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Accutane and comedonal acne - personal log

Hi. Here it goes.

Background:

Suffered from 'adolescent' acne for the last 5 years. Tretinoin (Airol ®) tretment administred during more than a full year gave results, but eventualy contact dermatitis developed. But after all, it was partialy helpful - resultet in nearly 50% remission. After that, tried Benzoil Peroxide, Clyndamicine, Azelax, apple cinder vinegar, baking soda, antibiotics for 1-2 months, Tretinoin (again) and different combinations of all above. No further effect. Skin became extremly thin and atopic dermatitis developed, so I went for steroidal cream. The face was the most affected area, but also there were some pimples and few active lessons on the back and chest. Oily skin, chronic presence of millia, and seborrhea.

Tried various tradicional chinese medicines (TCM), including Margarite acne pills, and significant improvement was noted. (Personaly recommend to anyone. With me, this resultet in another 50% remission)

Clinical picture now:

Face: no active lessons on face, but low grade comedonal acne still present. Abnormal keratinization and sebum secretion. High presence of millia around eyes. Facial area slightly inflamed, not responding well to corticosteroids, seems like easier form of A.Rosacea. I belive it's form of facila seborrhea, i.e. seborrheic dermatitis. Some macrocomedones might be present. Imperfect skin texture, face looks somehow weared down and 'dirty' even when completly clean. Nasal area has many blackheads, and junky stuff closes every single pore. Pores abnormaly big, bleeding sometimes happens when squeezed in attempt to cleanse, without noticable damage to visible dermis. Belive this is because of abnormal size of sebacenous glands.

Other body areas: Fading marks from previous acne. Closed microcomedones still present in large quantities together with millia (especially shoulders). Skin prone to foliculitis, because of high sebum production. One active acne lesson on the inner thight(?).

Aim:

1. Determine the effectivnes and clinical safety of Accutane on comedonal acne, when almost no inflamed lessons are present, and body is almost clear of any lessons. Only facial area can be diagnosed either with low grade comedonal acne, or with seborrheic dermatitis, possibly both.

Low-dose Accutane course will be initiated, with 20mg of 13-cis-retinoic-acid per day, and if needed dose will be raised to 20+10 mg per day. Body weight: 72kg.

Planned duration of course 5-6 months, no more than six months, because of higher incidence of DISH.

Total (estimated) cumulative dose of at least 60mg/kg should be reached.

2. Completly clear and white skin, with complete remission after therapy ends. Sebaceous glands function should be completly normalised, and low grade facial inflamation cleared. Skin should have normal elasticity, and no visible scars should be present.

Cooperation with dermatologist: currently no cooperation. No one wish to prescribe Accutane in my case, so I'm taking it on my own. This is experimental therapy. No blood work will be done, because this is low dose regimen. But if any time I feel like blood work should be done, I'll order it myself at the lab. No other medication would be used, nor any other special shampoons, gels, moisturizers or so, with exception of lipstick and Vaseline (if necessary).

State of mind: well I admit I'm scared, but trying to stay positive. I fear from IB the most, because my skin reacted very bad last time with topical tretinoin - it broke everywhere on facial area. So that may increase risk with isotretinoin also.

08/27/06 Day 1.

Took the first pill of 20mg. Side effects: none

08/28/06 Day 2.

Skin same as before. Sebum production on facial area still increased, especially nasal area. Lips slightly dry, not chapped. Number of new pimples/small pus-filled closed comedones increased slightly .

Side eff.: none

Preparing to take my 2nd pill..

08/29/06 Day 3.

More less the same. Maybe a few new pimples. Sebum was somewhat reduced throug the day, but went up again 2-3h after taking my third 20mg pill in the evening.

Expirienced very heavy mood swing today, but that used to happend even before Accutane, cuz I have really big problems, no solution and (in my opinion) no right understanding. I'm very unhappy somedays.

So I'll say no side effects.

Side eff.: none

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Hi there, Welcome to the boards :)

Now from how much detail you added to your post you must be a med student, in the medical profession or something similar or did alot of research?

Anyway i hope the results are what you are after once your course has finished!

Best of luck.

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Hi there, Welcome to the boards :)

Now from how much detail you added to your post you must be a med student, in the medical profession or something similar or did alot of research?

Anyway i hope the results are what you are after once your course has finished!

