Sesame / Skincare Rx

What it is

A monthly subscription to a prescribing relationship, at $59 a month. It buys an initial video consultation with a provider selected by the patient from a named list, unlimited messaging, and follow-up visits as needed. If medication is appropriate, the provider sends a prescription to the patient's own pharmacy. The medication is not included in the subscription and is paid for separately.

The bottle problem solves itself

This register exists because of a sentence we have written twenty-six times in various forms: the concentration is not on the page you buy from. Musely files it in a help centre. Curology and Ro decline on the grounds that the formula is personalised. Dermatica prints it beautifully and then omits it entirely on its newest page. Obagi prints it and omits the fact that the drug is unapproved.

Sesame never encounters the problem, because Sesame does not make anything. The prescription goes to a pharmacy and what comes back is a manufactured, approved product in its own packaging — a concentration on the tube, a fill weight, a lot number, an expiry date, a manufacturer, a patient information leaflet, and a pharmacist legally obliged to counsel you.

The page also names the drugs, against their brands: tretinoin for Retin-A, azelaic acid for Azelex, spironolactone for Aldactone, minoxidil for Rogaine, finasteride for Propecia, triamcinolone for Kenalog, hydrocortisone for Cortef. That is a company telling you in advance roughly what its clinicians prescribe — the opposite of a proprietary blend.

You pick a person, and you see their face

Every other service in this register runs the same intake: a questionnaire, some selfies, and an assessment by 'our dermatology team' or 'a US-licensed provider'. Honeydew is explicit that in many cases treatment can begin without a video consult at all.

Sesame's second step is a face-to-face video call with a specific clinician you selected by name from a list showing their credentials. That is a materially different transaction, and for a service that will prescribe oral corticosteroids, an anti-androgen and possibly isotretinoin, it is the appropriate one.

This needs stating carefully in both directions. Nurse practitioners and physician assistants prescribe dermatology medicines competently every day, in person and remotely, and the drugs on this list are squarely within their scope. Sesame is also scrupulous in its wording: it says 'dermatology subscription', 'dermatology care', 'top-rated provider', 'healthcare provider'. It never says dermatologist about its own clinicians, and the two occurrences of that word on the page both refer to somebody else's practice.

Equally, the page carries a patient testimonial about being unable to find a dermatologist for two months, immediately above copy promising high-quality dermatology care. A reader can be forgiven for joining those up. One line naming the provider mix would close the gap and cost nothing, because the honest answer — experienced advanced-practice clinicians and physicians, available today — is a good one.

It admits the model has limits

Buried in the safety accordion is a paragraph no other service in this register has written:

While many conditions can be effectively managed via telemedicine, severe or complex cases may require in-person evaluation. Your initial consultation will determine if the program suits your specific needs. Providers on Sesame cannot prescribe controlled substances online.

Sesame, Skincare Rx safety information

Twenty-six products have told us what they can do. This is the first to state what its own delivery model cannot, and to say that the first consultation may conclude the answer is no. The isotretinoin answer is in the same spirit: it does not merely say yes, it says that mandatory ongoing monitoring and frequent pregnancy testing come with it, that the drug causes fetal harm, and that it cannot be prescribed to anyone pregnant, breastfeeding or who may soon become pregnant.

The one gap there is a name. Everything described is the iPLEDGE risk evaluation and mitigation strategy, and the page never calls it that. Honeydew explains the programme in full, including the monthly windows and the two-form contraception requirement. Sesame describes the burden accurately and leaves the reader unable to look it up.

The price you can see, and the one you cannot

$59 a month is stated clearly, and what it includes is itemised: the initial video consultation, a treatment plan, unlimited messaging, and follow-up visits. What it excludes is stated too, twice, in the same words both times — 'Medication cost not included in the program cost.'

That disclosure is good. What follows it is not. No figure is given for any medication, not a range, not a typical month, not an example. The only quantification anywhere is a prescription savings card said to save 'up to 80%' — a percentage off an unstated baseline, which cannot be combined with insurance.

The mitigation is real and it is structural again: the drugs named are generic tretinoin, azelaic acid, spironolactone, minoxidil and finasteride, all of which cost very little and all of which can be priced at any pharmacy in about a minute. A reader can find out. They simply cannot find out here, on a page whose own headline is 'Personalized for you. Priced for everyone.'

The other absence is more surprising. Sunscreen and SPF appear zero times. This is a service that prescribes retinoids, treats melasma and lists rosacea among its conditions, and daily photoprotection is load-bearing for all three. It is the fifth consecutive review in which we have had to write that sentence.

If you are considering it

• ▸Be clear that you are buying a clinician and a prescription, not a product. That is the point of it.
• ▸Price the likely medicines at your own pharmacy before subscribing. Generic tretinoin and azelaic acid are inexpensive, and the page will not tell you so.
• ▸Check the provider's credentials and background before booking. You choose from a named list, which is an advantage worth using.
• ▸If you specifically need a dermatologist, ask before you pay — Sesame does not claim to supply one.
• ▸Raise pregnancy, planned pregnancy or breastfeeding unprompted at the consultation. Several drugs on the list are contraindicated.
• ▸If a topical steroid is prescribed, agree how many weeks it runs for and what you step down to.
• ▸Buy sunscreen. Nothing on this page mentions it, and every retinoid and pigment prescription depends on it.
• ▸If your condition is severe, take the page's own advice seriously and consider an in-person assessment.

Where we stand

At 75 this is the highest-scoring thing in the register outside CoreAge Rx and Honeydew, and it earns that mostly by sidestepping the problem the rest of the category has created for itself. There is no proprietary formula to interrogate because there is no formula. There is no missing concentration because the concentration is printed on the tube the pharmacy hands over. There is a named human being on a video call who can say no.

It is conditional rather than recommended for one reason and one reservation. The reason is cost: a service whose strapline is 'priced for everyone' should be able to say what a month of treatment actually costs, and this one stops at the subscription line. The reservation is expectation: sixty named providers, twenty-one of them physicians, none of them presented as a dermatologist, sold as dermatology care next to a story about dermatologist waiting lists.

Put typical medication prices on the page — they are low, and saying so would sell more subscriptions than hiding them. Say plainly who the providers are and what they are qualified in. Add one line about daily sunscreen. None of that touches the model, which is the soundest one we have assessed.