Today I found out that I have hit the total dose limit that my insurance company will allow. It's pretty much the standard protocol. I've been on 40mg/day for about 5 months. They said they will pay again if I get an appeal faxed from the doctor or if I wait at least 8 weeks. I asked how much it was if I paid cash. Wow, $900 for 60 pills of 20mg each! I'm not going to pay that. I'll let the doc and insurance company work it out. Doesn't bother me too much as I'm satisfied with the results on my sebaceous hyperplasia. My skin really looks good and the hundreds of black dots are gone for now. I really do wish I could get on some sort of permanent low dose routine. Sebaceous hyperplasia pretty much always returns in people that have it. Seems to me a continuous low dose would be a better way to go than cycling on-off every few months.
I agree and the insurance company said just that "Have your doctor fax an appeal." For whatever reason, my doctor decided to agree with the insurance company and wait 8 weeks. It bothers me a little, but my skin is in good shape now. I'll wait the 8 weeks, but I'm constantly searching for a derm that is familiar with long term use of isotretinoin for sebaceous hyperplasia. It's not easy to find docs that will prescribe it for sebaceous hyperplasia because most don't know it works on that particular affliction. Also doctors are scared to death of prescribing isotretinoin even though I've used it three times in my life with good results and minimal side effect.
It might be worth printing off some studies showing the benefit of isotretinoin in sebaceous hyperplasia, and showing them to your current/future Dermatologist:
http://www.ncbi.nlm.nih.gov/pubmed/?term=%22sebaceous+hyperplasia%22 [title]+AND+isotretinoin[title]
Thank you for those excellent references biggs881. My focus now is on finding a different derm and medical facility. My current treatment is at a well known university medical center. I've seen mostly new docs and some interns. They've all been really nice and did put me on isotretinoin, but they are ultra conservative. You know, "Lets wait and see how we do." Ablation was suggested but it's really only practical for a very few and not the proliferation of hundreds on my nose. The problem is that I've been down the Accutane road 3 times. I know what is going to happen. The sebaceous hyperplasia will be back and my pores clogged with dark thick sebum (sorry) in 4-6 weeks or sooner. If only I could find a derm that would permit 20mg per day with monthly monitoring I could avoid this cycle of "wait and see." Seems to me if it's low dose with monitoring any problems will be detected far before damage is done. I've really had it with the hundreds of dots that I've lived with for decades. Honestly I have to spend time doing extractions at home just to keep things under control. It's gross, depressing, and leaves the skin looking blotchy. Accutane really works for me and it is such relief. Honestly, I've been giving some thought so obtaining it by alternative methods if I can't find a doc that will work with me. Just giving it some thought.
It might be worth printing off some studies showing the benefit of isotretinoin in sebaceous hyperplasia, and showing them to your current/future Dermatologist:
http://www.ncbi.nlm.nih.gov/pubmed/?term=%22sebaceous+hyperplasia%22 [title]+AND+isotretinoin[title]