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FutureDoc's Accutane Journal

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After dealing with mild-moderate cystic acne for about 10 years, I am FINALLY going to give accutane a try. I am currently in the waiting period between pregnancy tests to get my prescription to start at the end of November.

Before starting medical school, the side effects of accutane that I heard about sounded so scary that I never thought it would be for me. But recently, a number of friends who are going in to dermatology as a career have recommended it as a convenient alternative to the dreaded topicals or lifelong antibiotics. Furthermore, I hope to do an elective rotation in dermatology at some point in my med school career, and definitely don't want to be hanging around dermatologists and their patients with cysts all over my face.

I am looking forward to starting the journey and plan to document the progress, side effects, and outcomes so that hopefully others may learn from my experience.

Stay tuned!

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Guest been13years

Hey, welcome to the forum! I just started Amnesteem today and am so relieved. It seems like cysts are waiting around the corner for some women, to jump out at you in your 20's. It sucks but hopefully Accutane will clear you up!

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I had my 2nd appt with the derm today and got my prescription, making today officially

Day 1

The doc started me on 1 mg/kg/d (which at 130 lbs is 60 mg/day for me), and I'm taking amnesteem generic (would be interested to know what differences have been noted b/w brand and generic by others). The co-pay for one month on my insurance is only $10 which was a wonderful surprise -- I didn't think insurance would pay for acne meds!

The 'rents were worried most about depressive symptoms they had heard about, so I talked to my derm about that and she reassured me that those reports are purely anecdotal and referred me to a cohort study published in archives of dermatology comparing minocycline users to accutane users which found no difference in the incidence of depression (I can provide the abstract if anyone is interested). So my parents and myself can breathe easier about that. :)

I was also told to discontinue using my BP gel (I had been on dan's regimen for quite some time) because the skin will dry out fast. So the current regimen shall be:

AM - wash with cetaphil, moisturize with cetaphil lotion

PM - 60 mg amnesteem with dinner; wash with cetaphil

Wish me luck!

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Hey you

First of all, Congrads into making med school! Looks like we both want to be doc's hey. Im from South Africa, and i too am at med school. Wits Univer. Unlike you guys, who study 4 years, we have to do seven years of academic studies, then only do we do resedency. I love medicine, so, ill enjoy all 7 years of it.

I too was on accutane, or Orratane(generic in SA) for 6 months, 40mg a day. Ill be honest, i hated the stuff. I obviously knew the side effects, and i can tell you that it was not plesant for me. BUT, if i had to do it again i would, because i love ,my new skin. I got moody, and i would classify my temperment at times to be. mildy depressive. It only occured in the first 3 minths though. After that, the dry lips become a bitch

PS: Always have lip ice, or lip balm or something on you, ALWAYS! Because it will drive you mad if you dont. Stick in there, and honestly, its not as bad as you think!

Julian. B MED

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Firegurl - thanks for sharing your experience with minocycline; I basically am going straight from topicals to accutane for the same reasons you stated - I don't want to have to be dealing with this for the rest of my days if I don't have to, and the possibility of resistance is disenchanting :)

Julian - Seven years is a lot, but it will be worth it in the end (or so I'm told) :). I am very glad to hear that accutane worked so well for you! I am looking forward to the day when I won't have to wonder if my patients are looking at my pimples while I'm talking to them...

Day 2

Haven't noticed any changes so far. I thought my skin felt drier this morning, but it was probably all in my head because my face was just as oily throughout the day today as it ever has been! At least there were no *new* pimples this morning. :) I am still awaiting the much-anticipated dry lips! Best of luck to everyone.

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Day 3

Two new pimples on chin and cheek, which seemed same as my usual pimples except they seemed to come to a head and go away faster than before - ? Could be my imagination though.

Day 4

That's today. No skin changes today. The eyes are definitely starting to feel dry, and I wonder how people deal with this - do you do Visine drops every day? I've been told that if you do eyedrops too frequently your eyes will get used to them and stop producing as much tearing and then you're stuck... So any advice about the dry eyes would help. My lips are also starting to get a little chapped (yay!!)

...waiting nervously for my IB...

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Hi FutureDoc,

Welcome to the 'Tane family! I'm 6+ month post-Tane, but I still like to keep in touch with the family. I had to use Visine many times a day, especially in dry places like malls or dept. stores.

