18 replies to this topic

[Hilzaa]

Hi everyone,
I've just come back from the my dermatologist (who seems clueless for a professional - she seemed okay the first few times I saw her but today and the time before were awful).

I expected to be on Roaccutane for 6 months but she told me to finish in 3 weeks which will be just over 4 months. My skin has calmed down a lot but she pointed out I 'still have a few spots' so I should start using Duac a week after I've finished the treatment.

I used Duac before and don't really want to go back on it I'm happy with my skin care regiem (although am thinking of moving from Dermalogica to either Kiehl's or Temple Spa).

Now I've gone through nearly 4 months of Roaccutane uncomfortable and awkwardness I'd rather continue, as I'm really worried it won't have a long term effect if I stop at 4 months? Even though my skin has calmed and it's a big difference it's not where I'd like it to be.

Any advice would be greatly appreciated.
Many Thanks!

PS Current Side-Effects:
Exteamly Dry Lips, especially the corners of my mouth
Constant runny nose!!
Itchy dry or itchy watery red eyes

[Quiescence]

Hilzaa, on 18 January 2012 - 08:03 AM, said:

Hi everyone,
I've just come back from the my dermatologist (who seems clueless for a professional - she seemed okay the first few times I saw her but today and the time before were awful).

I expected to be on Roaccutane for 6 months but she told me to finish in 3 weeks which will be just over 4 months. My skin has calmed down a lot but she pointed out I 'still have a few spots' so I should start using Duac a week after I've finished the treatment.

I used Duac before and don't really want to go back on it I'm happy with my skin care regiem (although am thinking of moving from Dermalogica to either Kiehl's or Temple Spa).

Now I've gone through nearly 4 months of Roaccutane uncomfortable and awkwardness I'd rather continue, as I'm really worried it won't have a long term effect if I stop at 4 months? Even though my skin has calmed and it's a big difference it's not where I'd like it to be.

Any advice would be greatly appreciated.
Many Thanks!

PS Current Side-Effects:
Exteamly Dry Lips, especially the corners of my mouth
Constant runny nose!!
Itchy dry or itchy watery red eyes

Hi lovely, can I have your doseage through each month of your course so far, and your weight please so we can calculate for you... x x x

[Hilzaa]

Hey I'm on 60 mg a day and I'm not sure of my weight I think she said on her notes it was 72 kg.

The reason she didn't up my dosage during the course was because my arms went a bit rashy/scabby (sorry gross I know).
So I asked to up my doseage for the last the weeks and she said no.

Thanks for your help

[Quiescence]

Ok so if you are 72kg.....best to check as this is important!!

For this weight your minimum cumulative doseage is 8640 mg... (which is 120mg per kg........120 x 72)

So basically it depends how much over 4 months you are going to stop at... you need to have been on the 60mg doseage for at least 144 days (aroundabout 5 months) to get your minimum doseage to stop it from coming back

...if you've been on it less than this 144 days and you have confirmed your weight etc then you need to show your derm some research papers such as http://onlinelibrary...1849.x/abstract which show that a cumulative dose of less than 120mg/kg significantly increases your likelihood of it coming back...

Or to quote:

"Those patients who received 0·5 mg/kg daily, or a cumulative dose of > 120 mg/kg, had a significantly higher relapse rate than patients receiving a larger dose. We did not elicit any long-term systemic or biochemical side-effects."

Does this make sense? x x

[Quiescence]

Happy to explain anything if my ramblings didnt make sense haha x x

[jhonyguy04]

thats bullshit. how is she gonna stop your course prematurely and put you on duac. wtf!! i would be so mad!!

[Hilzaa]

Quiescence, on 18 January 2012 - 10:38 AM, said:

Happy to explain anything if my ramblings didnt make sense haha x x

erm I'm going to read it a few more times to see if it makes sense to me?

In layman's terms do I need to be on it for longer?
I converted it from stones online 72 kg is about right.

Thank you SO much for your help!

[Quiescence]

In laymans terms: Count the number of days you've been on the drug... if its less that 144 days you defo need to be on it for longer x x

[Hilzaa]

Also I started 23rd September. I can't belive she just said see you in 3 months after today and doesn't want to see me at the end of my treatment.
The Doctor doesn't have a clue. Seriously thanks for the help.

[thrillpink]

Ok, I just counted for you haha, and on february the 13th you will have your minimun cumulative dosage. Did you derm tell you to quit before that?

[Hilzaa]

So I just worked it out the when the Doctor wants me to finish it (3 weeks from today), it'll be 139 days. Guess she wasn't to far off. I'm really not sure if I just want to do the 'minimun though' I think I'd rather do a bit longer and have a better chance, would really rather not have to go through all of this again!

thrillpink, on 18 January 2012 - 11:58 AM, said:

Ok, I just counted for you haha, and on february the 13th you will have your minimun cumulative dosage. Did you derm tell you to quit before that?

Thanks! I wasn't being lazy just took me a bit longer than you haha. I'll probably have enough tablets left to do 5 extra days just not sure if that's enough or would an extra month be doing too much?

