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isotretinoin + 31-y-old female

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Day 74

Cumulative dose: 72 mg/kg Changed side effects since last post: Heel pain, persistent blackheads, two small pimples Persistent side effects: Sweaty nose, dry lips, flaking skin on face The heel pain has been around for several weeks. It's definitely my heel or lower Achilles tendon--not plantar fasciitis. Very strange. It's uncomfortable but doesn't interfere with activities. That said, I stopped running and taking long walks because I was afraid I might be aggravating it. I don't think that helped. I notice it most when I've been sitting for a while and then put weight on my feet. Had my first pimples since starting isotretinoin, too--one near my hairline on my face and the other on my shoulder/back. The dermatologist I saw two weeks ago said I looked vaguely oily and increased my dosage to 1.2 mg/kg/day. I haven't noticed much of a change, which is disappointing, though the side effects are nil (though they transiently worsened the first two days at the new dose). I still have light blackheads on my nose and cheeks! I missed inputting my last labs. The following are fresh numbers after two weeks at the new dose: Lab values (3/5/12) AST: 21 U/L ALT: 14 U/L Cholesterol, total: 153 mg/dL HDL: 60 mg/dL Triglycerides: 121 mg/dL LDL: 69 mg/dL Chol/HDL risk factor: 2.6 WBC: 3.8 thousand/uL RBC: 4.07 million/uL HGB: 12.0 g/dL HCT: 36.0% MCV: 88.5 fL MCH: 29.6 pg MCHC: 33.4 g/dL RDW: 13.5% PLT: 194 thousand/uL MPV: 9.7 fL abs neutrophils: 2014 cells/uL abs lymphocytes: 1201 cells/uL abs monocytes: 494 cells/uL abs eosinophils: 68 cells/uL abs basophils: 23 cells/uL gran: 53.0% lymph: 31.6% monocytes: 13.0% eos: 1.8% bas: 0.6%

labRat

labRat

03/06/2012

 

Day 51

Cumulative dose: 45 mg/kg Changed side effects since last post: Sweaty nose Persistent side effects: Dry lips, flaking skin on face, blackheads fading, skin fragile Not much is new. I still have blackheads on my nose and very small ones on my forehead and cheeks (they're obvious only to me in the mirror). The ones on my nose have faded dramatically in the past month, but I'm really hoping they'll going away entirely. A bizarre side effect that first appeared several weeks ago is that my nose seems more sweaty, and this seems especially obvious in cold weather. I haven't spent a lot of time figuring out why this is happening. Since I'm virtually never without a moisturizer of some kind on my nose, I can't rule out that it's something about the CeraVe. I'm not too bothered by this effect and dab my nose whenever I feel sweat accumulate. (It's never dripping down, and overall I'm still less shiny than before.) That's it. My complexion overall is good, except for the flaky bits--my skin tone is much more even, and my cheeks are rosy.

labRat

labRat

02/11/2012

 

Day 32

Cumulative dose: 26 mg/kg Changed side effects since last post: Rash gone, no tolerance of alcohol/late nights Persistent side effects: Dry lips, flaking skin on face, blackheads fading, skin fragile Managed to clear up the rash with a lot of moisturizer. I'm up to 1.0 mg/kg/day from a month at 0.8 mg/kg/day. The first day on the new dose, I went out dancing and had a cocktail. I went to bed two hours later than I usually do. I felt like absolute crap--headache, major fatigue, weakness--the entire next day; I had felt a little off on the dance floor and noticed I never got buzzed (normally, one drink is enough). I drank two other times the previous weekend, and I remember mostly feeling tired afterward. I wasn't dehydrated on either occasion. I'm beginning to take seriously the idea that isotretinoin might mess with alcohol metabolism. I'll try to protect my sleep schedule too.

labRat

labRat

01/23/2012

Last Reply:
02/11/2012

 

