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Isotretinoin & Azithromycin

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Isotretinoin + Azithromycin Blog

Hello all, I am an 18 year old male that has suffered mild-moderate cystic acne since the age of 13. In recent years, the acne has been creating post inflammatory hyper-pigmentation marks and has turned my cheeks quite red. In the last year or two, the amount of pimples I have been receiving have reduced and the post inflammatory hyper-pigmentation is also diminishing but VERY slowly. Just 3 weeks ago I went to a new Derm and he put me on a new regiment that he said has worked wonders for most of his patients, and with very few side effects.   Along with keeping a good diet, drinking plenty of water, and washing my face with a prescribed face wash twice a day, he promised me that my face would be acne and inflammation free (not hyper-pigmentation free) within 5-6 months. After that, microderm or laser treatments would get rid of the hyper-pigmentation (which takes 6months-2years to disappear on it's own).   ORAL TREATMENT Drug 1: Azithromycin (500mg) - * To be taken once a day for three consecutive days per week, for 12 weeks (e.g if I take the drug Mon/Tues/Wed, then I would have Thurs/Fri/Sat/Sun OFF and continue it again the next Mon/Tues/Wed for 12 consecutive weeks).   Drug 2: Isotretinoin (10mg) * To be taken once a day every day for 5-6 months. The brand I am using is not Roaccutane, but rather something called "Isotane-10" (10 meaning 10 mg). Different brand, same generic drug = same exact effects). The main cause for concern here is the dosage. I weigh about 65kg so it would make sense for me to be taking 60mg a day according to the 1mg/kg rule. However, my Derm said that low-dose Isotretinoin (Accutane) has proven very effective for his patients mixed with the antibiotic Azithromycin, with MINIMAL side effects.     So far I am on Day 20 in the treatment, and will give you a weekly update of what I have already experienced, and then every week from now I'll post my improvements/side effects/concerns. MARCH 2012 - OCTOBER 2012 WEEK 1 - About a week into the treatment, there weren't too many things to notice. I had just had a breakout a week or two earlier, so those pimples were drying up and diminishing (this happens normally). No side effects so far   WEEK 2- I noticed my lips getting slightly cracked, and sometimes I would rip them a little and they would be bloody. No breakouts, although I had developed about 2-3 new pimples over the course of the week (I usually develop 4-5). However, the new pimples did NOT have any pus and went away fairly quickly.   WEEK 3- Lips continue to be very dry, one day I woke up and they were completely cracked. I have developed more self control and don't peel them anymore. I am in the middle of school so I am yet to find a suitable lip balm that I think will do the job in covering the problem. Face seems slightly less oily, and I have gotten new pimples but they are VERY small and disappear quite quick. Previous pimples are almost gone so my face is looking fairly clear. However, for a few days my face looked slightly more red than usual, but that's gone (I HOPE for good?).   So far I am on DAY 20, so the end of the third week, I will give you an update in about another week's time!   WEEK 4- So it has officially been 4 weeks since I started this new treatment. This week was a little different than the others in terms of breakouts, so far being the WORST week since treatment began. I had 3-4 breakouts on my cheeks, jawline and forehead. Now by breakouts, I don't mean I got 10 huge pimples all over my face. Most of the pimples were small and went away within 2-3 days, so it wasn't THAT big of a deal. However, there was one pimple on my left cheek that became really big, and wouldn't die down for the entire week ( It's actually pretty big as we speak). But besides that really big pimple, everything else is expected. I have read that during an accutane treatment, really good results are only seen near the end and breakouts are common. Also, I started putting on a special vaseline extra strength lip balm, and my lips are MUCH better now, barely cracking or dry.   One thing to note, for the redness that occured on my face due to accutane (known as tane-burn), I started applying a cream which is a mix of zinc-oxide and calamine on my face every night for about 2 hours. At first I thought this is what caused the breakout, but I doubt it now as I have applied it every night and I only had one breakout. Also, it diminished the redness slightly and even made my previous red marks look less pronounced. I've also read that it takes about 8 weeks for Azithromycin to really kill off all the P.acne bacteria (so far it has only been 4 weeks) so I have not lost hope yet!   