Best of luck.

Well. thanks.

I originally intended to be in medical profession, but however I decided to study software engeenering.

I still use to research med. related fields: biochemistry, drug interactions and pharmacology of various drugs, including isotretinoin. I also had very extensive research in the past related to natural vision correction (NVC) and morphologic changes to human eye that result in refractive abnormalities.

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Well, I used variuos combinations of TCM "cooling herbs", and also herbs that promote circulation of IQ and strengthing spleen in order to eliminate toxins.

Margarite Acne Pills (brand-name TCM combination) were also effective and good in reducing inflammations and smoothering the skin. However, I seriosly doubt that problem of excessive sebum can be solved without use of isotretinoin, so I decided to start Accutane and see what's going on.

In the case of need (such as excessive redness, or worse - breakout), I'll start adding up TCM medicines to Accutane therapy in order to try to control the situation and counteract possible side effects.

I think acne are serious desease and that they require serious measures to be taken, including any treatment available, and all possible combinations of above. I also think that 'oral' form of treatment is better choice, than creams, gels, etc.

Don't worry that TCM will "block" Accutane from doing it's job. There is no know anthagonist to Accutane. It's very difficult to interact with this group of molecules, like isotretinoin, once they reach the bloodstream.

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08/31/06 Day 5.

Sebum production approaching to normal range (face). Body sebum production reduced to normal.

Comedone count decreased slightly. Medium facial peeling present. So we have condition like 'becoming dry and oily in the same time'.

I'm currently thinking what is the best way to manage through this, and add some extra hydration to skin? One red mark on right cheek from a scratch, when trying to push out one comedo. It happens.

Some mood swings, but I seriously doubt it's from Accutane.

Side eff.: none for now

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i'm glad you're getting better with the help of TCM.

I read somewhere a story from a man who suffered from acne almost whole life, was on Accutane, etc. but only after he combined both western and TCM, he expirienced permanent remission. Thus, his advice is to combine and use every resonable approach in order to get rid of such stubborn problem as acne.

..and thanks!

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09/01/06 Day 6.

Face same as yesterday. Some peeling present.

Noticed few new pimples on left shoulder and chest, but nothing alarming for now.

Side eff.: just some headache. I'll put this as side eff. of tane, because I really rarely got headaches before.

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09/02/06 Day 7.

Well, not too much difference.

Nasal area is still pretty oily. And blackheads are still there.

Cheeks are dry (but not too much either), microcomedones still present.

Side e.: none

09/03/06 Day 8.

Pretty same. Face inflamed and red a bit, but nothing to worry about.

Still oily a bit more than necessary, especially nasal area. There is some peeling, but microcomedones still present. I hope Accutane really can affect these stupid comedos. Or, should I consider opting for comedo-expression? I'm really puzzled.

Preparing to take my next pill...

Side e.: none i think, just a bit lazy and sleepy

Read post by Stu2u about being 7 yrs on Accutane. OMG. :rolleyes:

Straight-forward and permanent cure for acne would be definitely one of the greatest discoveries ever. Having to deal with all that, and... Just I can't understand.

Because there is rarely something new to report on daily basis, I'll try to post every 2-3 days or even on a weekly basis.

There is no point in thinking too much about everything thats's happening. I belive that funny and lovely things are waiting out there, and I don't definitely consider funny nor too interesting looking in mirror X times daily, counting comedones, and writing observations just to conclude that everything is "well, almost the same".

:eh:

enjoy.

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09/09/06 Day 14.

And here we are at 2-week mark.

Yes, it does work. But very slowly. There are still blackheads and microcomedones around nose and skin there is still more oily. Face texture is better, but there is still much space for improvement.

IB is not a problem, althoug there were some new papules and pustules and one 'huge zit' (cyst-like), but hopefully it's all under control. So there are some new red marks, but I hope peeling effect of isotretinoin will take care of that.

Nothing serious, but expected this to work faster and more straight-forward.

Side eff.: dry lips, some minor lower-back pain in recent time

wadsthepointofliving, I hope you're now better with help the of TCM. I didn't have time to check on your log/other posts, cuz I'm pretty busy these days, but hope it's getting better for you.

;)

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09/19/06 Day 24.

