I'm currently on 20 mg/daily for persistent moderate acne that I've suffered from for close to 11 years, and am now approaching my fourth month. Since the beginning of my course, me derm told me he planned on keeping me on Accutane for five months at most.

I told him I needed to reach my cumulative dose as I don't see the point in trying a last-resort measure like Accutane just to have acne pop up again a couple months after wrapping up an incomplete course. My derm, however, has other ideas - he gets really condescending and tells me a cumulative dose course is ONLY necessary for people with very severe, nodulocystic acne.

This guy has said and done plenty of other things that have made me question his professionalism, but this is the most worrying. What should I do? He basically has the "you didn't go to med school for a decade, you don't know anything" type of attitude and has refused to extend my course.

What do you guys think?

I'm going to shop around for a new derm if continues to refuse me flat out, but I thought it was weird he would say what he did. I thought a cumulative dose was standard for ALL types of acne, except on a maintenance course.

This post has been edited by duchamp: Oct 6 2009, 08:16 AM

Hmm well I had the same thoughts as you on the dosage thing!

However, leaving that aside for a second, if he is being condescending I would look for another derm regardless!
I think from some of your other posts your around the same age as me, I'm 26...sorry if I'm wrong! But I think when you get to adult age and are not going to ''grow out of it' then I think any derm worth his salt would rather give you a 'full' course just so its hopefully sorted once and for all.

My dosage will be 120mg/kg at the end of my course....and my derm is the opposite..INSISTS I must take the whole course no matter what, otherwise he said it has been pointless and I will have a much higher remission chance.
I'm sure age and type of acne have a lot to do with remission statistics. Mine is cystic, I can't remember Ever being clear since I was about 12.

Isnt 120mg/kg enough?

yes my dosage is enough, it is the OP's that is a lot lower

I think he went to med school and you didn't. I'm worried that you think you know whats good for yourself based off reading other people's opinions on an internet forum.

Why don't you ask him what he would suggest you do, should you start breaking out again after the accutane treatment. Would he have you go on accutane again? (hey, you did say you wanted to extend your course). He did explain that he believes a cumulative dose is for more severe acne than you have. So maybe there is evidence that taking more months of accutane does not improve moderate acne.

Excuse me for my ignorance...but what does reaching your cumulative dose mean? What is a cumulative dose?

I'm curious since I believe my acne and history is similar to the original posters. I'm 26 and have been suffering from mild to moderate persistent acne for 11 years. My derm has me on a 5 month course with the following dosages:
Month 1: 20mg
Month 2: 40mg
Month 3-5: 60mg

I think when in doubt its never inappropriate to get a second opinion. There are studies out there on low dose accutane at 20 mg/day for 6 months or until the acne was gone with the average cumulative does of 70-80 mg/kg that have shown effectiveness. So what your dermatologist is saying is not unreasonable. Most dermatologist though I believe are more in the favor of the 120 mg/kg cumulative goal.

THIS. We need to get this stitched on a pillow or something.

A lot of derms are only willing to prescribe low doses short term because they're afraid you'll experience negative side effects and sue them. Would you win? No. Would your derm waste a lot of money and garner bad publicity from such a lawsuit? Probably the answer to both questions is yes. Just from reading posts on this thread it seems that every third person who experienced a negative side effect is planning to sue Roche or their doctor... ridiculous, and I hope they don't end up preventing this medicine from getting to the people who need it.

Which is a long way of saying, I think you're making a smart move by booking an appt. with a new derm, just do it SOON! I wrote on your log, it took over 2 months for my current derm to work me into his schedule. Unfortunately the best ones are the busy ones...

Ahab - wow. The fact that I didn't go to med school does not make my personal research null and void. It's not as if I stated some obscure Accutane-related procedure, and you need to factor my derm's specialty. He's trained as a plastic surgeon and does dermatology on the side, probably to make extra bank. I've asked him pertinent questions related to my course and each time he's responded evasively and uninformatively. He sucks and I know it but I'm a college student strapped for cash and paying out of pocket for consultations, so I'm taking what I can get.