WEEK 5- Week 5 was more or less the same as Week 4. I am continuing the 10mg/ day dose of Isotretinoin and the 3days a week of Azithromycin. I had another minor breakout this week, and the pimples took around the whole week to disappear (still have some on my face). However, I have noticed that my face is far less oily than it used to be. Even when I feel like I'm sweating, when I look in the mirror, my face has almost no oil on it. When I wake up in the morning, I don't have to wash my face as it is fairly clean (although I still wash it with the prescribed cleanser). As far as the side effects go, I had a few headaches this week but I attribute them to the fact that I was very stressed for exams! My dry lips are being controlled very well by the Vaseline lip balm that I mentioned in the Week 4 section, and my Tane-Burn (facial redness) seems almost diminished as well. I hope by Week 8 the azithromycin effects really start to kick in and control the P.Acne bacteria. Also, I believe the reason I'm still getting breakouts is because I'm on a low dose, so instead of getting one REALLY BAD initial breakout, the initial breakout will happen over a period of weeks so it won't look really bad all at once. After the junk that was under my skin is all released, then I have hope I will start seeing some major improvements!   WEEK 6-The amount of breakouts I had in Week 6 were relatively low compared to those of Week 4/5. However, somedays my facial redness (Tane-Burn) looks pretty bad, and on someday's there isn't any at all and even the hyperpigmentation marks on my face look duller. The few breakouts I received in Week 4/5 are still drying up, so I guess in another 3-4 days (if I have no breakouts) I will get to see how clear my face actually is. The oil production has reduced TEN-FOLD, which baffles me as to how I'm still getting pimples now and then. I might go to my derm and tell him about my situation, and see if he wants to increase my dosage of Isotretinoin to 20 or 40mg per day. The Azithromycin should also really START showing results between now and Week 8. It's only been 1.5 months! Still got about 4 months to go !   WEEK 7/8 - Sorry I wasn't able to make an entry last week, so I'll just combine my week 7 and 8 into one as the entries would have been pretty much the same. Let's talk about my breakouts first. They have reduced SIGNIFICANTLY. I actually took three days off of Accutane as I went out of the country and forgot the tablets at home, but resumed right when I got home. But yeah, my breakouts have reduced quite significantly, by about 80% ( I get the odd pimple here and there but nothing too much and definitely an improvement). Sometimes when I wake up in the morning I can go hours without washing my face because it is oil free. Prior to starting the treatment, my face would be really oily unless I washed it 2-3 times a day with a cleanser, but the oil has definitely diminished. Now, let me talk about the next thing I want to really let everyone know; the side effects.   The first side effect is that on the 3 days a week I take my azithromycin tablets, I get really tired and I get headaches. First I thought that this was a side effect of the Isotretinoin (Accutane), but I noticed that I only feel this fatigue and tiredness and days where I take both the Azithromycin and Accutane, not on the days where I'm taking ONLY Accutane. Therefore I have ruled that the side effect is caused by the Azithromycin. This could probably be because I was told it would take 6-8 weeks before the Azithromycin really started to kill off the P.acne bacteria, and if it is really doing that now and there's a war going on inside my body, well, there are bound to be a few side effects.   Now onto my next main side effect which is, in my opinion, more serious. Since the weather has been pretty mild throughout most of April where I live (Boston) I haven't really applied sunscreen when I go out. And my go out I don't mean playing in the sun for hours or doing outside labour, I mean an average of 20 minutes in the car a day, going in and out of buildings etc. And what have I noticed? Well, bags have developed under my eyes that were not there before, directly below the eyes my skin is light (normal skin colour), and then all around my cheeks and nose and beside my sideburns it's all RED. At first I thought it was a sunglasses tan because it looks EXACTLY like a sunglass tan (the area around my eyes is normal, but cheeks are all red) but there are other parts on my face, like my sideburn areas near my ears, and even my chin and the area around my mouth, that are NORMAL. Now as I mentioned before, I did have some hyperpigmentation marks prior to starting the treatment, but not only should they be even MORE light now than they were at the beginning, but they weren't even THAT dark to begin with! My entire cheek on both sides, and even the area directly beside my sideburns going all the way up to the sides of my eyebrows, is quite red. I have just ordered a Moisturizer which contains Aloe Vera and has SPF 15, and am NEVER going to go out without applying this. I am also quite tempting to go to my General Practinioner because I don't want this to develop into a permanent problem. Now the thing that I'm concerned about, is that is this "tane-burn," the thinning of the skin on accutane that causes blood vessels to be closer to the outside of the skin which makes the skin red. OR is this skin that has been damaged by the sun because I didn't wear sunscreen. And once again, I'm only taking 10 mg of accutane a day AND I don't even go into the sun a lot, just in the car and going in and out of places. If it is the second thing I will be more concered because that might take longer to heal. Hopefully it heals by itself and quick because if this had NOT happened, my face would have looked quite good by now but this stupid redness is really pissing me off.

