Can skin really be assessed from photographs?
Yes — it is one of the things remote care does best, provided the photographs are good. Daylight, no flash, no filters, one wide shot and one close-up.
The exception is moles, and that exception is absolute.
Why will you not look at my mole?
Because assessing a mole properly needs dermoscopy and someone examining the skin in person, and the cost of getting it wrong is not one worth taking.
Anything new, changing, growing, itching, bleeding, or with an irregular border or uneven colour needs seeing. We will refer rather than reassure from an image — and a reassuring photograph is worth nothing if it is wrong.
Am I using enough cream?
Almost certainly not — it is the single commonest reason eczema treatment fails. An adult with widespread eczema needs around 500g of emollient a week. If a tube is lasting a month, that is a fraction of what is needed.
Are steroid creams safe?
Used correctly, yes — and fear of them causes more harm than the steroids do.
Undertreatment is far commoner than overtreatment. A short burst of an adequate steroid is safer and more effective than weeks of a weak one used timidly, which is why the plan specifies where, how strong and for how long.
How long before acne treatment works?
Twelve weeks — not four. And with retinoids it commonly gets worse for the first four to six weeks before improving.
That initial flare is the point at which most people stop, and it is precisely the point worth pushing through.
My facial redness has been treated as acne for years.
Worth revisiting — rosacea is routinely mistaken for acne or for sensitive skin, and getting it wrong costs years.
Rosacea: background redness, flushing, visible small blood vessels, stinging — and no blackheads. If you have been given a steroid cream for facial redness, say so: steroids improve rosacea briefly and then make it considerably worse.
Is my hair loss definitely genetic?
Not necessarily, and that is exactly why we test first. Iron deficiency, thyroid disease, PCOS and shedding after illness or childbirth all cause hair loss, all are treatable, and none respond to minoxidil.
And "your bloods were normal" is often not the whole answer — hair is affected at ferritin levels well above the anaemia threshold.
Can you prescribe Roaccutane?
No — and nor can any remote service. Isotretinoin requires dermatology supervision, blood monitoring, pregnancy prevention and mental health review.
We can refer, and NHS dermatology referral is free.
Does diet cause acne or eczema?
Far less than the internet suggests. There is modest evidence for high glycaemic index diets in acne and weak evidence around dairy; food allergy drives a minority of infant eczema and almost no adult eczema.
Do not restrict a child's diet without allergy assessment — it causes nutritional harm and can paradoxically cause genuine allergy to develop.
Can you see my child?
From three months, with a parent present. Skin problems in children assess well remotely.
But any unwell or feverish infant under one needs in-person assessment the same day, and infected eczema in a small child needs seeing rather than photographing.