richardb, yes... I ramped up to every day towards the very end. It just didn't seem to be doing anything. My skin is weird because it responds really well to treatment, but it just doesn't last. I figured that since I had been on the retin a micro for ~2.5 months, it seemed a little pointless to keep plugging away.
Oh I feel bad for your cheezycakes, it's like mine... my skin looks so good, then the nastiness comes back. I'm on my 3rd course right now. The silver lining is, it's always permenantly a little better after every course. So even if your skin isn't 100% perfect, it's getting closer and closer each time. Then maybe you can manage with topical retinoids and antibiotics.
Keep us posted, yours is a really great thread because you're keeping track of post-accutane, and we all want to maintain our results!
Thanks richard, I appreciate the encouragement. Yea, totally agree: my skin was flawless for the last 3.5 months I was on accutane and then for about 1.5 months afterwards. I see a lot of people don't have clear skin on accutane until the third and fourth months, and for some reason, even though I clear earlier than them, it doesn't stay that way. My remission seems super short. Most people, even if they don't stay clear forever, they at least get a couple of years out of each course.
Did your dermatologist increase your dose on your second and third doses? Just curious.
I'm about 1 month into my second course. Things look good. About last week, pretty much all my initial breakout pimples dried out and nothing has cropped up since. HA! It's so frustrating to have it work so fast and then not stick in the end. I would say right now my skin is drier than it was on the first course. It could be because of the weather. I'm getting a lot of peeling on my hands and neck.
My dermatologist did not increase my dose. I'd always taken 80mg/day, and I'm 73kg. I think the side effects become bothersome beyond that.
In addition to the first 2 courses and the course I'm on now, I did obtain some accutane from a friend whose mother is a dermatologist. I took like a box of that... but that was all. I figured it couldn't hurt.
Just keep taking more until it works, so long as insurance pays for it. Or ask the doc to overprescribe and hoard the pills so you can take it longer. That's a good insurance tactic.
Hi cheezycakes
Would you say that your acne is associated with oily skin?
The higher dose course that you are now on may indeed prolong your remission time according to this study:
Rich: thanks for the insurance advice. I intended to do that, but my derm is particularly anal about prescribing the right number of pills. I wish I knew someone who can hook me up with accutane.
Biggs: absolutely, my skin has always been super oily. Before my first course, it was wiping every 30 minutes or so. I think it got better after the first course, but I guess when the oily crept back, so did the acne. Thanks for the study. I don't think I'm quite at 1.5mg/kg/day, but it is greater than 1.0, so I'm hoping for the best this time.
Ok guys, about 1.5 months in. I'm basically completely clear. HOORAY. I had a chat with my derm. She says that what happened to me was pretty common for someone who has moderate-severe acne. She is impressed by how quickly I clear; she says it takes most people 2-3 months to see big improvement. She also suggested going high on the last month. I think this is probably a good idea.
When I'm on accutane, I can do almost anything and not break out. My skin isn't actually too dry right now due to how humid it's been in the Northeast.
Things I'm doing differently on the second course:
1. I'm being extra careful in taking accutane w/ food. I think I was a little lax last go around (though not too bad).
2. I was taking accutane before meals on my first course. I'm doing it after meals on this course. Not sure if this makes a huge difference.
3. I was taking metamucil right after my meals. Not sure if this affects absorption of accutane. Now I'm taking metamucil before bed.
My (hopefully) final post on this Accutane Log!
So my course ended back in March.... Well, not really, because I had slowly been taking less and less Accutane instead of stopping abruptly like in my first course. I weaned from twice a day to once a day, then to once every two days, then twice a week, and finally once a week. However, by the time I got to that point, I was getting quite a bit of uninflamed bumps on my forehead and my skin was getting oily again. This happened the first time I came off of Accutane back in March of 2013. I think at that time, I had gotten as low in my outlook as ever on my skin. I thought I was pretty much destined to relapse a second time. What are the chances?
I was pretty miserable, but I still had quite a supply of Accutane left so I started ramping back up and taking 40 mg once a day. Within about a week, my uninflamed bumps went away and my skin dried out again. I then stopped altogether. My plan was to just ride it out for as long as the pills lasted (I had about 60 pills at this point). I figured every 5 pills would give me about 3-4 weeks of clear skin. I made a plan to just have the best time I can for as long is it was possible. I was filled with dread for that last pill, knowing that I was going to have a relapse. I did this off/on schedule for about two cycles. Each 5 pills gave me about 3 weeks of relief, after which, the acne and oily skin would slowly creep back. Finally, in the middle of May, I decided to just stop and stay stopped. I figured, give the skin a chance to recover, go on retin A micro (generic) and see if you can just stay relatively clear. I figured I wasn't going to live the rest of my life being scared of acne coming back. If it was going to come back, better to just get it over with instead of living with the constant dread.
So I stopped, and started retin A micro (this regimen did not keep me clear last time). I told myself I wasn't going to take another pill. The uninflamed forehead bumps never really came back and I am definitely not 100% clear. HOWEVER, every time I think my acne is going to have a full blown relapse, it hasn't really happened. I'm still getting some tiny whiteheads every now and then, but for the past 1.5-2.0 months, I haven't really had a deep cystic zit. My skin still gets a little oily during the day, but it hasn't necessarily translated to anything serious. I think I've learned some important lessons while on Accutane:
1. Take Accutane with food
This is so important and something I neglected the first time around. Isotretinoin is lipophillic, meaning it dissolves readily in fats. If you take it on an empty stomach, you'll be getting less than 50% of the dose!
2. During an Accutane dose, it's a good time to give your skin a break
If you're like me, then you probably use every product under the sun. While these products feel refreshing and cleansing, they're actually pretty harsh on the skin. Towards the end of my course, I was washing my face every 2-3 days or so.
3. Don't abruptly stop Accutane
I know this one is controversial and debatable. There's a school of thought that Accutane stays in your system for months. This is absolutely not true. The effects of Accutane may stay for months after you stop taking it, but most of the medicine is gone from your system in less than a week. The half life of isotretinoin is only about 20 hours. There have been anecdotal examples of people having a post-Accutane breakout (i.e. me). I think this is the same mechanism as people having an initial breakout when they first start taking Accutane. The abrupt increase or decrease of the medication in the bloodstream may cause the body to overreact in either direction.
4. Use a maintenance regimen
I've been using retin A micro since I've stopped. I can't say for certain if this is helping, but I seriously doubt it is hurting.
5. Exfoliate only a couple times a week
You certainly don't need to exfoliate every day. In fact, this may be harsh on sensitive skin types. I've been using a neutrogena scrub with those beads about once or twice a week to scrub away the dead cells. I feel like this is all I need.
I hope people have found something useful in my blog. I sincerely wish every one of you the best in your struggles against acne. I won't tell you to just forget about acne and live your life because I know it's almost impossible. I know it's unbearable sometimes and you might have those dark thoughts creep into your mind every now and then; I certainly have. It's hard to explain to someone who doesn't have acne the struggle we have every day when we look into the mirror. I don't consider myself a superficial person or that concerned with looks, but I know acne has been a shadow in my mind since I was 15. I struggled through college being shy and timid and going into the professional world, where 99% of people don't have acne, it's unbelievably crushing to have to take time off because you were too embarrassed by your acne. Don't be afraid to go to a dermatologist; it doesn't make you shallow.
