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Accutane: Yes or No?

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I am aware that nobody but myself (and my dermatologist) can decide whether or not I should take Accutane. But please tell me what you think about my skin. All comments are appreciated, especially those of people who have taken Accutane: Was your skin better/worse when you decided to take Accutane? What would you do if you were me? Is my acne a case where it is "justified" to take Accutane?

A note to the picture: I am using Azelaic Acid (Skinoren) at night and Erythromycin cream during the day, so this is as good as it gets with creams. Dermatologist offered to prescribe Accutane, but I am afraid of side-effects.

Thanks for your advice!

ps: I am 27(male), so growing out of puberty didn't do it for me. I am really really upset about my skin and emotionally suffering from it.

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That is a moderately bad case of acne. I would absolutely talk to the derm about accutane, considering you are breaking out ALL over. Yes there are side effects to accutane, some much worse than others. What you need to do is weigh risk versus reward. I would take accutane in a heartbeat if I could get a prescription. My acne is under control but I see topical therapy as very annoying and time consuming and it doesn't make your skin look very healthy. Accutane modifies HOW your skin works, making it function like a non-acne sufferer. It doesn't get any better than that. MANY people have success with it.

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If I was offered accutane, I would take that offer in a heartbeat. Your acne is moderate, I would go for it especially since it's affecting you emotionally.

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Thanks for your replies. Seems like you all agree with my dermatologist that I should consider Accutane. I have an appointment with another dermatologist on monday. I'll see what he says.

I know I am "fishing for negative replies" here, but is anyone in here thinking Accutane is not indicated in my case?


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I'm so extremely pissed off. It's never been that bad:

Look at this. It's everywhere. If it was at least concentrated on only a few parts of my face I could apply the (useless) stuff I put on my face more easily. But like this I have to spread on my entire face. F... this!!!

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If what you're trying right now is not working (and it looks to me like it obviously is not)

then you should try something else!! And do it now, don't continue with a regimen that doesn't work!

Have you tried the acne.org regimen yet?

you can find all the ingredients for it at your local store (then if you find it works for you,

you could then get a larger and cheaper supply online).

I've definitely had success with benzoyl peroxide, but it also has side effects.

dry skin, irritation, redness, sensitivity to sun (which when you think about it could lead to premature aging of the skin).

But accutanes side effects scare me also.

MY recommendation, which is only based on my limited experience and knowledge.

Would be to try another regimen that's known to work well(such as the BP acne.org style),

and if it works FOR YOU then stick with it for a while, you can always go with accutane later on.

And what I mean by "if it works for you"

is that, if you can deal with the regimen itself. IE applying cleanser, then applying tons of 2.5 BP, then moisturizing, then wearing sunscreen if you go in the sun. Because even if it clears ur acne you'll need to deal with that stuff.

You might find that it's not that hard to deal with at all, and something you can stick with long term. OR you might find it a big pain in the butt and then maybe it's time for accutane.

OR it could also not fix ur acne, which again.. time for something else.

Can you give us some history about you and what other treatments you've tried up to this point??

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If you are hesitant about Accutane, you should consider:

How long have you been using these topicals? Have you used others for more than a month or so to see if they work? Like BenzaClin, Differin, Retin-A etc? Oral antibiotics? Different combinations?

I know it is frustrating waiting what can turn out to be years to see if different prescriptions work for your skin.

Also, it looks like your acne is pretty superficial, but it may just be the picture. If it is scarring or if it starts to scar, I would definitely do Accutane.

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Sorry, this is a bit longer:

Thanks for your detailed answer, Tad. You are right it's definately not working. Right now I use Erythromycin during the day (product is called "Inderm") and Azelaic acid during the night (called "Skinoren", both German products). I am 27, male, and have been dealing with this for over 10 years but it has never been as bad as in the last few months. Part of this, I am sure, is stress as I finally handed in my MA thesis, had several exams (and still a few to go)...

I tried to figure out whether my diet might be the cause. So for some time I quit consuming coffee, sweets, very greasy stuff and, on the other hand, have tried to eat more fruit, vegetables etc. I drink a lot of water, hardly any alcohol, do not smoke, do exercise regularly.