So we have passed 3-weks mark. Here is what skin looks like now:

Number of microcomedones decreased signifficantly. Skin is no more oily, even in the nasal area. Facial area somewhat red and peeling intermittently. There are also some red spots on nose from skin I stupidely peeled off manualy. Patience, patience...

Skin texture continiosly improving. Some enlarged pores still present, but some reduced in size significantly, i.e. there is much less "junky" stuff. Less blackheads, also.

Overall, there is evident improvement when compared to baseline.

Interesting, my skin still gets "crab-like" red when in contact even with pure tap water. It was also the case before starting Accutane, but I would like it to stop doing so, because it looks very hmmm unusual to say.

I first suspect it's inflammation from hypodermic(subcutaneous) sebum/bacteria/debris deposits, but in the secound case it may be condition like persistent (low-grade) facial edema.

We're going to see what happens after some more time on isotretinoin, and if necessary ketotifen therapy may be added to alleviate this specific edematic condition, like done in one of the studies. I'll report back to you if I change anything in my regimen.

For now, it's still 20mg/day.

Side eff.: very dry lips, occasional lower back pain

Thanks!

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well here i am. i'm still alive. just if someone cares. i simply felt the need to write something in this log, so people don't have to guess what happened, they'll have it all laid down here.

i don't know why i wasn't writing. i even can't remember even more important things. actually, i'm astonished i remembered the password for this forum, because one of my yahoo acc. is forever gone because i waked up one beautiful sunny day and realised i had forgotten my password, password hint, and many other things...not just about yahoo accounts...

in the beggining side effects of accutane, as you could see were mild and like "nothing to worry about", and than little by little it striked me completly down over coming months...series of episodes of depression, ocd disorder going crazy, series of episodes of "mania" (i.e. thinking i can go without sleep, i can do anything, etc. and than failing back to depression) significant memory loss, poor work performance, and above all complete loss of motivation for, well anything...except, well, some natural urges...that's whats only left to entrain me, satisfy, because many other things failed...

actually, maybe it's not just that bad. i still recall cruical things (like where my University is located, so far so good), i can SOMEHOW continue my studies, althou it'll take much effort to go back on track.

here and there i would just freak out, having fears like "i'm running out of time", like constant feeling i'm going to get late to do something, blaming myself every day why i sleep for 7 or 8 hours, and not just 2, going through episodes of "mania" and depression. because all this, well, i developed a habbit to go to sleep every night really late, and with spooky fear that i cannot afford myself sleep because my performances are so low and i must work harder, so i freak out so much i simply cannot sleep until morning, and then i cannot wake up until afternoon i'm so exausted...and so on...unknow fears, things in the room going around from time to time...

well many let's call them "things" that never happened to me before i took isotretinoin. everything was happening so slowly, i barely noticed anything till this month.

i'm still doubiting it while writing this...but it's clear. yes. it is accutane. certainly.

alas, no one close related to me knows exactly what i'm taking, so even if they've noticed something, they'll write it up to...something...

ex about skin, it's better, yes, but not perfect, blackeads on nose are still pretty much there. number of whiteheads is reduced significantly, thoug. skin is not so oily, and well doesn't look bad. pores in nasal area are still enlarged, accutane didn't reduce them. "physicaly present" side effect - just dry lips. well, i don't know about internal organs, i can't see them, but i sometimes have that spooky feeling about that, also...

there is just 4 pills/days left, and i can't wait for the moment to get rid of this, so i'm going to conclude this "study":

Conclusion: Isotretinoin is SOMEWHAT HELPFUL in treatment of comedonal acne, but doesn't fully resolve the problem, especialy the problem with blackheads. Even with dosage such low as 20mg/day (on bw ~75kg), it POSSIBLY CAN produce moderate to severe side effects, more likely ones related to brain/mental health ("physical" undesirable effects like dry skin are pretty much dose related, and as such rarely present with low-dose accutane). It resolves problems with oily skin, at least temporary.

Slight elevation of blood pressure is possible. Slight joint pain possible. Intoxication with retinoids is cumulative over time, making side effects more prominent as months pass. Everything concerning Accutane is pretty much individual, and can vary from patient to patient.

Post-treatment period observations: to follow/not yet recorded

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Well even though I'm late I must admit that this guy wasn't cautious. This happens when buying Accutane online...who knows what the hell they put in his package

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