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26M - Mild, Persistent Acne


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#1 skk3

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Posted 15 March 2014 - 04:06 PM

Hey, I just wanted to start a log of my progress since beginning Isotretinoin (my doctor prescribed me Absorica). I am a 26yo M with mild, persistent acne. I definitely don't fit the typical profile of severe cystic, scar-forming acne. My acne is primarily small/medium sized white and blackheads. I have 4-5 blemishes (combination of active pimples, popped and red pimples, and scabs) at a time with one new one forming when another one subsides. I don't think there are many logs from people with my type of acne and I would like to share some light on my progress so other people can benefit. 

 

I started having acne sometime during middle school which persisted till now. I never really went to the dermatologist because my acne was never that severe and I simply thought I would outgrow it. At 26yo, I continue to have acne and extremely oily skin and I figured a more aggressive treatment would be best. I started becoming self-conscious of my acne due to my occupation. I work in a field that interacts and sees a lot of people and for some reason, I found myself noticing and worrying about my complexion, particularly when I was meeting a new client. 2 years ago, I finally visited a dermatologist. 

 

The following is a list of the treatments I have tried thus far: OTC (benzoyl peroxide--including acne.org--neutrogenia, clean and clear, etc, salicylic acid, sulfur, Proactiv. As for prescription medications: Duac (worked well for a while), Retin A micro, and Doxycycline (couldn't take it for that long due to severe stomachaches). I was prescribed Isotretinoin on March 12, which makes today my day 4 of my treatment. 

 

I am 175lbs (80kg) male and I am currently on 30mg twice a day for 1 month, which will later be increased to 40mg twice a day. Per my doctor, the recommended dosage is 1mg/kg/day which means I should be taking 80mg/day (40mg x twice a day) to see full results. To minimize the initial breakout and potential side effects, my doctor recommended a smaller dose of 60mg/day for a month followed by the full 80mg/day dosage. 

 

Day 4

Pros: None really seen. My complexion is about the same at this point. A few pimples, but no cysts. No breakout.

Side effects: No initial breakout. No dry lips/skin. No dry eyes. I had a mild headache that went away quickly. I'm unsure whether to attribute this to isotretinoin or not. I have noticed that my lymph nodes on my neck a.k.a. submandibular lymph nodes for those who care have been slightly tender. Swollen LN are one of the severe SE of isotretinoin, so I have been careful to monitor my neck to make sure they are not overly tender or swollen. 

 

Overall, nothing much to report. No extreme pro's and no real SE. Will update in a few days time. 



#2 skk3

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Posted 16 March 2014 - 10:25 PM

Week 0, Day 5

 

Yikes! Large, painful cystic pimple on the tip of my nose! I rarely ever get cystic pimples and not only did I get one, I got it right on the tip of my nose! I think this may be the initial breakout part of the journey. I also got a couple small whiteheads on my cheek which is the type of acne I'm used to getting. The only side effect at this point is mild skin dryness. 



#3 skk3

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Posted 17 March 2014 - 10:57 AM

Week 0, Day 6

 

Got a cortisone injection into my cyst on the tip of my nose. My dermatologist wasn't completely sure the injection would work, but he said it would be worth a try. He doesn't really the lesion on my nose is a typical cyst, but more of a wide, flat, red lesion on my nose. It's definitely not raised and doesn't have defined borders like the typical cyst, but it's just this really painful, really red area on the tip of my nose. It somewhat came to a head last night and I popped with with a needle, but only small amount of pus and lots of bloody, clear fluid came out. Hopefully this injection will work!

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Edited by skk3, 17 March 2014 - 11:08 AM.