Problem for me is that my skin is and always has been very sensitive. This, I believe, is uncommon first of all with men but also with acne patients (probably not too uncommon on this board though). Several dermatologists have told me to use BP. I must honestly say that I have never tried it longer than 2 weeks as it really "burned" my skin. I became extremely (!!!) red after a few days, even though I used 2,5% BP and not very much of it either. Last time that I tried it was after christmas. On new year's eve, I was on a party and people kept asking me why my face was so red. It looked like I had a terrible sunburn. In some places my skin even burst open. So I, again, quit using BP after only a short time.

I have been using my current regimen for 5 weeks as it is right now. I have used Erythromycin much longer (several months) and added Azelaic acid five weeks ago when I went to the derm after breaking out terribly. In the beginning, Erythromycin worked well. But now, after several months, I have the feeling, my p. acnes has become resistent (don't know whether this is the scientific way to express is, but you know what I mean). Azelaic acid has apparently faded some of the redness of old spots but hasn't done anything to prevent new ones. I know it has only been five weeks, but in the packaging, it says that you should go see your derm if you do not have significant improvement within four weeks. I haven't seen any improvement at all.

Apart from my current regimen, I have taken Minocycline pills. It worked really well and I was clear after about ten days (except of course for red marks). But as you are not supposed to take those longer than let's say 6 weeks or so, I really do not see the use of oral antibiotics in acne treatment. You can only use them for a very limited time and after one stops taking them, you are back to where you were before without any improvement at all. I cannot understand that theses meds are even licensed as acne (!) medication.

As you might have read in my previous posts, I am thinking about Accutane. Dermatologists have been in disagreement in my case. One keeps saying it's a last resort and not indicated in my case, another one has offered it after seeing me the first time and I think the one I am going to see on monday is going to offer it as well as he made remarks in that direction last time I saw him. I really don't know what to do though. I don't have a problem (or so I think) dealing with short term side effects during treatment. But I am afraid of long term effects. I am afraid I will ascribe anything that happens to my body to Accutane even though it might have nothing to do with it. Just imagine, as an example, you take it and in a few years you might need glasses. It is very common for people to have problems with their eyes as they get older. But, even though I know that, I might ask myself whether this was due to me taking Accutane. And this is just one example. The same thing applies to let's say problems with your bones/joints, your skin in general, digestion etc.

On the other hand, I really don't see any improvement with topical treatment of my acne. And just look at the pictures, I am 27, have quite an amount of acne and am about to (finally) start working (in an evironment btw where people are very conscious of appearance).

Had I know back with 16 or 17 that I would suffer so long from acne, I would have taken Accutane immediately, as acne really reduced the quality of my life during school and especially university. But back then, people kept telling me things like just wait, it's puberty, you will grow out of it by the time you are twenty or so. If I could look into the future and see that I still have acne in 10 years I wouldn't hesitate a second and take Accutane. But somehow, I am still hoping for it to become better, even though, right now, it's only getting worse.

I'll see what the dermatologist is going to say/prescribe on monday. If he wants to give me antibiotics again, I will decline. In that case I guess I will give the acne.org regimen a real (!) try for a longer time. If I don't see any significant improvement with it by fall, I guess I will go on accutane.

I hope someone reads this and gives me a short feedback. Thanks!


kmk621, thanks for your reply. You are right, my acne is very superficial and (luckily) not leaving any scars. But what upsets me is that it is everywhere. I know, people with deep cystic acne would prefer my kind of acne. But it makes topical treatment really difficult as I have to spread the meds over my entire face. This, during the day, leads to my skin feeling very greasy, which is a very uncomfortable feeling if you are out all day and have no means of washing.

So far, no one has prescribe topical retinoids even though they are available in Germany. I don't know whether this is due to me complaining about BP being to aggressive on my skin!?

Another thought is, Tad has said something similar, that all the acne routine is "a pain in the butt". Of course it is better than having to worry about side effects of Accutane. But the topical treatment really reduces the quality of my life. Take camping as an example. I really don't like doing it because caring for your skin is almost impossible and one wakes up with white heads and sometimes you don't even have a mirror and running water. The same thing is with sleeping over at other people's places. The girl you picked up last night will find it either strange that you get out your BP lotion before going to bed or she will disappointed in the mornig when she wakes up to a guy with several pimples. I know, this (unfortunately :)) doesn't happen every day. But nevertheless, acne just took spontaneity out of my life a long time ago.