If you are drying out already, that's good. I got much oilier at first (and I was REALLY oily to begin with) and then I dried out after a couple of weeks. I think that contributed to my initial breakout, which was pretty significant. However, the results after one month were almost completely positive and I'm very happy I did my course.

Regarding depression, I agree that it's mostly anectdotal, but I have heard a couple of people tell their stories and it sure sounds like the Accutane contributed to their depression. However, this is very rare, and depression is hardly ever mentioned on this site. The depression I hear about the most is due to skin problems and Accutane helps people deal with their depression, because they deal with the cause. That's how it worked for me. I was never clinically depressed, but I sure got down in the dumps when my skin was bad. I'm much more positive and outgoing now that my skin is clear.

Best wishes on your course, and this will certainly make you a better doctor, because you'll be able to empathize with people who have skin problems.


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For your eyes don't use Visine. Use some lubricating eyedrops. I like Refresh Lubrigel. I don't use them very often now, but I did in the beginning....the eye dryness subsided for me in the second month, as did the lip dryness (I am a weird one....my skin isn't even dry)......

Oh and not everyone gets an IB......I didn't.....

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Wow, so glad to hear that not everyone gets an IB!! Now I'll cross my fingers that I'm one of those... I'm really excited because I only have 2 more weeks of school left, then a 2-month long break -- so when I come back from break I hope to knock everyone's socks off with some new clear skin!!

Thanks for the advice LabGirl regarding lubricating eyedrops - I will put those on my list along with the omega 3 and aquaphor I've been reading so much about!

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Days 5, 6, 7

Got a small but exTREMEly painful pimple show up on the side of my nose, as well as another painful little guy no my left cheek. I think this represents the beginnings of my IB, but they're nothing that I can't handle. So far my skin overall looks the same right now as it did before the accutane.

No side effects noted really... I seem to have come down with a cold over the weekend but I don't think it's accutane-related. One thing I have noticed is that my urine seems BRIGHT yellow (like fluorescent) over the past few days -- has anyone else noticed/heard of this?

Went out and got the Aquaphor and Systane that others have mentioned, but so far I don't really need them yet :)

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When taking my accutane tonight, I realized that I've misplaced one of my 10-pill pill packs! I got 9 packs last week (i take three 20mg pills each day, so 3 x 30 days = 90 pills for the month), but somehow I lost one of the packs, even though they come in those boxes. Hmmm... I wonder if the pharmacy accidentally gave me a box that only had 2 packs in it instead of three? I should have checked more diligently when I picked the stuff up last week!

Anyway, on top of that because of the holiday season my next appt with my derm is not until Jan 3, which will be 38 days since my last appointment... So according to my new calculations, taking into account the missing pill pack and the extended time to my next prescription, I have just enough pills now to make it to the next appointment on 40 mg a day (2 pills) instead of 60.

So I guess that's my new dose! 40 mg a day! :(

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It's been a while since I updated, which is a sign that things are going well for me on my accutane... But I have a holiday break now, so I figured I'd get back into the swing of things and fill everyone in.

Today is day 21! In my last post I reported that I was going down to 40 mg since I had misplaced one of my pill packs, but I found that pack which gave me 10 more days at my full 60 mg dose. So now I'm sort of mixing it up--40 mg one day, 60 the next, and so on, just to try to space things out more evenly.

The important part - the skin. It's doing great, and I seriously couldn't be happier with the results so far. For the past couple of weeks, I've been having sporadic, single pimples pop up here and there, which can be quite painful and red, but they subside after a few days. I started spot-treating with 10% BP (clearasil) at night, which has been helping. I was afraid it would dry my skin too much, but it didn't seem to have that effect at all. For the past couple of nights I have been doing a VERY thin all-over layer of BP at night to try to prevent these pop-ups (in anticipation of seeing my boyfriend this weekend) and it seems to have worked -- the first thing he said when I saw him yesterday was "you're even more beautiful than last time I saw you--your skin looks great!" :):):):)

My skin continues to be dry all day long, and my makeup looks great at the end of the day! Sometimes I even feel like I could go to bed without washing my face, it feels so fresh! (Of course I always do wash the face). I have exfoliated a couple times since I started with Apricot Scrub (non-medicated), which I know is not the best thing for bad skin (since it can cause mini abrasions that might turn into scars) but it feels so good that I just have to indulge once in a while! :)

I am so happy with the results so far and it's only been 21 days--I am very confident that after a few more months I will be completely clear! I never had really horrible self-confidence issues, but now I'm even looking forward to going to the MAC counter to shop for makeup, whereas before I always HATED shopping for makeup because of my skin!