#4 skk3

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Posted 19 March 2014 - 07:42 AM

Week 1, Day 1 (8 days)

 

"Cyst" on my nose has gone down nicely. It's still visible and there is definitely a hard bump under the skin, but the redness has mostly gone down. I'm still on 30mg twice a day. I haven't really noticed any benefits or side effects yet. My skin may be slightly drier, but that could just be my imagination. The flaking of my skin is actually a LOT better now that I don't use any topical creams/gels. When I used DKR, retin a, or duac, the gel would cause my skin to flake like crazy even with consistent exfoliation. Now that I'm using an oral medication, flakiness has definitely gone down. 

 

Overall, nothing much to say. Will report back in a few days. 



#5 skk3

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Posted 23 March 2014 - 07:54 AM

Week 1, Day 5 (12 days)

 

Still taking the original 30mg twice a day. I've been very good about taking it with a pretty large meal with a good amount of (healthy) fats. Overall, I'm seeing a REMARKABLE improvement in my complexion. Though my acne was mild to begin with, I can definitely say my skin is nearly clear at this point. The large cyst on my nose is almost gone. I am noticing a lot more dry lips and flaking skin, however. I also got sunburned on the back of my neck. I put on sunscreen on my face and neck so I have no idea how I got burned only on the back of my neck. I definitely plan on being more liberal with the sunscreen. 

 

The absolute best part of taking isotretinoin is the fact that I don't have to put medicated creams on my face which irritate it like crazy. All I have to put on is lotion. 

 

As for my face washing and lotion-ing routine, I've combined what I learned from acne.org and my own experiences. 

 

So I gently wash my face with Cetaphil and pat dry. Before my skin becomes completely dry, I slather on jojoba oil all over my face and massage it in for 3-4 minutes. Then I wipe off the excess oil with a clean towel. I put on EltaMD UV Daily Broad-Spectrum SPF 40 on my face and neck. Then I wait for it to sink in before I apply Cetaphil Moisturizing Lotion. After it completely soaks in, I wipe off the excess shine with a towel again. This keeps my face and neck well-moisturized for 4-5 hours, but I've definitely been noticing that the flakiness comes back after that. I'll probably have to re-moisturize later in the day. 

 

At night, I do the exact same thing, except I skip the SPF. 

 

I hope this helps and I'll come back in a few days with another update. 



#6 Kim0728

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Posted 24 March 2014 - 01:55 PM

Hi skk3, thanks for sharing! FYI, sunscreen is the last thing you should apply, after you apply all your other topicals. You might have gotten a sunburn because the Cetaphil would've diluted the sunscreen. Hope that helps.



#7 skk3

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Posted 25 March 2014 - 09:23 PM

Thank you Kim! I appreciate your input. I will definitely keep that in mind.

 

Week 2, Day 0 (14 days)

 

I spoke too soon! Got 2 new pimples and a couple of bumps that I think will become pimples soon. I'm used to this cycle of good weeks followed by bad weeks. What's surprising is how long old pimples are taking to heal! Typically a pimple takes 4 days to become a flat, red mark and 5-7 days to completely heal. However, I'm noticing that while on isotretinoin, my popped pimples and scabs take MUCH longer to heal. Many of my scabs are at the 7-10 day mark and they are still scabs and are not flat, red marks yet. This completely makes sense given the mechanism by which isotretinoin works, but I'm still surprised. 

 

Definitely feeling the dry, chapped lips. However, regular old chapstick is working well so far. My skin has been dry and somewhat flaky, but still shiny. It's kind of weird because while I'm moisturizing my skin, it doesn't seem like it's penetrating the skin like it used to. Weird. 

 

Oh, I forgot to mention that I am exfoliating twice a week with Dermalogica Daily Microfoliant. (Excellent product btw!)



#8 skk3

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Posted 30 March 2014 - 11:27 AM

Week 2, Day 5 (19 days)

 

Definitely breaking out more. I typically don't get acne around my nose, but I've been getting 3-4 pimples on my nose/side of my nose for the past few days. Also, I've been noticing that the pimples cause a lot more swelling than usual. It's kind of weird because the side of my nose has ballooned in size due to the pimple. It also kind of hurts to wiggle my nose. Side effects are mild. I still have dry lips that are easily treated with some chapstick. Otherwise, nothing really to report. 