Hey guys. Clearly I didn't keep this blog post updated throughout the course of my Accutane treatment and beyond. However, I stumbled upon my very own blog post through a Google search and decided to login (after multiple "Forgot my Password" attempts) and create another post to finish the initial post + talk about my post-isotretinoin skin health. 

So the skin redness or "tane-burn" that I talked about in my last post (7-8 weeks in) did turn out to be the worst side-effect for me on isotretinoin. Because it was in about May, the sun was out and quite strong. Even though I didn't go out a lot in the sun, and even when I did I was sure to apply sunscreen prior to doing so, I think the 1 - 2 times I went out into the sun without sunscreen did most of the damage. I was on 'Tane until about October 2012. The 'tane-burn / sun burn (I'm still not sure what it was for sure) started to diminish about 2-3 weeks after I stopped the course. However, it took a little longer (I'd say about January 2013) for my skin's colour to revert to it's natural colour 100%. 

So yeah for me, that was the biggest side effect. Obviously I had drying of the lips and dry skin, but that can be controlled by a consistent application of moisturizer and lip balm. However, its much harder to fix the skin discoloration that I had, and that was there until after I completed my course.

Now the results?
Do I wish I hadn't done the course? Absolutely not. For someone that had acne between 13-18 and quite serious acne (at times) between 15-18, low dose (10mg) of accutane for 6 months plus 3 days a week of azithromycin for 12 weeks did wonders; I had never seen these results from tetracycline and other oral antibiotics, benzoyl peroxide, face washes, diet, chemical peels. I had tried everything for 5 years and nothing had a permanent and noticeable effect. However, this did. I started my course in the middle of March 2012, and by mid June (about 3 months in), I remember my skin being almost absolutely clear. Obviously, I didn't have 100% confidence because I had to deal with my skin being noticeable red on the cheeks until much later. But acne wise? I was really clear 3 months in. 
During the course of the 'tane and beyond, I still got the occasional pimple. My skin was much less oily (during the course it was almost never oily), and I didnt have to worry about what I ate or did; I barely got any breakouts and even if I got the occasional pimple, it would not be cystic and would disappear in 1-2 days. Life was good (especially after the 'tane-burn died down).

At the end of 2014 (December), I got a pretty bad breakout on both sides of the face. Now, this breakout still made my face look a lot clearer than pre-accutane. However, I had experienced consistently clear skin for about 2.5 years, so it was a pretty big deal for me. However, it was exam-season and my face wash had ran out, and rather than using face wash everyday, I was just washing my face with water for about 3 weeks. After exam period I bought a new face wash and continued washing my face 2 times a day as I normally do, and my skin returned to being clear but with an occasional pimple every week or so. 

One thing to note: Even though my breakouts in late November/December 2014 were caused by not washing my face, and once I did my skin was clear again, I would not have had this issue in December of 2013. For about one year post-accutane (until end of year 2013), my skin produced virtually no oil. So even if I didn't wash my face for a day or two at all, my skin wouldn't produce any oil. Towards the end of 2014, I needed to take care of my skin at least a little to keep it clear. Not washing my face with a medicated facewash for 3 weeks caused me to break out and even develop a few cystic (something that had not happened to me since early in my initial accutane regime).

Now that I've told you about my side effects on/after the course as well as the results on/ after the course for the past 3 1/2 years (man does time fly), I now need to reveal my reason for revisiting this post.

I have had a "relapse." 2015 has been a deteriorating year for my skin. I am now 21/22, and my skin since about June 2015 has started to see breakouts again. I still take care of my skin quite well (use clean towels/sheets at all time, wash my face twice a day, use good shampoos, drink a ton of water), but I have noticed that the amount of breakouts and the size of individual pimples is slowly increasing. 

Between 2012-2014, even minor breakouts were extremely manageable as the pimples would be really small and would diminish quickly. However, since mid 2015-now (October 2015), and especially for the past 1-2 months, I have received breakouts on both sides of my face and forehead, as well as breakouts on my upper back and shoulders that were also clear for the last 3 years.

I have tried using different face washes and different shampoos but to no avail. I remembered what it felt like between the ages or 13-18 to try every product on the market and see no results. I went straight to my old derm and told him about my skin now and how I don't want to go down the road again where my breakouts continue to get more and more severe and result in long term hyper-pigmentation and scarring. He told me that with low dose accutane, relapses are more likely to occur, and that some of his low dose patients with really severe acne took up to 4 courses before they saw long term (5+ years) of acne-free skin.

He told me that since my breakouts were not too severe, I could take a half course. Therefore, 3 months of 10mg a day of isotretinion, and 6 weeks of 3/times a week of Azithromycin. I am currently on Day 4. 

I will try to update this post at least a few times during my course and after as well (I'll try my best but dont hold me to it). On Day 4, I have already started to experience some mild dryness (although this usually starts to get a lot worse around Week 3-4). The dryness is tolerable, it can be corrected with hydration and moisturizing. HOWEVER, what I'm worried about is the 'tane burn. I really really hope that the reason that my skin was really red throughout my initial course was due to the fact that it was summer (March-October) for most of my course and the sun here in Boston can get quite intense (Even though I barely spent any time outside and always used UV protection). My life is quite different now; I am about to graduate from college and I have an office job as well. During the summer of 2012, I was at my parents house and had 4 months off of school so it was much easier to stay at home when my face got really red. I'm not sure if I'll have to discontinue my course if my skin gets too bad. But because it's a short course (only 3 months), I may just warrior though it.

I'm really glad I found this post today though because I was able to see what the initial results and side effects from my initial course were. I will try to keep it updated atleast once or twice over the next few months.




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