As for side effects, the only thing I have experienced is the dry lips--those have been pretty annoying, because I hate having those lip flakes peel off and form little painful spots on my lips. But as long as I keep my Aquaphor nearby at all times, it's not too much of a problem. But like others have said, if I ever get stuck somewhere for a while and don't have my Aquaphor--WHOA, major lip chapping disaster!!! Oh, one more thing - my gums have been bleeding a little bit when I brush recently, but I think that might be due to the new toothbrush I got (I accidentally got a medium bristle when I always use a soft). I switched back to a soft and we'll make sure the bleeding goes away. :)

OK, happy holidays everyone and good luck to those who recently started!

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Awesome that you found that pill pack! I HATE not having everything perfectly planned out the way the derm palnned it!

I agree with Labgirl about the visine-get real tears or something instead.

Personally, I wear my contacts ALL the time and have little problem with dry eyes. I got some lens luybricant and use them maybe once/week...

Good luck-you're going to get super results!

Oh, and if you could post the link to that abstarct about the minicycline vs accutane,t hat would be great. There's a raging debate going on in the accutane forum ;)


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Foomph - Sure thing, here's the link to the abstract:


The full text is not available without a subscription, so it's not clear what the "conservative treatment" group got, although I think it's safe to assume some combination of antibiotics and/or topicals. Maybe I'll venture over to the accutane board and check out the discussion.

I did indeed end up getting some lubricating eye drops (I need to update my sig with the latest products), I got the Refresh drops that were recommended by LabGirl. It turns out I haven't needed them nearly as much as I thought I was going to... maybe once a week so far.

I'm not taking any other supplements or anything at this time, because I want to find out what my blood work looks like after a month - then I'll decide if I need to change anything in that regard.

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Day 30!

Wow, I can't believe it's been a month already... I thought this process would be more stressful or cause more disturbance to my life than it has so far. Of course, I haven't gotten the results of my first set of bloodwork since starting the accutane yet. I'm anxious to see how my liver is responding to the tane. My next appt is next Wednesday (the 3rd), so I'll be sure to update after that.

Anyway, currently the skin has sort of reached a plateau of ... dry yet pimply! :( I mean, it's dry as a bone all the time (except for after I put on my Cetaphil lotion), yet I am still getting new pimples. Probably ~1 new one every day that start off as just a really tender area, then the bump starts to form, then it gets really big for a couple days, until it finally sort of disappears one morning. So I'd say right now I'm getting about one of those every day pop up, and they last for probably 4-5 days, which means at any given time I've got 4-5 big ones in various stages of development on my face. :( They're not very red, just very BIG and sore. Earlier this month when my skin wasn't as dry I could still spot-treat these suckers with some BP overnight, but now my skin is so dry I definitely don't feel like touching the topicals. Actually I'm not even washing my face in the mornings now, it's so dry.

Aside from those cysts that keep popping up, I have this background of smaller bumps which are just very stubborn and don't seem to want to budge.

So, in summary, one month in, my face is definitely completely dry, but the pimples continue to appear despite the dryness, and it's generally pretty frustrating.

Side effects wise, nothing new to report. Same old, same old with lots of aquaphor and cetaphil.

Happy new year!

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DAY 37

Tomorrow I have my "month 2" derm appointment - yay! I am very excited about embarking on the second month of my journey. Month 1 had its highs and lows--overall, here is how I would summarize my response thus far:

Week 1: dry lips, fewer pimples

Week 2: skin dried up

Week 3: skin pretty much clear and dry

Week 4: pimples returned

Week 5: pimples continue to crop up, leaving skin almost pre-tane only with dryness.

I am also somewhat anxious to get the results of my one-month bloodwork and see if the TG's are going up and see if my total cholesterol is elevated again. Since I found out I have high cholesterol a month ago, I've been eating better than I used to, although there's still room for improvement, so I won't feel totally hopeless if it hasn't come down a whole lot.

Currently I have 5 cysts in various locations on my face (chin - 2, temples - 2, between eyes - 1 OUCH!). Other than that my skin still has its background tiny bumps in various locations as well. So overall, right now I would rate my skin a 4/10. Not good. But at least I am hopeful that it will eventually clear for good. I am very happy with how the oil has dried up and remained dry, which makes my makeup look 100 times better and last longer too. And other people say they can notice a big difference in my skin, too.

Well, here's to a new year and a new month of tane!

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