When Should You See a Dermatologist Instead of Trying Another Skincare Product?

You should see a dermatologist instead of trying another skincare product when a skin problem has lasted more than two to four weeks despite gentle care, is painful, scarring, bleeding or spreading, keeps coming back, disturbs your sleep, or appears suddenly, such as patchy hair loss or a changing mole. These are signs of a medical skin condition that needs a diagnosis, not a new serum. Continuing to self-treat can delay the right treatment and, with unverified creams, add new harm.

What is the “skincare treadmill”?

The skincare treadmill is a familiar cycle. A rash, breakout or patch of pigmentation appears. You try a product recommended online or by a friend. It seems to help for a week or two, then the problem returns, so you try the next one, and then the next.

Along the way:

• the underlying condition is never named, so it is never properly treated;
• layering several active ingredients can irritate the skin and make it more reactive;
• money and months are spent while the problem slowly worsens;
• some products bought from unverified sellers may contain ingredients you would never knowingly apply.

Good skincare supports healthy skin. It cannot diagnose or treat a skin disease.

What are the signs that a skin problem is medical, not cosmetic?

The American Academy of Dermatology advises seeing a dermatologist about any new spot, a spot that looks different from others, or one that is changing, itching or bleeding. It also lists a new or changing dark streak in a nail among nail changes a dermatologist should examine. For acne, the NHS advises seeing a doctor for moderate or severe acne or for nodules and cysts, because they need proper treatment to avoid scarring.

Bila perlu jumpa pakar kulit?

Jika masalah kulit tidak pulih selepas dua hingga empat minggu, terasa sakit, meninggalkan parut, berdarah, merebak, berulang, atau mengganggu tidur, sudah tiba masanya untuk berjumpa doktor atau pakar kulit. Elakkan mencuba krim tanpa label atau yang dijual tanpa maklumat notifikasi yang jelas.

Why are unverified online creams a risk in Malaysia?

Creams sold online, at markets or through social media can look professional and still be unsafe. The Ministry of Health Malaysia (KKM), through the National Pharmaceutical Regulatory Agency (NPRA), regularly issues warnings about cosmetic products found to contain scheduled poisons, and cancels their notifications so they can no longer be sold in Malaysia.

NPRA’s published list of cancelled cosmetic notifications includes products found to contain:

• mercury and lead;
• skin-lightening and retinoid medicines that are not permitted in cosmetics;
• corticosteroids (steroids);
• antibiotics, antifungals and antihistamines.

NPRA warns that using cosmetics adulterated with these chemicals can cause serious adverse effects.

What does mercury do to the body?

According to a KKM media statement, mercury is banned in cosmetic products because it can be absorbed into the body and damage the kidneys and nervous system. It can also interfere with brain development in young children and unborn babies, and can cause rashes, irritation and other changes to the skin. This is particularly important for anyone who is pregnant, planning a pregnancy or applying products to a child.

What should you do?

The same KKM statement advises the public to:

• stop using an affected product immediately;
• seek advice from a healthcare professional if you notice any discomfort or side effects;
• check a cosmetic product’s notification status on the NPRA website or through the NPRA Product Status app.

Selling and distributing such products breaches the Control of Drugs and Cosmetics Regulations 1984. If you are unsure about a product you have been using, keep the container and bring it to your appointment.

Why can hidden steroids in creams be harmful?

Steroid creams are not the problem in themselves. DermNet notes that side effects are uncommon when topical steroids are used appropriately under medical supervision. The danger comes from strong steroids used every day for months, on thin skin, or without the user knowing they are there.

DermNet lists local side effects that include:

• thinning of the skin, easy bruising and tearing;
• stretch marks, particularly in the armpits and groin;
• visible small blood vessels;
• steroid rosacea and a rash around the mouth and eyes, which can also occur in children;
• causing, worsening or disguising skin infections such as impetigo, fungal infection, cold sores and molluscum.

Absorption, and therefore risk, is greatest on the thin skin of the eyelids, genitals and skin creases. A cream that makes the skin look clearer at first, then leaves it worse each time you stop, deserves a medical review. If you suspect a product contains a hidden steroid, stop using it and see a doctor soon: skin that has been exposed to strong steroids for a long time can flare when they are withdrawn and may need supervised treatment.

What does delaying a visit to a dermatologist cost?

Waiting a few days for a minor rash to settle is sensible. Waiting months while trying product after product can cost more than money:

• Scarring. Deep acne and hidradenitis suppurativa can leave permanent scars when treatment is delayed.
• Pigmentation. On brown skin, prolonged inflammation often leaves dark marks that take months to fade.
• Spreading infection. Fungal and bacterial infections can spread, and inappropriate creams can make them harder to recognise. See skin infections.
• Missed diagnoses. A changing mole or nail streak is far easier to deal with when assessed early.
• Quality of life. Poor sleep from itch affects work, school, mood and family life, particularly with eczema and children’s skin conditions.

What can a dermatologist offer that skincare products cannot?

• A diagnosis. Naming the condition is the first step to treating it properly. Eczema and psoriasis, for example, can look similar but need different plans.
• Prescription treatments. Depending on the condition, these may include prescription creams, oral antibiotics, retinoids, hormonal treatments, immune-modulating medicines, phototherapy or biologic medicines, chosen and monitored for your situation.
• Patch testing. For people who react to products, patch testing can identify specific allergens, so you can read labels with confidence. Read more about skin allergies.
• Skin scrapings, swabs and biopsy. Simple tests confirm fungal or bacterial infection, and a small biopsy under local anaesthetic can confirm diagnoses that cannot be made by eye.
• A long-term plan. For chronic conditions, that includes what to do during flares and how to keep the skin well between them.
• Practical advice about skincare. A dermatologist can help you simplify your routine and choose gentle products suited to your skin and your condition.

For guidance on preparing for the visit, see Dr Kartini’s Guide to Finding the Right Dermatologist for Your Skin Condition.

Is it time to see a dermatologist? A simple self-check

Answer yes or no to each question:

1. Has this problem lasted more than two to four weeks despite gentle care?
2. Is it painful, deep, or leaving marks or scars?
3. Is a mole or spot new, changing, itching or bleeding, or is there a new dark line in a nail?
4. Is your hair falling out suddenly or in patches?
5. Does the itch wake you at night?
6. Does it keep coming back, or spread, after treatment?
7. Did it start or worsen after using a new product?
8. Are you using a cream with no label, no ingredient list or unclear notification details?
9. Is it affecting a baby or child?
10. Is it affecting your confidence, mood, work or school?

If you answered yes to any of these, it is reasonable to seek a medical opinion. If you have blistering, peeling skin, sores in the mouth or eyes, swelling of the lips or tongue, difficulty breathing, or a rash with fever and feeling very unwell, go to the nearest emergency department.

Seeing Dr Kartini

Dr Kartini Farah Rahim is a Consultant Dermatologist in Shah Alam whose clinical focus includes acne, eczema, psoriasis, skin infections, allergic skin reactions and blistering disorders, as well as the care of women and children. She practises at Avisena Specialist Hospital and Avisena Women’s & Children’s Specialist Hospital, and consults in English and Bahasa Malaysia.

At a consultation, she takes a detailed history of your skin problem and everything you have tried, examines your skin, explains the likely diagnosis, arranges tests where needed, and agrees a treatment plan with you. It helps to bring the products you have been using, including any creams bought online. Read about Dr Kartini, see the FAQ, or make an appointment.