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Derm Prescribed Over 150 Mg/kg Cumulative Dose... Good For Extreme Oil?

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#1 OilyAcneQueen

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Posted 12 January 2014 - 01:21 PM

Hello friends. I'm a 27 year old female finishing up my fourth month of accutane (technically Absorica) and upon seeing my face at a recent derm appointment (I had two pimples and 1 cyst that was in the process of shrinking) she said she's putting me on another month of it. I wasn't too happy to hear this because I've been experiencing lots of annoying side effects like: dry lips (duh), eczema on tops of hands, dry skin, dry bloody nose, fatigue, minor short-term memory loss, lack of concentration and lethargy (probably all from the fatigue), joint pain in knees and back, occasional mild face and arm flushing, mild tane face burn that others have noticed, curticles in nails stopped growing, nails are weak and split and crack easily, and weight loss. I think that's about it in terms of side effects. The most annoying ones are the fatigue, weight loss, and knee pain.

My accutane doses have been the following: month 1: 30mg, months 2 though 5: 60mg. I'm pretty tiny so I weighed about 49kg at the start of my accutane course. According to research, the best and ideal accutane course is a cumulative dosage of 120-150mg per kg. According to that formula, my cumulative dose will be 128mg/kg at the end of 4 months (which I will finish in a few days). At the end of 5 months, which is what my derm just prescribed, my cumulative dose will be 165mg/kg, which is above that 150mg/kg limit.

My acne is moderate to semi-severe at times but persistent and hasn't responded well to all other prescription meds until accutane. My skin is about 92% cleared at this point and continues to improve. My skin was extremely oily before accutane. I could soak one or two of those oil blotting sheets within 1 hour of washing it before starting accutane. It was that bad and the extreme oil would melt any makeup and concealer (even mattifying/oil absorbing powder) I had on within an hour or two to try to cover up my acne. I'm soooo happy with what accutane has done with my oily, shiny disco ball of a face in addition to clearing the acne.

My questions are: should I stop the accutane early once I reach the 150mg/kg? Will going over help prevent as much oil from coming back?  Has anyone gone over 150mg\kg and want to share their experience (positive or negative)? Or just share your experiences if you've been in a similar situation, particularly with extremely oily skin? Thanks!


Edited by OilyAcneQueen, 15 January 2014 - 12:19 PM.


#2 OilyAcneQueen

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Posted 15 January 2014 - 12:20 PM

Bump


Edited by OilyAcneQueen, 15 January 2014 - 12:20 PM.


#3 CWR24

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Posted 16 January 2014 - 06:41 AM

Hello friends. I'm a 27 year old female finishing up my fourth month of accutane (technically Absorica) and upon seeing my face at a recent derm appointment (I had two pimples and 1 cyst that was in the process of shrinking) she said she's putting me on another month of it. I wasn't too happy to hear this because I've been experiencing lots of annoying side effects like: dry lips (duh), eczema on tops of hands, dry skin, dry bloody nose, fatigue, minor short-term memory loss, lack of concentration and lethargy (probably all from the fatigue), joint pain in knees and back, occasional mild face and arm flushing, mild tane face burn that others have noticed, curticles in nails stopped growing, nails are weak and split and crack easily, and weight loss. I think that's about it in terms of side effects. The most annoying ones are the fatigue, weight loss, and knee pain.

My accutane doses have been the following: month 1: 30mg, months 2 though 5: 60mg. I'm pretty tiny so I weighed about 49kg at the start of my accutane course. According to research, the best and ideal accutane course is a cumulative dosage of 120-150mg per kg. According to that formula, my cumulative dose will be 128mg/kg at the end of 4 months (which I will finish in a few days). At the end of 5 months, which is what my derm just prescribed, my cumulative dose will be 165mg/kg, which is above that 150mg/kg limit.