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I am definitely not a doctor, but just throwing this out there since you mentioned how sensitive your skin is-- what about rosacea?

A lot of people with it get acne or acne like blemishes. There is a section on the board with some info. I think there are slightly different topicals for it than regular acne. But, Accutane I think is still the closest thing to a "cure" for it as far as I know.

Also if BP irritates you, in the future (if you haven't already) you could try a little tea tree oil diluted in water. It is gentler but has a slightly milder antibacterial effect.

I really feel your pain. I am about to graduate from law school and have to go into the "real world" with acne prone skin. Whatever you choose to do, good luck!

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I think whether you take it or not, check out some of the diet suggestions in the natural/holistic message board. For some reason westerners get way more acne then other cultures, and it is probably diet.
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Thanks for your replies!

kmk621, you are right. I have thought about Rosacea too. I will ask my derm on Monday. It would be a shock though, considering that I have seen at least 10 different dermatologists in the last ten years and none of them has ever said anything about Rosacea. There is actually quite an amount of redness in my face. On the other hand I don't have symptoms like unususal tissue formations or flushing. But my skin IS very sensitive. I will see on monday. Good luck to you too!!! Law school? Then at least you will earn a lot of money :D

Alternativista. It was interesting to read your diet. I don't eat Oranges at all. I understand that's not what you meant though. I have tried changing a few things in my diet. So far I haven't found the/a "culprit". I guess my diet could be healthier, but honestly I find it very hard. There are so many things people will tell you cause acne that I doesn't leave much to eat. I am already quite skinny too and trying to gain weight. But here is one thing I am pretty sure of: Whenever I drink alcohol, ie beer, I find that the next (already) my skin looks much better. I don't know whether this is due to ingredients of the beer, relaxation while being drunk, going to the bathroom more often... But drinking beer every day cannot be a solution :)

I will keep you updated about what the derm told me!

Have a nice weekend!

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I've been taking doxycycline for 5 months. 50mg a day. I've done so in the past and my doctor has no problem with it. I also use skinoren cream occasionally. I've never had any bad reactions to antibiotics so if you're afraid of accutane, I would go back on minocycline (preferably doxycycline because its has less effects, though I don't have any at all).

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I was offered that stuff years ago and just had a bad feeling about it. (Suffer for occasional but bad acne cysts and general acne) I havn't had a break out for a while of cysts. I saw something about the increased use of cotton seed oils in foods and people sensitive to it. I have been very carefull about not eatting anything with it...not sure if it helped, but havn't had any break outs of cysts since I started watching that, knock on wood

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Unbelivable! I do have my derm appointment in 2 hours. When I woke this morning I went in front of the mirror: Not a single active (!) pimple! WTF? I mean of course this is good, but my skin was crap the last weeks/months and now that I have an appointment it is very good. Spent a lot of time in the sun the last two days...maybe that was it. Will see what the derm says.

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Well he scraped some bits off of my skin, returned after a few minutes and told me my skin was heavily colonized with bacteria. He took another sample to send in to a lab for cultivation and examination. Prescribed DUAC and told me to see him again three weeks to see what the lab says about the bacteria on my skin and where to go from there. Mentioned that half a year of Accutane might be possible. He also said something about possible yeast fungus etc.

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Just wanted to pipe in with my experience. I had good luck on BP when I was a young teenager, but when I tried to use it in my late teens my experience was not the same. My skin had become more sensitive and I actually got a chemical burn on the portions of my face that came into contact with the BP. I got angry little bumps, severe redness and then dry patches after a couple days. I'm posting all of this to just say be careful with topicals if you've already experienced skin sensitivity while using them.

With my sensitive skin I decided to go to an all natural skin care regimine that is working very well. I'm about 95% clear now and have not had any cysts for at least 2 months. I used to have at least 1 active cyst at all times prior to making the change and I really think the cysts were a result of my skin being too dry.

