Acne Consultation

Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.

Yes

No

What is your biological gender?
Please select your option

Male

Female

Transmale (Born a female)

Transfemale (Born a male)

Do you have a history of using Dalacin-T-Lotion to treat acne?
If so, how effective was it?
If not, have you tried any other acne treatments? Were they able to succeed?

Yes

No

Differin has the potential to harm an unborn child. Are you aware that women who are fertile and sexually active must use effective contraception to avoid pregnancy when using Differin?

Yes

No

Do you have a history of using Zineryt to treat acne?
If so, how effective was it?
If not, have you tried any other acne treatments? Were they able to succeed?

Yes

No

Do you have a history of using Differin to treat acne?
If so, how effective was it?
If not, have you tried any other acne treatments? Were they able to succeed?

Yes

No

Do you have a history of using Duac gel to treat acne?
If so, how effective was it?
If not, have you tried any other acne treatments? Were they able to succeed?

Yes

No

Do you have a history of using Zindaclin Gel to treat acne?
If so, how effective was it?
If not, have you tried any other acne treatments? Were they able to succeed?

Yes

No

Do you have a history of using Epiduo to treat acne?
If so, how effective was it?
If not, have you tried any other acne treatments? Were they able to succeed?

Yes

No

Can you relate to any of the following statements?
You have or have had stomach or duodenal ulcers, as well as stomach or intestinal bleeding in the past.
Your doctor has ever told you that your kidney function is less than 100 percent.
You have previously suffered a terrible reaction to aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).
You want to use Ibuprofen Gel on skin that is fractured, injured, diseased, or infected.

Yes

No

Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.

Yes

No

Did you know that:
A healthcare practitioner should assess any acute injuries.
You should see your doctor about chronic pain at least once a year.

Yes

No

If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option

Presently Pregnant

Presently Breastfeeding

Planning on getting pregnant

Neither Pregnant nor Breastfeeding

Are you on any of the following medication?
Antibiotics.
Antihistamines such as stemizole or terfenadine.
Cisapride for stomach discomfort.
Quinidine for circulatory problems.
Pimozide for schizophrenia.

Yes

No

What's your gender?

Male

Female

Transmale (Born a female)

Transfemale (Born a male)

Are you on any of the following medication:

Antibiotics such as erythromycin, clarithromycin, and other macrolide antibiotics.

Dapsone.

Sulfacetamide.

Yes

No

Does any of these describe you?
You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function

Yes

No

Treclin has the potential to harm an unborn child. Do you realise that while using Treclin, women of childbearing age who are sexually active must use appropriate contraception to avoid pregnancy?

Yes

No

Do you have a history of using Teclin Gel to treat acne?
If so, how effective was it?
If not, have you tried any other acne treatments? Were they able to succeed?

Yes

No

Do you have a history of using Tetralysal to treat acne?
If so, how effective was it?
If not, have you tried any other acne treatments? Were they able to succeed?

Yes

No

Are you aware of the fact that that minocycline is no longer advised for the treatment of acne since newer antibiotics, such as Tetralysal, are thought to be just as effective but have fewer adverse effects?

Yes

No

Are you aware of the fact that every six months, you must take a one-month break from these types of medicines to check that you still require it?

Notably, You should use a topical acne medication to control your symptoms throughout this period.

Yes

No

Are you experiencing any of the following problems?

Anaemia.

Deficiency in glucose-6-phosphate dehydrogenase.

Methaemoglobinaemia.

Atopic dermatitis - a type of dermatitis that affects the skin.

Yes

No

Can you relate to the following statements?
Naproxen causes an allergic reaction or hypersensitivity in you.
You've previously used Naproxen and experienced major adverse effects.
You have a stomach ulcer, perforation, or bleeding now or in the past.
You're having trouble breathing.
You have serious renal, liver, or cardiac problems.

Yes

No

Do you have a history of using a topical acne cream, gel, or ointment to treat your acne?
Panoxyl, Skinoren, Differin, Isotrex, Epiduo, Dalacin, and Duac are just a few of the topical acne treatments available.

Yes

No

Are you aware that:
You should use the smallest dose of HRT possible for the shortest duration possible.
If your doctor has instructed you to discontinue using HRT, you should stop immediately.
You should check your breasts for lumps on a regular basis. Instructions can be found here.

Yes

No

Are on any of the following medication?
Simvastatin or lovastatin are two types of statins.
Tolterodine.
Mizolastine.
Amisulpride.
Astemizole.
Terfenadine.
Domperidone.
Cisapride
Primozide.
Erogtamine and dihydroergotamine are two types of ergotamine.

Warfarin.

Yes

No

Are you aware of the following?
It has been proven that taking more than the suggested amount of a hair loss therapy does not boost its effectiveness.
If your spouse is pregnant or could become pregnant, you should use a condom during any sexual activity and don't let them handle hair loss therapy.
If you need a PSA blood test, notify your doctor that you are taking hair loss treatment because it may impact the findings.
If you have any unusual side effects while taking finasteride or dutasteride, you should consult your doctor. These include breast tissue changes such as lumps, larger breasts, discomfort or nipple discharge, a decreased libido, erectile dysfunction, and ejaculation disorders, as well as a decreased libido, erectile dysfunction, and ejaculation disorders.

Yes

No

Are you aware that Minocycline should be taken on an empty stomach, either one hour before or two hours after eating?

Yes

No

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