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I've struggled with acne for years. I've experimented with different regimens and cleansers. I tried most of the home remedies and over-the-counters. I was prescribed every topical cream and gel. I even went for laser and long term antibiotics.

Looking back on the last TEN YEARS I view all that stuff as a waste of time and money. Few helped, and most made it worse. At best, a select few kept acne "under control" but the persistence of the lesions lead to scarring.

But then I found Isotretinoin (accutane). I had to do my own research. Dermatologist after dermatologist never made mention of it?. Yet they prescribed long-term antibiotics and lasers for God's sake! (BTW, the side effects of these are far worse than my Isotretinoin.)

There is FAR too much NEGATIVE HYPE surrounding this drug. It took me a year to decide to go on it; during which time I was burned by laser "therapy." I'm now in month-two of my five month dose. My acne is greatly reduced and pimples I do get are smaller and heal in a day or two (without scarring).

My face is much less oily. My pores are smaller. The blackheads are gone. The only side effect is dry lips and to a lesser extent dry face. Both are easily remedied and far less of a side effect than some cleansers I tried.

For 60 percent of patients Isotretinoin puts their acne into prolonged remission (years). Of that 60 percent, 90 percent are CURED for life. Patients that do not respond from one treatment course can be put on a second, third, and even fourth round. The percentage of acne remission goes up with each course of Isotretinoin. So the odds are it will CURE you.

It took me 9 years to find out about Isotretinoin (accutane) and another 1 to decide to go on it. I really think Isotretinoin should be given as a prophylactic at puberty. Especially in those who have a family history of acne in parents or older siblings.

There is no excuse for CHILDREN to go through what I did. My "moderate/persistent, papular/pustular acne" was a daily torment. It kept me from dating and making friends. It lead to obsessive compulsive behavior regarding clean sheets, handwashing, face touching, mirrors, etc.

I was even afraid to go to sleep at night for fear of waking up with fresh crop of zits. My mood deteriorated. I became depressed and at worst suicidal.

Of course I couldn't tell my dermatologist any of this. I'd never have been prescribed the WONDER DRUG. But I as I suspected, Isotretinoin indirectly acted as an ANTIDEPRESSANT. It gave me initial hope after so many let downs. And now finally, the acne is clearing. I am a completely different person. I have a life again. Thanks to Isotretinoin.

Sadly, the iPLEDGE program is now making it more difficult to obtain the drug. It violates patient privacy laws. There are impractical regulations you, your doctor, the blood lab, the pharmacy, and the iPLEDGE processing center must coordinate with. There is usually a gap of 3 days at the end of every month during which you will be unable to get your medication. It can be weeks if your pharmacy has to order the correct dosage or become "iPLEDGE registered."

I can't stress enough how important early intervention is. If I was put on Isotretinoin even as late as 2-3 years into my acne I would not have scarring now. New scars also respond much better to treatment than scars older than six months.

That doesn't mean one should rush into scar treatment. It is important to note: SCARS SHOULD NOT BE TREATED WHILE ON Isotretinoin and for six months afterwards. The skin is far too sensitive and scarring could worsen.

Acne scars are extremely DIFFICULT and EXPENSIVE to treat once you have them. Even with current treatments, deeper scars can never be erased. Nevertheless, there are treatments that can LESSEN the appearance of deep scars. Superficial scars can more-or-less be "erased." But it is still EXPENSIVE; I've probably spent $10,000 easy.

Before Isotretinoin I tried several lasers to ameliorate my scars. I tried the NON-ABLATIVE lasers: CoolTouch, SmoothBeam, N-Lite, Intense Pulsed Light (IPL), and a diode laser. One session with any of these lasers can cost more than $1000. NONE WORKED EVEN SLIGHTLY. Not even on superficial scars. In fact, the IRRITATION they caused exacerbated my acne and led to a few small, new scars.

I can only blame myself. I did not exhaustively RESEARCH them. The company websites are questionable and the patient stories on message boards show these lasers don't work.

For the last year or so I've been doing my homework. I looked into ablative procedures. Carbon dioxide laser has been around for 20 years and has demonstrated results. However the down time was considerable and the risks high. I've come to the same conclusion for dermabrasion and microdermabrasion (the latter just being a gimmick).

The FRAXEL laser seems to be the best choice right now. The majority of patient reports are positive. The downtime and risks are minimal. But it only got FDA approval for acne scars this month. I'm glad I have to wait at least another year to get it.

I'm not sure I believe the company's claim that Fraxel treats the skin microscopically. It's supposed to damage the skin in "microscopic" dots that are .1 millimeters wide and 1.0 millimeter deep. That's about twice the size of a large pore and still visible to the naked eye. I guess it would work for deep scar tissue. But probably will probably make normal skin seem mottled. I guess a bad complexion is a trade off for reducing scars.

I realize this is a long post. I just wanted to contribute my thoughts. I hope it's helpful to anyone struggling with acne/scars and trying to make sense of it all.

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I should also note that patients need to figure out their cumulative dose and make sure they reach it before stopping Isotretinoin.

My cumulative dose is 12-13,000 mg. At my dose I won't reach that unless I'm on for seven months. So I need to talk with my derm about this.

The studies show that if you do not reach your cumulative dose (based on body weight), the acne is more likely to come back, be more persistent, come back quicker, etc.

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dude--after all that experimenting, your still willing to go out and spend more on scarring treatment with the Fraxel?...

Forget that, frequent the scarring section of the board more often and you'll discover two surfire CHEAP ways that are effective: needling and TCA CROSS...

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It's based on body weight. 120-150 mg/kg. Do a google for "cumulative dose Isotretinoin."

I think needling a TCA are quackery. So many horror stories with both on here.

Only one bad review with fraxel on here (and that guy had previously tried TCA and needling; his fraxels were way high and too close together).

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