My acne is moderate to semi-severe at times but persistent and hasn't responded well to all other prescription meds until accutane. My skin is about 92% cleared at this point and continues to improve. My skin was extremely oily before accutane. I could soak one or two of those oil blotting sheets within 1 hour of washing it before starting accutane. It was that bad and the extreme oil would melt any makeup and concealer (even mattifying/oil absorbing powder) I had on within an hour or two to try to cover up my acne. I'm soooo happy with what accutane has done with my oily, shiny disco ball of a face in addition to clearing the acne.

My questions are: should I stop the accutane early once I reach the 150mg/kg? Will going over help prevent as much oil from coming back?  Has anyone gone over 150mg\kg and want to share their experience (positive or negative)? Or just share your experiences if you've been in a similar situation, particularly with extremely oily skin? Thanks!

I would definitely do the extra month your derm prescribed. The higher the cumulative dose you take the better chance of remission especially with oily skin. I have extremely oily skin too and it returned along with the acne after my first course of 70 mg for 5 months. Now Im on my second. So hang in there an extra month so have a better chance of not having to take a second course like me. Also I took Clarvis last time and now Im on  Absorica which is suppose to be better absorbed than other brands. 



#4 OilyAcneQueen

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Posted 16 January 2014 - 10:11 AM

Thanks for the advice!  I'll stick with it this 5th month.  As a fellow oily skinned person, I have a few questions I hope you could answer about your accutane experience:

 

What was your cumulative dose (total mg per kg) for your first round?

 

How long did the oiliness take to return after stopping your first round? 

 

When the oil returned was it exactly as oily as it was before accutane or was the oiliness reduced by a certain small percentage after accutane compared to before accutane?



#5 CWR24

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Posted 16 January 2014 - 06:03 PM

Thanks for the advice!  I'll stick with it this 5th month.  As a fellow oily skinned person, I have a few questions I hope you could answer about your accutane experience:

 

What was your cumulative dose (total mg per kg) for your first round?

 

How long did the oiliness take to return after stopping your first round? 

 

When the oil returned was it exactly as oily as it was before accutane or was the oiliness reduced by a certain small percentage after accutane compared to before accutane?

Well I weighed around 170lb and took 70mg a day for 5 months my first course.

 

My oiliness came back a few weeks after I got off. Cant remember to be exact.

 

I would say it was just as oily as before. (again I dont exactly remember) But even though my skin was really oily the acne didnt return right away. But I was a oily mess again before I went on my second course. 

 

Sorry this probably didnt help much and probably isnt what you wanted to hear lol. Everyones different though.



#6 OilyAcneQueen

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Posted 17 January 2014 - 10:35 AM

It definitely helps, thanks!



#7 OilyAcneQueen

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Posted 28 January 2014 - 10:08 AM

I found this peer-reviewed article of a scientific study that suggests that significantly higher cumulative doses (≥220 mg/kg) of isotretinoin are effective for decreasing relapse rates without increasing adverse effects, with the exception of eczema/retinoid dermatitis rashes.  The article is entitled: "High-dose isotretinoin treatment and the rate of retrial, relapse, and adverse effects in patients with acne vulgaris."

 

The group that had cumulative doses less than 220 mg/kg had a relapse rate of 47.4% 12 months after finishing their course.  The average cumulative dose for this group was 170mg/kg.

 

The group that had cumulative doses greater than or equal to 220mg/kg had a relapse rate of 26.9% 12 months after finishing their course.  The average cumulative dose in this group was 306mg/kg. 

 

Relapse specifically means that they needed some sort of prescription medication (topicals, etc.), but not accutane, to control their acne within those 12 months.  Retrial rates were also measured.  Retrial means that the patients needed a second round of accutane within those 12 months.  There are more statistics and info in the full text versions of the study.  The full text links of the study can be found within this link:

http://www.ncbi.nlm....pubmed/24173086

 

or directly here: http://archderm.jama...ticleid=1764027


Edited by OilyAcneQueen, 28 January 2014 - 10:11 AM.