[thrillpink]

Hilzaa, on 18 January 2012 - 12:04 PM, said:

So I just worked it out the when the Doctor wants me to finish it (3 weeks from today), it'll be 139 days. Guess she wasn't to far off. I'm really not sure if I just want to do the 'minimun though' I think I'd rather do a bit longer and have a better chance, would really rather not have to go through all of this again!

thrillpink, on 18 January 2012 - 11:58 AM, said:

Ok, I just counted for you haha, and on february the 13th you will have your minimun cumulative dosage. Did you derm tell you to quit before that?

Thanks! I wasn't being lazy just took me a bit longer than you haha. I'll probably have enough tablets left to do 5 extra days just not sure if that's enough or would an extra month be doing too much?

Yeah, I know what you mean, I also want to be somewhere in the middle of my minimum and maximum dosage. Maybe you can ask for some extra pills?

[Quiescence]

Between 120 - 150mg/kg is ideal..as you're still getting actives I think a bit longer would be better... but hey i've not got a medical degree... x

[Hilzaa]

Quiescence, on 18 January 2012 - 12:07 PM, said:

Between 120 - 150mg/kg is ideal..as you're still getting actives I think a bit longer would be better... but hey i've not got a medical degree... x

I'd give you a medical degree! I could say I 'lost' a box of my tablets and get a pescription for another box. I had to do that when I actually did lose a box, I just feel a little unsure about messing around with this stuff.
My new actives are in areas I didn't get before Roaccutane if that makes a difference?

[Quiescence]

Id try and keep it above board!! Just explain the situation and what you've read (not on forums but on research papers!!) x

[kkcc]

My doctor wants me to stop after 3 months, in which case the cumulative dose would only be around 50 mg/kg; I do have mild acne though. She said their criteria for stopping treatment is a 70% improvement (I've seen this referred to in a few places, like here: http://www.livestron...rides-accutane/) because the skin continues to get better even after treatment stops. So if I'm not there by the end of 3 months she'll prescribe me another month's worth of pills. She also mentioned that she thinks most doctors prescribe way too high of a dose than is necessary, but she didn't say anything about the possibility of recurrence. Anyways, I'm a little concerned too (about having too low of a dose - I want this to be permanent!) so I'm going to mention it, but I do trust her judgement.

[Quiescence]

kkcc, on 18 January 2012 - 05:59 PM, said:

My doctor wants me to stop after 3 months, in which case the cumulative dose would only be around 50 mg/kg; I do have mild acne though. She said their criteria for stopping treatment is a 70% improvement (I've seen this referred to in a few places, like here: http://www.livestron...rides-accutane/) because the skin continues to get better even after treatment stops. So if I'm not there by the end of 3 months she'll prescribe me another month's worth of pills. She also mentioned that she thinks most doctors prescribe way too high of a dose than is necessary, but she didn't say anything about the possibility of recurrence. Anyways, I'm a little concerned too (about having too low of a dose - I want this to be permanent!) so I'm going to mention it, but I do trust her judgement.

That's interesting....I'm afraid my worry is still the reccurence...but yes I agree for mild acne the reccurrence rate does seem to be less than us severe folk anyway so maybe you're all good ... a good derm hopefully will have years of experience and have seen hundreds of acne patients.... but on here some derms really seem to have no clue! Interesting and informative article thank you.... but I'd like to see the research papers journals the 70% figure comes from though...the article on livestrong doesnt cite any peer reviewed references just other general info sites on the web.... many experiments i've seen showed reccurence was reduced when the acne patient continued accutane for 2 months after the full healing of lesions...

But you're all right...they still don't know exactly who/why some people get the spots back...some who do everything ''right'' will still get them back..we're all so different.... for example some papers say if you're male, live in a city, are under 20 and have truncal (body) acne you're more likely to have a relapse! Quite specific!!...... but one overriding similarity in all the papers does seem to be this cumulative dose...

I can't seem to surpress the scientist in me sorry haha..having spent most of my adult life searching in databases and reviewing/colating references from science journals I can't resist haha, I'm all about the evidence!!.... I can't speak for anyone else but I'm going to be making damn sure I get my minimum 120mg/kg... just for my own peace of mind haha....I dont want to have to go through this again a year down the line...I may still have (my acne seems pretty resillient and goes through phases) to but anything I can do to help my chances!! x x x

[kkcc]

Haha, I understand, I'm a scientist too! 4th year biology. I assumed my doctor got the 70% figure from the product monograph or perhaps just her professional experience, not any particular study. I just referred to that because it was the first thing I found that mentioned that number specifically.

I found the monograph, and it doesn't say anything about cumulative dose at all.

"The therapeutic response to ‘Accutane’ (isotretinoin) is dose-related and varies between patients. This necessitates individual adjustment of dosage according to the response of the condition and the patient’s tolerance of the drug. In most cases, complete or near-complete suppression of acne is achieved with a single 12 to 16 week course of therapy. If a second course of therapy is needed, it can be initiated eight or more weeks after completion of the first course, since experience has shown that patients may continue to improve while off the drug."

https://docs.google....nz4hVJTE5bQ2LmQ

So my understanding is that the chance of recurrence depends on dosage, acne severity, and possibly other complex individual factors, which makes it kind of tricky to guarantee long-term remission. Of course you can increase your chances by upping the cumulative dose, and since it's essentially just a trade-off for monetary cost and side-effects, I bet your (our!) doctors will be open to the idea.

[Quiescence]

haha you're right... basically too many confounding variables and no one really knows! x x