Posted 01 November 2007 - 03:39 PM
I did my first two trials with Accutane about 20 years ago. Doctors would not prescribe it for my moderate acne -- "only for severe cystic acne", they said. No mail order pharmacies back then. I bought it in powder form from a chemical supply company that sold it as a dye for tunable dye lasers. Compounded it myself with vegetable oil. No alcohol, no tanning.
Did the first treatment for four months at 35mg per day -- the minimum dose recommended by the Physician Desk Reference. It worked great, but the drying was severe -- great patches of skin peeling off my face. In four months, however, I had skin like a baby. Alas, the acne came started coming back nearly as soon as I stopped treatment.
I tried again at 70mg per day. This time I moisturized my face with aloe vera gel, which took care of the peeling. The higher dose didn't work any better or any faster, but it did last longer. Still, the acne came back after a couple of years. After that I didn't want to try it again because it dried out my eyes too much to wear soft contact lenses. In retrospect, I should have stuck it out to get a higher cumulative dose, but 4 months is what the PDR was saying back then.
Anyway, I started a month ago with 5mg per day. Although it is available in 5mg capsules, the 10 mg capsules are the most economical, so I'm taking a single 10 mg capsule every second day. And it's working just as well and just as quickly as the higher doses. Accutane has a short half life, so I suppose a daily dose might be better, but since this is working fine I see no reason to bother with the extra hassle and expense. I plan to continue taking it until I reach a cumulative dose of 150mg/kg.
Side affects have been minimal. When you start on Accutane, the existing lesions become irritated and inflamed. Lesions that were buried and unnoticeable now become visible, so the acne APPEARs to temporarily worsen, but it really doesn't. This affect faded away after three weeks. No problem with contact lenses at this dose. No peeling. Slight dryness, controlled with Dove soap. Existing lesions did take longer to heal.
A word about the Dove soap. Skin is slightly acidic. Nearly all soaps are alkaline. When you wash your face with an alkaline soap, your skin produces extra sebum to restore the acid balance. So you might want to try a ph neutral soap. Dove is the only mass market soap I've been able to find that is pH neutral. Plus it already contains a moisturizer, saving the hassle of applying one separately. (Neutragena, despite the name, is no longer pH neutral. There are liquid cleaners that are pH neutral and even pH balanced to match skin acidity, but they are really detergents, not soaps, and detergents are drying in themselves.)