Day 27

Cumulative dose: 21.6 mg/kg Changed side effects since last post: Light rash on hand and arms, blackheads fading, skin less blotchy, skin more fragile Persistent side effects: Dry lips, flaking skin on face Apologies for not posting sooner! I've been busy, partly with traveling. The blotchiness in my skin largely disappeared a few days after my last post (i.e., days 17-20). I've been moisturizing with Cerave twice a day and washing my face (with soap, usually Cetaphil) twice a day, though this routine was disrupted last week while I traveled (I used harsher soap and washed less often). While away, I tried to get by on Aquaphor alone--that is, I smeared it all over my face before going to bed--and although it might have been effective, it was too gross to handle for more than two nights. My face is currently peeling more than it was 11 days ago, but the tone is much more even. I noticed that my skin is more fragile. Gently peeling off skin that is already starting to peel itself off easily leaves pink spots. I might also be getting small cuts and tears on my hands more easily, but I'm not sure the change is significant. Some of my blackheads are finally started to fade away. They're being pretty discreet about it, which I appreciate--no obvious protrusions. The ones on my nose are still pretty obvious, though. A few days ago, I developed a rash on the back of my right hand that then quickly spread to patches on my left and right arms. It's red, raised, and bumpy, though it doesn't itch much. I've been applying Cerave to the area, and it seems to be fading. In other news, I have lab values from yesterday. There's slight leukopenia, which might be due to one of the bazillion bugs I was probably exposed to while traveling. Will follow up next week. I suspect this means I'll stay at 40 mg/day (= 0.8 mg/kg/day) next month (will find out tomorrow), even though my AST, ALT, and lipids look good. Lab values (1/17/12) AST: 19 U/L ALT: 13 U/L Cholesterol, total: 162 mg/dL HDL: 69 mg/dL Triglycerides: 87 mg/dL LDL: 76 mg/dL Chol/HDL risk factor: 2.3 WBC: 3.5 thousand/uL RBC: 4.12 million/uL HGB: 12.1 g/dL HCT: 36.1% MCV: 87.6 fL MCH: 29.4 pg MCHC: 33.6 g/dL RDW: 13.0% PLT: 188 thousand/uL MPV: 10.0 fL abs neutrophils: 1589 cells/uL abs lymphocytes: 1484 cells/uL abs monocytes: 336 cells/uL abs eosinophils: 60 cells/uL abs basophils: 32 cells/uL gran: 45.4% lymph: 42.4% monocytes: 9.6% eos: 1.7% bas: 0.9%

labRat

labRat

01/19/2012

 

Day 16

Cumulative dose: 12.8 mg/kg Changed side effects since last post: General redness, peeling/flaking skin all over face Persistent side effects: Dry lips, obvious blackheads The side effects are getting gross and discouraging. My skin is increasingly raw and blotchy looking; there's a growing mismatch between my foundation and overall skin tone. I also have these flaky patches, especially around my mouth and chin, that don't seem to go away. My skin is really sensitive too--almost everything stings. A couple of questions for readers: Does the redness ever get better during the treatment? That is, does it ever get better before you actually stop the isotretinoin?
Same as above, but for peeling.
I'm really worried about how much everything hurts (and contributes to my overall blotchy, red look). This morning, for the first time, I waited a good 20 min after showering before applying a bit of Cerave to the worst areas and then suncreen (Neutrogena Ultra Sheer Dry-Touch Sunblock, SPF 45), and it didn't sting so much. I'm hoping that introducing this lag will be enough. Currently, I'm using Cetaphil wash twice a day (using a soft washcloth or my hands). I then use Cerave in the evening or Neutrogena sunscreen in the morning, but I think I'll pre-apply some Cerave in future mornings too. Did anyone else have this kind of irritation, and did it go away? Were other products less irritating?
I reeeeeeeeeaally want my blackheads to go away and to get the flakeface under control. Yesterday, I went into work happy that I didn't have any meetings and didn't have to worry about people staring at my face. I then got some good news, and my boss and I went out to celebrate. He stared a bit. It was crummy. And now I'm gearing myself up for the next phase of my career, which is a bit intimidating, and I would really prefer to avoid all forms of dermatological drama. So... any advice on what I can expect? I'm guessing I'll go up to 60 mg/day next month and probably stay there for a while.

labRat

labRat

01/08/2012

Last Reply:
01/08/2012

 

Day 12

Cumulative dose: 9.6 mg/kg Changed side effects since last post: Blackheads more visible (and/or more of them), skin starting to peel/flake around mouth Persistent side effects: Dry lips I seem to have gotten new blackheads in my T-zone, and/or the ones that are there look really obvious. Not pretty. I hope it's the isotretinoin working and not the fact that I've upped the moisturizer--about a week ago, I tried a different moisturizer. Only after rubbing it into my face did I notice that the seventh or so ingredient was petrolatum (doh!). I only used it once, but it might contribute to the problem. The skin peeling and flaking isn't bad by a long shot when compared to the kind of irritation and peeling I would get with benzoyl peroxide or any of the retinoids (adapelene, tazorac, etc.). Yay. I also started taking an algal DHA+EPA supplement on day 10. Probably all placebo with me, but it won't hurt.