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After only one day, DUAC is actually working quite well in terms of acne. But my face looks like that of a lobster- colorwise :) .

So, ClareB, what is it you are using? The -intensly discussed- theory that one should leave their face alone, i.e. not wash with harsh cleansers etc., always sounded quite convincing to me. But whenever I did it, e.g. on a vacation, I broke out pretty badly. I know that I do have very sensitive skin but I don't think that this is what causes the acne. It is just like people telling me that one doesn't get acne from not washing their face. It is a half-truth. Of course somebody with regular doesn't break out when he doesn't wash his face. And, of course, someone who has acne doesn't necessarily NOT wash their face. But whenever I don't wash my face, I break out badly. So, washing my face only once a day is simply impossible (objectively as I see acne increasing and subjectively as it doesn't feel good).

I can't wait to get the results from the histological tests. In the end, it is some kind of yeast fungus. If that's the case, I am going to beat up every single dermatologist I have ever seen. No seriously. I really wonder what causes all this. It seems as if the amount of people who are suffering from acne really has increased. Or at least this is what it appears like. Thus, genetics would only be one part of the explanation. I don't know what else. Diet, stress, environmental pollution... What upsets me is that everyone keeps saying something different. Of course this happens on an internet message board. This doesn't surprise me. But what upsets me is that dermatologists keep saying different things as well. For everyone saying that certain foods, sunshine and stress are bad, I find one telling me that none of these affect your skin or are even positive, e.g. sunshine. It seems so strange that in the face of the many things science has achieved, there is still no cure for this.

I wonder why, at my last derm appointment, it was the first time ever he made a swab of my face to send it in for a histological examination. I have been seeing derms for over ten years. So if this would really yield new results, I would ask why TF nobody has ever done it before.

Has anyone of you ever had their derm send in "samples" from your skin to a lab? If yes, what were the results?

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Are you still checking out accutane? There are other possible long term side effects (besides birth defects) your Dr should give you info before prescibing it so you can make an informed choice. Your doctor may want to try some other stuff before accutane, also if I remember correctly for insurance to pay there needs to be a history of severe acne. From what I have seen/heard from Dr's and misc people on boards it helps long term with cystic acne in most cases but not long term with regular acne. It looks like most of what you have is "regular" acne. Cysts are under the skin and are almost more like boils. Try some baking soda scrub, gentle cleansers like cetaphil. Maybe SA and BP is too much for your skin, I have seen people break out in rashes from that stuff. I have also had good luck with some serums from MYChelle skin care line, took atleast 1 month to notice any difference. (got on line, mucho $ but 1 bottle has last almost 1 year)

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Izzi, I am sorry for not replying sooner. I am still not sure about Accutane. I must say I have become more sceptical in the last few days. Many people who have used it not only report severe side-effects but also that their acne returned shortly after their treatments or a few years later. I still don't know how common the relapse is. Of course, people with severe side-effects and relapses are more likely to go online and write about it, which somewhat distorts the actuall success-rate of Accutane as you don't hear from people who didn't have problems. Nevertheless, it has scarred me off a bit.

It's strange. Sometimes I think that I will definately go on Accutane, at other times I think I would never ever do it. But I think, for me personally, the smartest thing to do is to wait until I am 100% sure I want to take it. That hasn't happened yet. Also, DUAC is working pretty well and I want to give The Regimen a real (!) try before I go on Accutane. So, for now, I think I am not going to take it. I have a derm appointment in two weeks. I will the results from the histological tests. Can't wait to hear what's living/growing on my skin...


ps: Could you please give me a link to the products you mentioned!? Thx.

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Being a person who is currently on Accutane, I say GO FOR IT!!

I didn't go on it for so many years because I was afraid of the side effects I could potentially have, but I've been on 40 mg since December, and 60 since March, and I can't believe how amazing its working. I can finally go out without any kind of makeup on. My skin isn't red anymore, the acne is almost gone, and I haven't had one side effect except for a minor fatigue, which I only experienced for the first few weeks.

Going on Accutane was the best decision I've made about my skin thus far. I mean, I can't say for sure, but I think you'd have equally awesome results if you were to start taking it. It's completely worth it.

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