#9 skk3

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Posted 02 April 2014 - 02:44 PM

Week 3, Day 1 (22 days)

 

Yikes. Skin is still breaking out... The rate my skin is breaking out is similar to my pre-accutane days, but the healing process is so much slower on accutane that my overall face looks worse. I have a small number of active pimples, but a lot of scabs and hyperpigmentation. Also, the cyst on my nose will NOT go away. It became a hard bump underneath the skin and the small scab that formed does not fall off and change into normal skin. I'm suspicious that there may be residual pus leftover in the cyst that has hardened. I did open the scab and squeeze the pimple, but nothing came out. I have a dermatology appointment soon so I'll see what he says. I have a feeling he might resort to incision and drainage (I&D) aka cut it open with a small knife and extract whatever is inside. 



#10 Lilypad89

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Posted 02 April 2014 - 09:12 PM

Hey, when I was at day 22, I broke out too. So don't worry, I was on 20mg on day 22. Then by 30plus my dosage was increased to 40mg, that helped to clear my breakouts. But.. there is still a risk of me getting another IB in few weeks time!

 

Press on!



#11 skk3

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Posted 04 April 2014 - 08:40 PM

Thank you so much for your encouragement! I'm just hoping when I get bumped up to 40mg 2x day in a week, my skin will respond.

 

 

Week 3, Day 3 (24 days)

 

I developed a really painful cyst on my chin and I went to see my dermatologist for an injection. Cysts really really suck! I normally don't get them, but the accutane has been really making it more frequent. I've already had 2 develop in 3 weeks. Anyway, after the injection, when my derm was evaluating my skin, he thought that I'd benefit from a 2 week course of an antibiotic called cephalexin. He thought my pimples may have a staph infection which is why they're not healing. He also said that it'd help with the IB. So I have to take this antibiotic three times a day along with my accutane. 

 

It sucks so much being an adult at 26 yo with a job that requires meeting a lot of new people and having a skin that's just a mess. I asked a bunch of my guy friends what their skin routine was and they looked at me weirdly. They said they wash their face once in the morning with a cleanser they buy at a drugstore and that's it. No moisturizer, no jojoba oil, no nothing. Their skin looks so healthy and clean with NO oil and NO flaky skin throughout the day. I'm quite jealous. I'm crossing my fingers that in 5 months time, I'll be able to say the same. 

 

 

Hey, when I was at day 22, I broke out too. So don't worry, I was on 20mg on day 22. Then by 30plus my dosage was increased to 40mg, that helped to clear my breakouts. But.. there is still a risk of me getting another IB in few weeks time!

 

Press on!



#12 chimychanga

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Posted 05 April 2014 - 12:19 PM

I can definitly relate. I've been on 40mg 2x p/day for the last 5 months. I'm on my last week of tane' to finally finish 6 months. I didn't have full blown acne all over my face just a few pimples scattered over my forehead, cheeks and mouth area. For me it did get worse before I started seeing good results. My skin started to really clear up around the end of month 3. My side effects really sucked both emotionally and physically but having clear skin is almost priceless. Just remember one day at a time and you'll make it.

#13 skk3

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Posted 09 April 2014 - 11:34 AM

Thank you so much! I'm starting 40mg 2x/day in a couple days. I'm seeing my dermatologist tomorrow to get a new prescription. 

 

Week 4 (Day 29)

 

I had a pretty bad breakout the past few days. I developed 6-7 whiteheads across my chin along with a few on my nose and forehead. I typically only get 0-2 new whiteheads each morning, but this was a nightmare. After extracting all of them, my face was a red, splotchy mess. I got so desperate that I asked one of my friends (girl) for makeup concealer stuff. After a few days and nights of alcohol swab + neosporin + patience, a lot of the scabs have fallen off and many of them are now just flat red marks. 

