14 replies to this topic

[aracon504]

After much deliberation in finding a dermatologist willing to prescribe Accutane in Colorado for mild acne- today finally I managed to get a derm on board/blood results back/jump through 93424 hoops to satisfy their whim in order to begin course #2.

As I stated I have mild acne, which Accutane course #1 (August 22, 2011-February 22, 2012) cleared up after a horrible two month initial break out. My skin was flawless and I was extraordinarily happy. However, after one month of being Accutane free, I started getting REALLY oily (which never was the case pre-accutane). I was using a drug hCG (human chorionic gonadotropin) to regenerate function on my pituitary axis; as I have hypopituitarism. hCG simulates LH (Lutenizing Hormone) in males-LH is the pituitary's signal to create Testosterone. As many of you know may know, in both men and women, testosterone levels are responsible for the amount of oil sabaceous glands excrete; specifically DHT (dihydratestosterone). Either way, my Testosterone levels skyrocketted, around the time I finished Accutane course #1, and soon after the drug was out of my system, all that was accomplished with the treatment was undone.


I was on Accutane for six months:
Month 1-3: 60MG
Month 4-6: 80MG




At that time I was living in Chicago, and it was really easy to get a dermatologist on board with Accutane treatment for mild acne. In Colorado, they are much more conservative and feel it is only for the most severe forms of acne. As I stated, I finally found one an hour away- and today they called in 30mg/day of Accutane.


I have concerns- but perhaps not rightfully so- about this low dosage. I was started on 60mg last time (again I weigh 150lbs), and bumped up to 80mg once the IB was done. 80mg really seemed to knock the acne out of the park.

I put a call into the derms office to ask if they plan on increasing the dosage from 30mg to a more "reasonable" dose for achieving a therapeutic "cumulative dosing".


What are some of your thoughts? Why would a dermatologist prescribe such a low dose on month 1?

My thoughts:
1) Wants to see how the liver panel responds.
2) Preventing IB in a patient how has relatively mild acne.

Assuming one of these is true, or both- should I be concerned that I am only starting on 30mg? I want this second treatment to be completely affective, at least for a year (a month acne free post Accutane...really wasn't awe-inspiring). So I want to make sure I reach the proper dosing.

Input is appreciated!

[ForeverUnited88]

The only input i can give you really is just going to teach you how to suck eggs lol.

They start you on a low dose and progress it, monitor your side effects to see if your body can handle it. Annoying for you though obviously since you know your body can handle a large amount. My derm told me that if i take 80mg per day for 4 months or 40mg per day for 8 months, the cumalative dose is the same and the results will be the same, it just takes longer.

Im on my first month, the derm said by rights i should be on 30mg per day since i weigh 64kg, yet hes giving me 2x20mg per day, hes kinda chilled out about it lol. My course will progress up to 90mg per day im guessing thats gona be intense.

[aracon504]

Just to correct this, derm actually wrote 30mg twice daily (60mg), which is how I started last time. Not so long ago, not even a year to the day. Picked up my first month's supply of Claravis, here we go!

And you are correct, cumulative dosage is all that matters. I, for one, do not enjoy chapped lips or having to plaster my face with lotion/being unable to cycle in the intense Colorado sun. So I want it done ASAP, over with. I'd rather take a higher dose and experience the side effects I did last time (extremely dry lips/skin was all) then prolong my agony.

Perhaps I will post some photos- will be interesting to if I have an IB since this is my second course in less than a calendar year, if it works faster, etc.

[aracon504]

As far as products used- I'm rather high maintenance for a male; having had many girlfriends that forced me to spend hours in Sephora/Ulta.

1) Lips:
C.O. Bigelow Lip Buffer (it's menthol/sugar scrub that gently exfoliates those annoying flakes of skin off of your lips so you do not bite them causing a true laceration, it's also cooling and feels awesome) I use it a few times a day to keep dead skin flakes off- and sometimes leave it on when I'm around the house to really help things along
Note: Bath and Body Works used to sell this, some still do, but most do not- so you have to order it from C.O. Bigelow online. OR try Philosophy's Lip Scrub (Wayyyy more expensive, and not nearly as good in my opinion).
As far as a chapstick/balm I have found the Carmex to be the best- it's really hard to shop any upper-tiered balms, because they're all glossy and geared around females.


2) Hair:
My first course I strictly used Fekkai Protein RX shampoo/conditioner and occasionally the same protein RX deep conditioner. I found my hair still got really dry and broke easily, this time I plan on implementing a moisturizing shampoo/conditioner- as too much protein can actually damage hair (especially when it's already damaged and dry). Not sure what this will be yet.