labRat

labRat

01/03/2012

 

Day 8

Cumulative dose: 6.4 mg/kg Side effects since last post: Dry lips (since day 5) I took my first dose on 12/22/11. I'm taking 40 mg/day of Claravis. Great excuse for nightly ice cream. My boyfriend gave me a giant tub of Aquaphor in my Christmas stocking. Awww.... I've been using it on my lips several times a day. I had a headache the whole day before my first dose, and it continued the first two days of treatment. Because it preceded treatment, I'm chalking it up to something else. I was also very tired the first few days, but it could have been the weather, work, etc.

labRat

labRat

12/30/2011

 

Introduction

My goal is to provide useful information for other current or potential users of isotretinoin. (Also, in the long run, this kind of blog data should totally be aggregated and analyzed!) Basic statistics Female
31 years old
50 kg (110 lbs)
5'4"
Caucasian

History of acne
I first got acne when I was 13. Since that age, I've continuously been on one medication or another. My dermatologist and I discovered when I was in high school that my acne responded very well to oral contraceptives (OCs), and it has generally been well controlled by them. I never had nodular or cystic acne as an adolescent. I've been off of oral contraceptives for only one year since I was in high school; in the exceptional year, I was on doxycycline as an antimalarial prophylaxis.

Starting in my early and especially in my late 20s, I wondered if OCs might be messing with my libido. I was also concerned about the long-term cognitive and sexual effects of being on very anti-androgenic (anti-testosterone) meds. The OC I responded to best, Yasmin/Ocella, is known for being the most anti-androgenic of them all. Twice I briefly went off of my OCs, and each time I flared up with terrible, cystic acne around my chin, chest, back, and neck within weeks of being OC-free. Despite immediate and aggressive treatment with topical and oral antibiotics and benzoyl peroxide, these flare-ups never subsided until I had been back on the pill for at least a month. Note, I don't have PCOS and have never had high testosterone levels (though they weren't measured during these flare-ups).

I'm trying isotretinoin as a long-term solution to the acne/OC tradeoff. I'm also hoping it will help with oil production (I'm on the oily side) and my annoying, steadily expanding zone of blackheads.

My concerns
I'm most worried about isotretinoin's possible effects on bone density
neurogenesis
lipids/insulin resistance (short-term)
I was diagnosed with osteopenia ten years ago, though I managed to improve my bone density substantially over the next few years. Studies of a single course of isotretinoin suggest that it has a small to no effect on bone density (in adults on standard doses)--or that the effects, if present, are swamped by other factors. My goal is to be very careful with my calcium intake (1000 mg/day supplements w/ vitamin D) and exercise (running two or more times per week). My worries about the effects of isotretinoin on neural growth and metabolism are probably dumb and neurotic. The exercise should help, and I'll start taking omega-3/DHA supplements (which haven't been shown to have an effect in normal people, but I'm vegetarian--probably won't hurt). For the lipids and insulin resistance, I'll just try to eat kind of well. That's it! I'm really excited. Will post regular updates from now on. p.s. Note on photos: I don't think it makes sense to post them. I don't have much acne--maybe 1-3 small whiteheads and a smattering of blackheads--because I'm on OCs right now. Edit: Bonus - initial lab values! I had almost forgotten! I'm recording these here just because I want to see how they change. They're from 12/20/2011: AST: 14 U/L ALT: 12 U/L Creatinine w/o eGFR: 0.71 mg/dL BUN: 10 mg/dL Glucose: 86 mg/dL WBC: 5.1 thousand/uL RBC: 4.29 million/uL HGB: 12.7 g/dL HCT: 38.0% MCV: 88.5 fL MCH: 29.6 pg MCHC: 33.5 g/dL RDW: 12.8% PLT: 204 thousand/uL MPV: 10 fL abs neutrophils: 2856 cells/uL abs lymphocytes: 1765 cells/uL abs monocytes: 367 cells/uL abs eosinophils: 71 cells/uL abs basophils: 41 cells/uL gran: 56.0% lymph: 34.6% monocytes: 7.2% eos: 1.4% bas: 0.8%

labRat

labRat

12/30/2011

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