insurance or much money and I am independent of my parents. I'm not sure where to start, or how much money it will cost, or if there is any way to reduce the cost of visiting the dermatologist. I live in NYC.

You can call a few dermatologists' offices, say that you're interested in a consultation but haven't got insurance, and ask how much that will cost. Usually, secretaries will be sympathetic and will happily let you know the rate ahead of time. Additionally, you should ask if there is a discount for paying in cash or by check - very often, doctors will charge uninsured patients less than those with insurance, because insurance companies have private deals with the doctors that mean that they already pay less than the normal rate, and because they have nothing to lose by charging insurance companies more for certain work, but they might lose you as a customer if they try to charge YOU too much. (For example, if a doctor is in the Blue Cross Blue Shield network, then even though her normal rate might be $200 an hour, the insurance company might only compensate $170 an hour for normal work. In exchange, more Blue Cross Blue Shield plan members might use that particular doctor. Often, doctors will be willing to give you that same lower rate if you ask, so that you'll only have to pay $170, because the whole reason they charge so much is to try to get that basic amount out of the insurance companies.)

If you find a dermatologist whose price is right, then go right in. You should be unashamed to tell the doctor that you don't have insurance, so you are hoping for a treatment that requires a minimum number of visits or a minimum cost to fix. I think it probably would make sense to try to budget at least a follow-up doctor visit, as well as the cost of some kind of medication, but beyond that, you should be clear with the doctor that you are on a budget.

In NYC, sometimes your best bet cost-wise will be quite far across town. If things are too expensive near where you live, try calling a dermatologist in another borough. You can also try medical practices that are associated with various hospitals in town.

Good luck!

There's scar ointments (main ingredient is onion extract) that softens scars at the drugstores. Exfoliate weekly, then apply it. Try a glycolic acid exfoliation product.

ask your parents or take a loan

I'm really sorry, I know exactly what your situation is like.

CONTACT, your state-senator and your US congressman. You can be vague about what the medical condition is, but ask them where to turn. They should have a website that you can just write an e-mail to, they are usually pretty good about providing resources for stuff like that (especially US congressman). And at the least, you will be encouraging them to push healthcare reform.

And I know that you have probably tried countless things to fix your skin, and you will probably only get decent results with a prescription. I eventually went to college, where there was a medical center--but until then, I think hormonally something changed (almost right after I turned 19)....but, what really helped was washing with a salicylic acid wash (the best is the Biore blemish fighting ice cleanser, second best is the Clean and clear advantage salicylic wash), then washing with a benzoyl-peroxide wash (I used Oxy wash, the SA makes the skin easier for the BP to cleanse). Then, I would either use a loreal SA acid peel, or the biore triple action astringent. That, plus drinking a lot of water got helped to get rid of a lot of the gross stuff w/in the cysts...it did leave giant red spots, and for those spots (hyperpigmentation) and scars, facial peels if done correctly are very affective. But, I really think alpha-hydroxy acid creams do wonders (Walgreens has a really cheap one that was like $9 and is great, it is just their brand and called "Alpha Hyrdroxy Face Cream"). After a few nights of using that after your facial treatment, your pores will look smaller and your hyperpigmentation and scarring will look better.

Good luck! And just know, it looks ten times worse to you, than it does to everyone else.

I"m a dermatologist, and you should read (and follow) the advice that SK has written above. She is right-on. In our office, if someone is a private pay, we will give them a price break,and allow for some payment schedule that will fit into their budget. Plus we will try, if possible, to get the meds for free for the patient from the drug company. Despite what the public perceives, our goal is to treat disorders, and not get rich. If money were our goal, we'd have become CEO's of some big corporation or stock company.
The one unfortunate fact for you is that the cost of seeing any doctor in the NY area is much higher than elsewhere in the US. I do have some very good, compassionate dermatology friends in the NY area, if you'd like to write me for their names.