3) Face Wash:
My first course I made the mistake of using extremely abrasive and/or hydroxy acid based cleansers. At first, Salycylic Acid, then Glycolic, and around month 3 realized this was brutalizing my skin, stripping it of the little natural moisture it had. I switched to Philosophy's Exfoliating Face Scrub (still too harsh) but used this the remainder of my six month treatment. This time I am beginning using Bliss- Fabulous Foaming Face Wash.

4) Lotion):
I've used many drugstore products, and never really found one I thought was good for various reasons; mostly wound up using designer based mosturizers.
I didn't begin using lotion until month 3, BIG mistake, my skin really took a hit for at least a month until it caught up, and was decently hydrated, but still of course, Accutane-dry.
Cetaphil- REALLY greasy, but hydrated ok, made me look like I was sweating for many hours after putting it on, so I ditched it quickly
Neutrogena- Alright for the money, decently hydrating and no oily look. But I swear it clogs my pores even though it is non-comedegenic.
Cerave- I've used Cerave as needed since quitting my first course in late Feb, 2012- it is a good compromise between Cetaphil and Neutrogena in my opinion. Will probably start Accutane course #2 with it, and move on from there.
Kinerase- Used it for a week or so, and really liked the matte finish/natural look it left me with. Expensive though...might use it again, we shall see.
Dior Night Cream- REALLY hydrating and only leaves you oilyish for an hour, then calms down, probably the best thing to keep you from looking flakey for a full 24 hours.
Dior Day Cream SPF 15- Nice that it has SPF, hydrates well and leaves you without an oily look from the get go, perhaps not as hydrating as the Kinerase- which did the same, though. Not sure which of those two are better.

NOTE: Problem with Kinerase/Dior is the cost, I have the money, but I found myself going through numerous bottles a month, costing anywhere from $120-170.00.

[AutonomousOne1980]

if you have done any significant amount of reading on this site, you will see its not rare for people to go on 3rd 4th 5th courses of accutane.

if you are this far into the "game", i would put a hold on that course and try to improve your diet, after that, only then should you try another course, if you have not already done this that is. it could be enough for you, and you may not have to endure anotehr course.

the problem sometimes is people do not believe in much of a connection between their acne and what they are eating, and there believe their drugs are their only hope, before trying anything else. And some of these repeat accutane users may be a prime example of this, or, perhaps there acne is just too bad. but do not make the mistake of trying to improve your diet, and relying soley on accutane to solve your problems, although its possible, im here to tell you its not always the case so you are prepared, and hopefully more successful.

[jennyband]

good luck! i'm close to finishing a second course.

all the best

JB

also i just read that you had problems with your hair being dry and breaking (which was the case with both my courses) however i've just discovered something amazing, a liquid zinc supplement the chemist suggested which i started three weeks ago and a goats milk conditioner (randomly given to me by my mum)...

split ends gone, no brittle dryness... hair soft like before accutane...

i wasn't expecting any of this to help so it was a welcome surprise.

look into it!

JB

Edited by jennyband, 08 August 2012 - 11:16 PM.

[aracon504]

good luck! i'm close to finishing a second course.

all the best

JB

also i just read that you had problems with your hair being dry and breaking (which was the case with both my courses) however i've just discovered something amazing, a liquid zinc supplement the chemist suggested which i started three weeks ago and a goats milk conditioner (randomly given to me by my mum)...

split ends gone, no brittle dryness... hair soft like before accutane...

i wasn't expecting any of this to help so it was a welcome surprise.

look into it!

JB

Thanks for the advice! How did your second course go? Initial breakout as bad if you experienced that in go around #1?

[jennyband]

and one last thing, get yourself some jojoba oil. i used all the expensive creams in my first course and to be honest the additives and ingredients aren't good for your skin while your on accutane. jojoba oil is totally brilliant and its chemical structure in very similar to human skin oil (the most similar you can get i believe) you can wash your face with it, and i use it in the shower before i get out and then put on a simple moisturiser.

This 2nd course has been so much simpler with products.

yeah second course has been generally better because i had a derm who prescribed me prednisone in my second month. It's currently day 150 for me, i haven't cleared entirely yet which is so annoying (i was clear last time at this point), i have a few things that were lingering under the skin near my cheeks that have finally decided to up and vacate..

but its looking pretty good i have a few more weeks till i meet 120mg (28 August). Skin texture improving rapidly so thats good! besides the concentrated spots on my face that break out the skin around it is perfect. i didn't get congested breakouts or blackheads or anything like the first course.

i was thinking i should do the whole course to 150mg? the main question i have is whether a second course has to be all the way to 120/150mg. do you know?

[aracon504]

I decided to post some photos, not the best, but IPhone camera will have to do!


