Joel - what's up with the quotes?

Whenever i make a post that's quoting someone, i like to quote, hit the hard return, then reply so there is a nice space between the quote and response - it's easier on the eyes. But ever since the update, it only registers the hard return on every other quote. The first response is always right up against the quote with no space, the next one is normal, the next one is right against the quote, next one has a space, etc. Adding extra hard returns has no effect. It's not a big deal of course, just kind of annoying. Is it a known bug? Here's a link to one of my posts so you can see what i'm talking about.

http://www.acne.org/messageboard/forums.html...t

Search feature

Is there any way to upgrade the search feature on this board? The current one is very limited and i think it makes it difficult for people to search for information.

Shiseido 'White Lucent' N

I recently ran out of my moisturizer and began looking for something that might help speed the fading of my stubborn post-Accutane red marks. I came across the Shiseido 'White Lucent' N system (the N apparently indicates that it's a new formulation, the old one has been discontinued) which looked promising. I picked up the gel-type moisturizer. I tried the SPF moisturizer from the display sample and was amazed to note absolutely no reaction (SPF usually stings and gives me a rash within an hour or so) so i'm definitely going to pick that up next and continue to use the gel type at night.

I was wondering if anyone here has tried the whole system or even just the serum? I would be willing to drop the $100 for the serum if it actually works, but i wasn't ready to without trying the less expensive products to see if they are effective and don't break me out.

After reporting a post

After reporting a post, could you make it take you to the index of the forum you were in instead of back into the message? I don't really need to see the spam again.

New Accutane FAQ for this forum

I've been thinking for a while that we need a new Accutane FAQ. The one that's up there just isn't useful or properly comprehensive. I think we might get a few less repeat questions if we had a better FAQ - or at least we could refer them to the FAQ when they asked a common question. I'm hoping this might also reduce the Accutane questions so that people who want to talk about other prescriptions feel like this subforum is for them too. I have cleared it with Dan, so, without further ado!

Please submit questions/answers that are frequently asked to this thread. Also please submit links to any useful off-site resources that you are aware of. Bump the thread if it falls off the front page so everyone will have a chance to see it and contribute if they wish. I will compile/edit the questions/answers into something presentable as soon as i am able and will post it once Dan has approved it. I'm requesting that he stickies it and locks it. Feel free to submit answers that differ from those i primarily give - if they are well founded i have no problems including opposing viewpoints. But don't be a jerk about it, i won't be including anything that i think could open up Acne.org to litigation. So no advice on where to buy Accutane on the internet please. Feel free to copy anything in that you found useful that's in the current FAQ.


Isotretinoin (Accutane) FAQ - draft

What is isotretinoin?

Isotretinoin (13-cis-retinoic acid) is a naturally occuring derivative of Vitamin A used to treat acne vulgaris. When taken systemically, isotretinoin noticeably reduces the production of sebum and shrinks the sebaceous glands. It stabilizes keratinization and prevents comedones from forming. The exact mechanism of action is unknown, however it is known that it alters DNA transcription.

Under what brand names is isotretinoin sold under?

Isotretinoin is sold in the US by the original manufacturer under the name Accutane, and in Europe and Australia as Roaccutane. It is also available as generic brands - Claravis, Amnesteem, and Sotret are available in the US (what else is available in other places?)

Should i use the brand name (Roche) or is the generic just as good?
The reputable generic brand names which are available in the U.S. are just as effective as the Roche version at substantial savings. They contain the same active ingredient and have to demonstrate similar bioavailability. The only difference is the binders, capsule style, etc. There are other generics which may be available, but it's hard to know if they are really equivalent.

Who should take isotretinoin?
Isotretinoin is intended to treat severe, recalcitrant, nodular/cystic acne. However, it is effective against a wide range of keratinization-related skin disorders, so is often prescribed for off-label uses. It is also often prescribed for less severe acne which has not responded to conventional therapy.

People who have liver problems should not take isotretinoin. Women who are pregnant or may become pregnant should not take isotretinoin because it is a powerful teratogen causing serious birth defects in many exposed fetuses. If you are considering isotretinoin treatment you should dicuss it with your doctor and make sure that it's the best choice for you.

Who can prescribe isotretinoin?

U.S. rules - In the U.S., dispensation of isotretinoin is controlled via an F.D.A. program called iPLEDGE. iPLEDGE is an extremely complicated system ostensibly designed to prevent isotretinoin-exposed pregnancies. Female patients of childbearing potential must submit to two pregnancy tests before treatment, one each month during treatment, and one a month after treatment, as well as demonstrate knowledge of birth control each month via a web or phone entry system. When the prescription is written the patient has only seven days from the date of the office visit to fill it. If you miss this window you must wait at least 23 days and another blood test to get a new prescription. No exceptions.