 

I've also noticed a really odd side effect. I tend to flush in my face really easily. Randomly throughout the day, I can feel blood rush to my face and my skin becomes red and warm... the type of feeling you get when you feel embarrassed. I can be reading a book when it just randomly happens. Searching through the forums, there have been mention of this, but it definitely seems like a less common side effect. 

 

I've also been developing red, dry bumps on the back of my hands... I figure they are eczema patches so I've been moisturizing them. It's not painful or anything. It's very odd, though. 

 

Anyway, I have a derm appointment tomorrow after which I will be bumped from 30mg to 40mg 2x/day. Hopefully I'll see some good effects then. 

 

 

I can definitly relate. I've been on 40mg 2x p/day for the last 5 months. I'm on my last week of tane' to finally finish 6 months. I didn't have full blown acne all over my face just a few pimples scattered over my forehead, cheeks and mouth area. For me it did get worse before I started seeing good results. My skin started to really clear up around the end of month 3. My side effects really sucked both emotionally and physically but having clear skin is almost priceless. Just remember one day at a time and you'll make it.



#14 megtree

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Posted 09 April 2014 - 01:44 PM

Yeap, all those side-effects are completely normal, including the flushing. I'm on my 100th day, and I flush randomly and super easily. If I get even minorely excited or nervous, my face turns red enough that other people notice. :\

 

The rash is also completely normal, if it spreads or gets worst you can apply hydrocortisone to it. 

Please avoiding extracting the white-heads. I know this is really REALLY hard during the initial breakout, but your skin is extra sensitive and slow to heal while on accutane, and scarring is much more likely. 



#15 brokensword8402

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Posted 09 April 2014 - 02:09 PM

Your path is pretty similar to mine. Mild persistent Acne, late 20's male, same weight, Cetaphil, etc. I felt like I was reading my own journal lol. I actually started out on 40mg twice a day but experienced similar side effects along the same time frame. I broke out around the same time but now they have subsided by the end of month 2 to the point where there may only be 1-2 active bumps (everything else is just scarring). As far as the red bumps, I also got those around the same time. I don't think I acted fast enough and they turned into scabs like objects that left some scars (now gone after a few weeks). But now I am more "proactive." I put on thick creams (cetaphil and/or cerave [non greasy look/feel unless it gets wet]) in the morning and at night and if I feel more starting to emerge I rub more cream in. This is usually around the tops of my hand which I am guessing is because of constant drying to to washing and friction (I put my hands in my pockets frequently). Good luck with everything!



#16 skk3

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Posted 12 April 2014 - 10:44 AM

Thank you both for your input! I will definitely keep them in mind. I'm glad to know that the flushing side effect and the eczema/red bump side effect are seen in others and not just me!

 

Day 32

 

I had a derm appoint a few days ago and I was increased from 30mg to 40mg twice a day. I am at my target mg/kg goal dose so I'll be staying on 40mg 2x/day for the next 4 months. I was originally on Absorica, but my pharmacy didn't have the 40mg dose so I was changed to Myorisan. I'm also still taking Cephalexin 3x/day to reduce the staph infections that my doctor thought some of my pimples had. 

 

Overall, my skin is doing better. A lot of the red marks and scabs that I spoke about in the previous post has subsided and are hardly noticeable. I am still getting 1-2 small whiteheads every day, but they definitely don't last as long and are small. I've also noticed that a few of my pimples don't form heads anymore and simply go away which is awesome. I think my skin has been slowly improving. Over the past month I've been on accutane, my skin initially took 1 step back, but I feel I've now taken 2 steps forward. Hopefully it'll continue to get better. 

