Hello,

In a nutshell, I'm considering a ridiculous fourth course of Roaccutane at a reduced dosage to hopefully defeat my diabolically persistent acne problem, and am interested in your thoughts. Here is my background;

I'm 30, male, with mild cystic acne. I've battled acne on and off since I was around 15-16 (i.e.around half my life). Although my acne is much less severe than it used to be, most likely due to my Roaccutane treatments, it is still bad enough to cripple my confidence. Although there might only be a few spots on my face at a time, they are usually large, ugly, painful, and persistent cysts (sometimes even recurring before healing). There are also times when my skin is essentially clear without medication, but this never lasts. I suspect my breakouts might be linked with stress, since it got noticeably worse during a time of unemployment, and then noticeably improved after getting my next job. I am otherwise healthy, with good diet, vitamin D, etc.Some topicals like Clindamycin and BP have helped but obviously never fixed the problem, and I took Minomycin when I was younger, with no response.

Here is my history with Roaccutane;
- I took it for 6 months at age 17, the standard 20mg dosage, morning and night. This kept me clear for probably close to two years before the acne started creeping back;
- I took a second course at age 22, same dosage and duration, and similar success.
- By age 25, the acne was coming back again, although less severe, so my dermatologist prescribed a third course, but only for 4 months. Unfortunately I stopped this course a week early due to an adverse reaction I started having to it. Up until this point, my side effects had been relatively minor and expected, such as dry lips and occasional nose bleeds. But around the 3.5 month mark,my lips suddenly started splitting dramatically, I began getting frequent nose bleeds, and got a rash on my wrists and face. These side effects subsided soon after stopping. My skin had not completely cleared by this point, but fortunately did continueto clear after stopping.

So the last 5 years have alternated between having clear skin, and having acne bad enough to effect my state of mind. I'm reaching another tipping point, where I feel like I'd sell my soul to just be done with this, which is why I'm contemplating Roaccutane for a fourth time. Since I reactedadversely last time and would expect a similar reactionto the standard dosage again, I'm wondering if there is value in the weaker 10mg dosage. Thoughts? Otherwise I figure I'll be using BP and SA until I'm a geriatric.

Many thanks