Being nearly broke and having suffered with acne for over a decade makes me want this to be the last stop. And nikkia, yeah - I think he's being extra cautious (he refused to let me take over 20 mg/daily) to save his own butt should something bad happen. I'm not an unreasonable patient though and I signed all those waivers: I just want my acne to be gone for good.

So no one has had their derm suggest they take a low-dose course for under 5 months? I'm surprised he'd suggest it for persistent adult acne. I'm in my twenties and clearly wasn't outgrowing it any time soon.

.

This post has been edited by HateANDLove: Oct 8 2009, 01:08 PM

Hi there, buddy.

Dealing with this problem can be somewhat hard. Your derm most likely, like any other derm, have had patients with severe side effects. Some people can deal with these effects, while others are having a real hard time with them.

For instance, I know someone who had to stop taking this drug when she had nightmares and depression.
I dreamt about suicide one night, and I woke up with a smile wrapped around my face, it was such a big paradox. I would never have taken suicide, and the whole dream was pretty ironic.

I am pretty sure your derm is trying to be careful, rather than taking the plunge and risking your personal health, which in my opinion seems fair of him.
I personally feel too much focus about total dosage in here. Too many in here thinks that more is better, and side effects are manageable.
Well, if I would ever be a derm, I would never prescribe more than 20mg/day as a starting dose, and then see what happens with the patient.
It it not logical to start with too big a dose, and then take a step down if side effects occur, while the acne gets cured even on the low dosage.

Accutanes effectiveness is taking a steep curve at the start (from 0-20mg), and from 20 up to 40mg, it starts gradually becoming less effective, and the difference from 40mg to 80mg is not by any means worth the side effects and risks bond to it.

This is pretty much the deal with every known medicine. For instance, I only use half a pain killer, in order to deal with headache and such, while I know people who use 2 or 3 pills to cure their headache - this is stupidity. We also see this effect in for instance finasteride, a drug used to deal with hair loss. Finasteride usually comes in 5mg tablets. They are supposed to be split in 4 or 5, which means you use 1-1.25mg of finasteride every day.
I know several people who use this drug, and they used 1.25 every day, until they stopped loosing hair. Then they stepped down to 0.2mg per day, and they are keeping their hair. Finasteride has to be taken even after your hair stops falling off, as it is reducing the DHT in your blood. Immediately after you stop taking the drug, DHT-levels reaches normal.

My bottom line is: Listen to your derm! After all, you are one lucky bastard who gets a prescription. You are one of the lucky ones. If you had two alternatives:
1) No accutane
2) Some accutane + follow up from a derm

What would you choose? See where I am going here? I am confident your derm is more than willing to discuss stepping up on your dosage if it is needed.

hello yes I have the same question...

is the cumulative dose the same whether you take 1 20mg pill a day...or every 2 weeks? thanks guys!

Mochi - I forget the exact calculation, but it's on the boards somewhere. Also, a lot of derms will typically prescribe a monthly dose on what you weigh in kilos. The cumulative dose has little to do with how often you take Accutane, it's based on how much you take cumulatively over the length of your entire course. It ensures that your acne will be less likely to come back, and I think most derms prescribe Accutane in such a way that the cumulative dose is more or less reached.

In my case, I should have been on Accutane for about 9 months if I was going to stick to 20 mg.

I'm surprised I haven't gotten more answers to this. I'm not blasting the fact that my derm put me on a low dose, which I think was a pretty smart thing to do. But he ha told me he's terminating my course next month, despite the fact that I'm still breaking out and nowhere near clear. He told me that Accutane isn't meant to eliminate breakouts - I was incredulous. Well, what it is for, then?

I was wondering if anyone had had their course halved and whether their acne went away anyway, for good.

I think you should find another derm. I have very mild acne and was given accutane for 6 months. 2 months at 40mg/day and 4 months at 80mg/day. I weighed 165lbs/75kgs. The oily skin is completely gone and i never have to wash my face or anything. I will not breakout no matter what i do. 20mgs for 5 months and you're a guy? That's nothing. This derm seems like an idiot to be honest.