Men and women with no childbearing potential are luckier - there is no waiting period for them, but i beleive they are still required to fill the prescription within 7 days.

Canada rules help me out, people!
UK rules (are these basically the same throughout Europe?) help me out, people!
Aussie/NZ rules help me out, people!
Anyone else i missed please submit your rules and where you are from!

Dosage
Doctors vary in their philosophy regarding dosage. Some take a low and slow approach, keeping patients on a low dose for a long period of time to minimize side effects. Some doctors opt for higher dose, shorter courses. The official dosing guidelines from Roche are as follows:

Some data indicates that remissions are most common in patients who receive a minimum cumulative dose of 120-125mg/kg. Doses beyond 150mg/kg may not provide additional benefit.

The jury is still out as to which approach is the most effective as far as producing lasting remissions with a minimum of side effects, but it appears that all of these approaches can be effective depending on the patient.

How do i calculate my cumulative dosage?

First you need your weight in kilograms. If you are in the US, you'll need to multiply your weight in pounds by 0.45 to find your approximate weight in kilograms. Now you need to know how many milligrams total that you have taken or plan to take and add up the dosage. Then divide the total by your weight in kilos.

So for example, if you weighed 57.6kg (127lbs) and took 40mg a day for six months that would be...

(40mg)x(30days)x(6 months)=7200mg/57.6kg = 125mg/kg

What should i take my pill with? Can i take it on an empty stomach?

E. Take your dosage with fat! Link to high fat meal doubles absoption
1. suggested meals/fats
F. Take your dosage with a full glass of liquid to avoid esophagal irritation
G. Can i take my dosage all at once or must i split it up?

IV. Side effects - for full list see http://www.rxlist.com/cgi/generic/isotret_ad.htm
A. birth defects
1. importance of TWO reliable forms of birth control
2. do not give blood
B. typical minor side effects and how to counter them
1. dryness - dry skin (rash), dry lips, dry eyes, dry EVERYTHING, dry nose may cause nosebleeds, dry hair may lead to breakage
2. initial breakout (acne flare)
a. methods your doctor may prescribe to lessen this effect
1. dosage ramp-up
2. antibiotics before or during (no -cyclines during!)
3. steroids
3. minor headaches at start of course, fatigue, muscle and joint aches, weight loss/gain, flushing/redness, slow healing (explanation), sun sensitivity
4. bloodwork related (minor) - lipids, liver enzymes, blood sugar issues
5. when do these side effects go away??
6. hair loss - Isotretinoin can cause a type of hairloss called telogen effluvium. Hair growth occurs in cycles - during the active (anagen) phase, the hair grows. Eventually it enters the resting (telogen) phase, during which time the hair is just sitting in the follicle but it not actually rooted. These hairs are easily dislodged by hairbrushes, shampooing, and the like - it's perfectly normal to lose about 100 telogen hairs a day. Now, enter isotretinoin. It stresses the body, and the body diverts resources away from less important functions like hair growth. This results in many hairs entering the telogen phase prematurely as treatment progresses. Then, after the stress (isotretinoin) is removed (often a couple months after treatment ends), many of those hairs enter the anagen phase at the same time, pushing the dormant telogen hairs out of the follicle - this manifests as a diffuse shedding across the scalp which lasts until a normal amount of hairs are in the anagen phase. Usually the hair growth returns to normal within six months of the beginning of the event.

If hair continues to shed, there may be an issue such as hormonal imbalance or genetic predisposition that contributes to hair loss - at this point you should see a doctor as continued hairloss is not normal.

Isotretinoin can also cause breaking of the hair due to dryness of the scalp. Hair really depends on the oils produced by the scalp to remain in good condition, and isotretinoin almost competely shuts down this oil production. Treat your hair gently. Don't tug on it, limit shampooing, load up on deep conditioning and utilize leave-in conditioners. Limit heat styling and chemical treatments as much as possible. The scalp oils should return fairly quickly, although you may never produce it as prodigiously as before.

C. rare serious side effects and their warning signs - call your doc immediately
1. pseudotumor cerebri (benign brain swelling)
2. digestive problems (link to IBD? - is this supported or just anecdotal?)
3. hearing problems/tinnitus
4. allergy (particularly parabens sensitivity)
5. cardio problems
6. hypertriglyceridemia (pancreatitis)
7. liver problems - hepatitis
8. night vision
9. possible premature epiphyseal closure
D. Drug interactions
1. -cycline family antibiotics
2. St John's Wort for females on BCP
E. Depression/psychosis controversy