Why Your Derm Office Doesn’t Know Anything About Skincare

Most dermatologists prescribe medications—but skip skincare education entirely. Here’s why that gap exists (and what actually works instead).

(I said what I said.)

Maybe you’ve been there. You see your Dermatologist or Derm PA for your acne, hyperpigmentation, or whatever skin concern brought you in. They prescribe a couple of topicals, great! You’re ready to start your journey to clearer skin.

Then you ask: “What cleanser and moisturizer should I use?”

“Oh, anything is fine.”

…Excuse me? You’re a skin expert. You’re supposed to have the best recommendations. You’re supposed to walk me out with a full morning-and-night routine, right?

Sadly, that’s not the standard , and I’m here to explain why, and what actually works instead.

Here’s something most patients don’t realize: there is very little skincare education in dermatology training. The focus is on the science of skin disease (aka diagnosis, pathology, prescribing). If you find a provider who breaks down your full routine all the way to the exact sunscreen for your skin type, you’ve hit the jackpot. That provider has gone out of their way to invest in the research themselves.

The reality of a typical derm visit? 10 to 15 minutes. In that window, your provider has to:

∙ Complete a full skin check

∙ Address your concerns

∙ Write prescriptions

∙ Fit in whatever education they have time for

This is the medical model most of us are stuck in, driven by insurance reimbursements and systemic limitations. It’s not the provider’s fault, but it is a serious problem.

And to be clear: the prescriptions really are doing the heavy lifting. If you’re coming in for acne, your retinoid is the MVP of your routine. But that doesn’t mean the rest of your routine is irrelevant, or that you can grab just anything off the shelf and expect it to work alongside a powerful active ingredient.

I want to contrast that very common experience with what we do differently, and I’ll be honest, I’m lucky. The Dermatologist I work with, Dr. Leslie Baumann, is exceptional. She founded the first Cosmetic Dermatology department at a university and wrote the very first textbook on Cosmetic Dermatology and Cosmeceuticals. Starting my career in that environment shaped everything about how I practice. All of that information (your skin type, your camera results, etc.), lands in my hands before I even walk into the room.

When I do come in, I combine that data with a close-up skin evaluation and something most providers skip entirely: I go through every product you’re currently using. How does your cleanser feel? Does your moisturizer make you oily or dry? Is anything causing irritation, breakouts, tingling?

I ask patients to bring in every single product they own. I want to read the ingredients. I want to feel the texture. I want to understand exactly what your skin has been dealing with.

And whenever I can, I try to keep some of your existing products in your routine, because I know the cost of skincare adds up, and I’m not in the business of telling you to throw everything out. You already know I believe a simple routine done consistently beats an elaborate one every time, and one of the perks of that is keeping it within your budget!

Here’s where the stakes get high.

The medications we prescribe (retinoids, exfoliants, acne treatments) are powerful. And that power comes with irritant potential. Without proper education and the right supporting routine, adverse reactions aren’t just possible, they’re common.

How many of you have started an acne treatment only to have your skin get worse and not know if that was normal? Is this purging or does my skin just not tolerate this product? Or maybe you ended up with a rash or dermatitis and quit altogether?

I hear this constantly. When a patient tells me they “failed” a treatment before, my first questions are:

∙ How were you using it?

∙ What education were you given?

∙ What else were you using alongside it?

Nine times out of ten, the medication wasn’t the problem, the context around it was. And if we try that same medication again, I am very explicit: here’s how to use it, here’s what to use with it, here’s what’s normal, here’s what’s not.

I’m also thinking ahead. If I know a product or ingredient is going to change how your skin behaves, I’m warning you before it happens, trying to answer the questions you’ll have over the next four weeks before you’ve even had them.

One more thing traditional derm gets wrong: the timeline.

“Here’s your acne medication, see you in four months” is not a treatment plan. In my clinic, I see patients every four weeks until we’re in a good groove.

At that first four-week visit? I’m upfront: “You probably won’t see changes yet. Your acne might actually be worse.” I call this our cheerleading visit. I want to look at your skin under the camera, check your bacteria levels, assess up close, because a lot of the progress happening at this stage is invisible to the naked eye, and I want you to stay the course.

Here are some common situations I see again and again:

Patient using a strong retinoid like adapalene, and pairing it with a salicylic acid toner, an acne moisturizer, and an exfoliating cleanser. That’s four active ingredients hitting compromised skin at once. No wonder it fell apart.

Patient using exfoliating peel pads for texture, plus a serum and cleanser that also has similar ingredients. Three exfoliants in one routine. The barrier never stood a chance.

In both cases, the solution wasn’t a different prescription. It was education, simplification, and a routine built around what the skin actually needed, not just what sounded good on a label.

This is exactly what I cover in depth for paid subscribers, direct Q&As, ingredient deep dives, routine building by skin type, and exactly what to use (and avoid) when you’re using strong actives. If you’re not already a paid subscriber, this is your sign. 👇