Day 1/Week 1 (8/08/2012):

[aracon504]

Bumping this for Day #7 over and done with:

Not much going on, face has felt oilier? I do not remember that happening in my first course around this time last year. Can see some of the milla being pushed out and healing quickly which is disgustingly cool! I had a bad IB my first go around (my acne was probably a 3 at its worst, and the IB turned things into cysts, which I never had, and all that painful stuff). I'm hoping since I was only off Accutane for five months (after doing a six month course)- I'll avoid the IB.

On the bright side, getting my wisdom teeth removed tomorrow before college starts again. Only one tooth is impacted though so hopefully it shall not be that bad. Worst part is not being able to bike everyday, I had to take two days off already this week because I'm just getting over a killer sinus infection...one of the worst I've ever had.

Here's to smooth sailing!

[aracon504]

Day 8:

Only reason I'm updating since nothing is new with the skin is that my wisdom teeth were extracted this morning (3 simple, 1 bony-impaction). Ironically, the 3 simple extractions hurt whereas the impaction does not. They told me my mouth would be numb for four- six hours post op. I have a long medical history in which I have had 10 lumbar punctures and a spinal catheter, lidocaine/novcaine just do not have much of an affect on me- I also was on nearly 1600mg of morphine a day (in the form of synthetic opiates) starting at age 18. I was naive and did not know what I was getting into, even with chronic pain, those meds are no way to live. Glad to be free from that prison. POINT being, the 4-6 hour lidocaine wore off 20 minutes after I left, and my prescription for 2 MG Dilaudid pills is candy. 1mg of Dilaudid is 5x stronger then Morphine. So for somebody with my opioid tolerance, pain relief doesn't even begin to come unless you where to prescribe nearly 150mg of Dilaudid a day and that may be knocking 1-2 points MAX off the pain scale for a very short time (an hour at most). Needless to say, doctors are not familiar with opiate comparison charts, nor willing to prescribe the required dosages I need for pain. SUCKS FOR ME! (I only take these meds when I really need though, because they are HARMFUL to your body and just terrible for your mind.) So I called the oral surgeon letting him know shit hit the fan- and he brought me back in and gave me a different synthetic version of Novacaine that was extremely long acting, and injected three times per area. WOW CAN YOU SAY NUMB!


The sucky part: Lips starting to get really chappy (Accutane chappy as of day 7) but Novacaine completely shuts down your saliva glands in your mouth, so in addition I have the dryest mouth possible, as well as lips that are pretty bloody and chapped! Glad its over, hopefully the pain doesn't come back when the numbing wears off, cause there isn't much that can be done for oral pain management.

[craze321]

Hey dude from the pics you posted in this thread, why are you doing a 2nd course when you don't even have any acne at all in the 2 pics you posted? I don't get it.

[aracon504]

Hey dude from the pics you posted in this thread, why are you doing a 2nd course when you don't even have any acne at all in the 2 pics you posted? I don't get it.

I have minor acne, but that's what all my friends said the first time I did it. Some under the skin stuff that NEVER goes away (except with Accutane) and the short answer is it affects me (causes anxiety). Explaining this to a dermatologist was a trick, I had to see 3 different one's to finally get the script the second time (the first time I lived in Chicago and it was really easy because there are so many derms that are geared to cosmetic needs and they aren't busy enough.

[craze321]

Hey dude from the pics you posted in this thread, why are you doing a 2nd course when you don't even have any acne at all in the 2 pics you posted? I don't get it.

I have minor acne, but that's what all my friends said the first time I did it. Some under the skin stuff that NEVER goes away (except with Accutane) and the short answer is it affects me (causes anxiety). Explaining this to a dermatologist was a trick, I had to see 3 different one's to finally get the script the second time (the first time I lived in Chicago and it was really easy because there are so many derms that are geared to cosmetic needs and they aren't busy enough.

Are you talking about sebacous hyperplacia or aka "enlarged oil glands" under your skin that only accutante can shrink? I think accutane also heals milia too also right?

[aracon504]

It's milla mostly, Accutane will push the milla into a blackhead/whitehead/some sort of nasty acne. It's complicated with my skin, because the under the surface/minor acne I do have is due to hormone levels. I had a free-testosterone level of 1500ish. Which is way above range. Men who use steroids often get REALLY bad cystic acne from the high T levels that kickstart your sabaceous glands. So basically my goal with the Accutane is to dry up the glands that were kickstarted by exogenous Testosterone/Dihydratestosterone. I also have oil-ish skin (pre-Accutane) after only a few hours of cleansing which I never had, so I'm sure the Accutane will kick that to the curb as well. I'm definitely not the classic case for Isotreinoin. But topicals didn't get me where I wanted. And I have obsessive-compulsive disorder, and I really have issue with topicals on my face, as well as with the little acne I have.