 

As for side effects, I've noticed that my skin is much drier and flakey. Despite putting on jojoba oil, cetaphil lotion, AND elta md spf 40, my skin feels tight. It gets much worse when I go to the gym and sweat. Every time I wipe sweat off my face or neck, I feel like I'm stripping my skin of oil and it gets so dry. I might actually carry lotion to the gym. I've also noticed that the back of my neck has been getting really dry as well. I've been trying to moisturize it more, but I think there is some irritation that happens when I roll around in bed and my neck rubs against my pillows. 

 

Nonetheless, my skin is overall doing better. I'm going to be more liberal about putting on lotion and trying to re-lotion throughout the day as necessary. 

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#17 skk3

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Posted 16 April 2014 - 06:26 PM

Day 36

 

Something odd has been going on.. Ever since being switched from 30mg to 40mg twice a day, I've noticed that my side effects have decreased dramatically! I have almost no dry skin, no eczema on my hands, and no dry patches on the back of my neck. I'm not quite sure if this is a good thing as I figured increased dose meant worsening side effects. I'm slightly worried because I switched from Absorica to Myorisan, both of which are forms of isotretinoin. However, Absorica was supposed to have increased absorption (thus its clever name ABSOR-ption-ICA). I'm taking my myorisan with a healthy dose of fats in the AM. My breakfast consists of cereal with whole milk and slice of bread with glob of natural peanut butter. I'm hope I'm getting 40mg's worth of the drug into my system. 

Anyone else experience lessening of their symptoms through their treatment?

 

As for my skin, it was doing AWESOME last week. No pimples in sight. However, I developed one small whitehead on my upper lip and a large pimple on the side of my nose. Kinda bummed, but I'm used to these up and down weeks. 



#18 skk3

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Posted 20 April 2014 - 07:41 PM

Day 40

 

Since the last post, I had a mini breakout with 3 tiny whiteheads overnight. However, after popping + neosporin, all my pimples have been reduced to a scab or red mark. The cyst on the side of my nose is still there, but overall my face is doing pretty well. 

 

As for side effects, I really haven't noticed any other than occasional dry lips. It's crazy because if you see my picture above, my chin was flakey and horribly dry. Ever since switching to 40mg Myorisan (from 30mg Absorica), my side effects have been non-existant. My skin stays oil-free and shine-free all day without the flakeys. It feels so nice. 

 

I'm finally starting to appreciate and notice the effects of accutane. Skin has been taking 2 steps forward, 1 step back. However, that's still forward progress overall! Skin stays oil free all day and the average pimple that pops up has been a lot smaller and heals quicker. 



#19 skk3

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Posted 25 April 2014 - 08:29 PM

Day 45

 

Skin is doing pretty well lately. I had one medium-sized white head pop up and after I extracted it, it went away in about 2 days. I still have a red mark leftover. Side effects are really mild. Even the lip dryness has been quite minimal for me. Yes, it is dry, but it can easily be overcome with chapstick every few hours. I love how clean my skin is at the end of the day because of the drying effect and oil-zapping effects of accutane. Though I still have red marks and active acne occassionally, my skin stays oil-free and shine-free. 

 

Overall, I'm definitely seeing the effects of accutane and I'm enjoying them. Side effects are absolutely minimal with occasional lip dryness and random patches of eczema on my arms. Otherwise, I feel great. I feel a lot more confident about my skin and I wake up without worrying about the condition of my skin. 

 

Feels great. 



#20 skk3

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Posted 05 May 2014 - 12:10 AM

Day 55

 

Skin is doing great! No active pimples at all and the red spots from previous pimples are much less visible. It's a great feeling waking up each day and not having to worry about whether I have a new pimple or not. Even if I do, they're tiny whiteheads that go away in 24 hours. Also, not having oily skin at the end of the day is a huge plus as well. 

 

Side effects are really mild. I have mild chapped lips that require chapstick every couple hours. I've also noticed that I'm a lot thirstier and require a lot more water. The weird thing is drinking water does not quench my thirst... I just pee a lot. haha. That's the only annoying side effect. 

 

Updates will likely become a lot less frequent as my skin is doing well and not changing too much. 






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