Tuesday, November 10, 2020

Skincare Update: Trying out Curology

Via Unsplash, where I think Curology has provided a lot of their own stock photography.

One random and somewhat unexpected consequence of life in the COVID-19 era is that my skin really doesn't seem to like my new working from home, never really going out lifestyle. My persistent adult acne - a decade-long issue for me, unfortunately - is noticeably worse than it generally was for the past year or two before March 2020. And it's almost certainly not because of wearing face masks whenever I leave my apartment, as most of the breakouts are on parts of my face that aren't covered by a mask. 

It's probably silly - and clearly premature - to write a blog post to announce I'm trying Curology when I only just received my prescription serum yesterday and haven't yet spent much time using it. (I always start slow with new products for my face, testing on my wrist on the first day; on a small spot on my face or neck the second day; and on a larger patch of my face the third day.*) But I've been around the block more than a few times - alas! - when it comes to seeking medical assistance for my acne. With all that experience, I'm comfortable with Curology's approach so far. 

Curology is, essentially, a dermatology telemedicine startup that prescribes custom compounded topical treatments with combinations of some of the active ingredients typically found in prescription skincare products. My prescription topical formula currently includes tretinoin, clindamycin, and azelaic acid. The first two active ingredients are ones I've used for years in other prescription products.  

I've been aware of Curology - originally called Pocketderm - for a while. It was popular with the skincare bloggers I was reading back in 2015. And over the years, a few different readers here have also commented with positive feedback. If I remember correctly, the fees have always been ~$20/month for acne treatment. I have this vague memory of their offering a higher price tier for anti-aging treatment at some point, but that's no longer the case. These days, the prescription formula is $19.95/month, plus tax and $4.95 shipping after an initial "free" month's trial, for which the new customer just pays shipping. Customers can also add Curology-branded cleanser, mosturizer, etc. for an extra fee. 

Until now, I've never been interested in trying Curology for myself because the numbers simply didn't work. Back when I first heard of them, my total co-pays for doctor's visits plus acne-fighting prescriptions always worked out significantly cheaper than the ~$20/month cost of Curology. Unfortunately that started to change for me by 2017 or so. I've always had fairly good insurance coverage, but the co-pays for the same dermatology prescriptions I've used - some on and off, some constantly - for over a decade have just kept climbing. From 2015 through late 2016, my Retin-A Micro 0.1% and Clindamycin topical refills still cost ~$10-$15/each, like when I first started using those products around 2005. From 2017 on, the co-pays grew to ~$40-$45/refill per product. Since 2019, it's more like ~$75/refill. Ouch! I believe my experience is consistent with larger industry trends for dermatology prescriptions. 

Anyway, I obviously can't yet make any pronouncements about how effective my Curology treatment is for my acne. But the advice they've given me so far - and the ingredients selected for my treatment - are consistent with what I've previously gotten from visiting dermatologists in person. 

Like my fancy dermatologist said in 2017, when one's acne is not well-controlled, it may be best to take a step back from acids, peels, exfoliation, and the like in order to let the prescription active ingredients do their work. That means sticking with a relatively basic, non-irritating cleanser, moisturizer, and sunscreen in the meantime. This is pretty much exactly what my Curology treatment plan says as well. While they offer their own branded cleanser and moisturizer - a free set of which can be included upon request with the "just-pay-shipping" trial - they don't seem too aggressive in pushing those. Their website also includes recommendations for other "no-frills" cleansers and moisturizers

The one caveat I notice upfront is that they include some before-and-after photos in their marketing where the customer's (patient's?) "before" photo shows a fairly severe acne outbreak that might be best served by a combination of prescription pills in addition to topicals. While I'm absolutely not a doctor or medical professional and cannot give medical advice, I've had multiple - alas! - rounds of personal experience with my acne getting to a miserable-looking state that took at least three months of prescription pills plus topicals from the doctor to really start turning around. I don't think Curology can offer quite that level of treatment plan. (I believe they sometimes issue prescriptions for certain pills, but I'm not sure they're able to do so for the full range of medications doctors have used with me in the past.) 

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With all my experience treating my persistent adult acne I can think of a few other contributing factors to my skin's current fussy condition. My skin's gotten progressively more sensitive and dry over time, and it no longer really tolerates Retin-A Micro 0.1%, even though I've been using it for well over a decade now. (My Curology formula has 0.04% tretinoin, a lower dose that may work better for me now.) I think the Cerave Foaming Cleanser I've been using since at least 2014 is also a bit too drying now, so I'm hopeful the Vanicream Gentle Facial Cleanser I switched to recently will suit me better. Since dryness is an issue, it'd probably also be helpful to get a humidifier. 

And I have to admit I've personally found diet to be a factor with my acne, albeit not a dispositive one. It definitely wouldn't cure my acne, but if I was more serious about treating it quickly, I'd probably also work on my dietary composition, particularly to limit dairy. (I have milk daily with coffee, enjoy yogurt, cheese, and ice cream, etc. etc.) From having eliminated dairy from my diet a few times in the past for up to four weeks at a time, that specific lifestyle change generally correlates with noticeable improvement to my acne, though it was't a cure any of those times. I'm less sure about whether other diet changes would actually have much direct effect on my skin. 

*To tell the truth, this testing process is probably only useful for catching a product that causes an immediate allergy-like reaction, which I've never actually had with any skincare product. Instead, with the more typical bad reaction I get - where a new product seems to cause breakouts - it tends to take much longer than three or four days to set in. But a bad allergy-like reaction all over the face would be pretty miserable, so I think it's worth taking the time to test new products a bit before jumping in fully! 

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