#8 chimychanga

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Posted 09 March 2014 - 09:43 PM

I thought I was the only one that had some of those side effects. I'm about to finish up my 5th month on accutane 80mg/day. I have the common side effects dry lips ,skin, nose bleeds, sore muscles/joint pain, fatigue ,mood swings,weight loss. I started out weighing 182lbs and now I'm 173lbs. I'm going back to my derm tomorrow and I hope this is my final month. My skin has cleared dramatically and I hope this lasts forever. I won't ever subject myself to this medicine again. Too many side effects. I hope your results last forever and your side effects slowly and totally disappear!

#9 OilyAcneQueen

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Posted 17 March 2014 - 12:53 PM


I thought I was the only one that had some of those side effects. I'm about to finish up my 5th month on accutane 80mg/day. I have the common side effects dry lips ,skin, nose bleeds, sore muscles/joint pain, fatigue ,mood swings,weight loss. I started out weighing 182lbs and now I'm 173lbs. I'm going back to my derm tomorrow and I hope this is my final month. My skin has cleared dramatically and I hope this lasts forever. I won't ever subject myself to this medicine again. Too many side effects. I hope your results last forever and your side effects slowly and totally disappear!

Sorry to hear that you've also been experiencing a lot of the side effects. They sure did suck!

All in all, I'm glad I ended up taking that last month of tane. It's been about a month now since I've taken my last pill and my side effects have been diminishing and my face is amazing, totally acne free and the oil still hasn't come back, not even a little bit :).

Edited by OilyAcneQueen, 17 March 2014 - 01:01 PM.


#10 chimychanga

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Posted 17 March 2014 - 03:57 PM

That's awesome news that your skin is staying clear and the oil hasn't returned. My derm said that I need to take 1 more month of accutane. I'm kinda bummed out cause of this but if 1 more month gives me a better shot of never having acne again then I'll suffer a little bit more. I hope that once I finish with accutane that all my side effects will slowly disappear too. I'm happy for you!

#11 zodistarr

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Posted 20 March 2014 - 07:51 PM

Hi everyone-

 

So Queen- what did your final cumulative dose end up at? I'm on my second course… my first one I ended up having around 130 cumulative dose… I wanted to reach 150 this course, but am wondering if I should just go for the 220mg if my Dr. will let me.

 

Here's my question:

 

My derm wanted me to take 40mg a day first month, then go to 60mg a day (like last course). I would LOVE to minimize the side affects and stay at 40mg a day. Is it the same result if I take 40mg a day for longer (like 7 or 8 months) because it's still accumulating? Or should I get large amounts in quicker?

 

Thanks :)


Edited by zodistarr, 20 March 2014 - 07:51 PM.


#12 OilyAcneQueen

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Posted 14 April 2014 - 09:47 PM

Hi everyone-
 
So Queen- what did your final cumulative dose end up at? I'm on my second course… my first one I ended up having around 130 cumulative dose… I wanted to reach 150 this course, but am wondering if I should just go for the 220mg if my Dr. will let me.
 
Here's my question:
 
My derm wanted me to take 40mg a day first month, then go to 60mg a day (like last course). I would LOVE to minimize the side affects and stay at 40mg a day. Is it the same result if I take 40mg a day for longer (like 7 or 8 months) because it's still accumulating? Or should I get large amounts in quicker?
 
Thanks :)


I lost 10-15 pounds during my course, so factoring in the weight loss (an average of start and end wright) my total cumulative dose ended up being around 180mg/kg. I'm not doctor so I don't feel comfortable recommending dosing for others :-/

In terms of bumping up from 40 to 60mg per day, if you don't mind the side effects, go for it, you'll be done quicker. It'll be like ripping off a band aid quickly instead of slowly peeling it off.

Unfortunately I must report that the oiliness did return, at about the one month after stopping mark. The good news is that all of my side effects have disappeared and I feel great again (finally!). Also, my face isn't as oily as it was before absorica (I would estimate about a 35% reduction from before absorica as of late), and best of all, with the exception of about 3ish tiny face pimples and one bacne pimple since stopping, my acne hasn't returned bad at all. I've also been using 0.05% trentinoin (retin a) cream every night so that could be helping keep acne at bay.




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