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Accutane 6-month Treatment DONE on 10/5/09

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Treatment Recap

DONE! :dance::dance::dance::dance::dance::dance:

I ended my 6 month course of Accutane (40mg for 2 months; 80mg for 4 months) on 10/5/09. I started with moderate nodulocystic acne (although I had no actives on the day I first started), was basically free of serious acne by Week 11, and finished clear at the end. Being clear was no surprise to me because I knew that Accutane would work – the real concern was whether I'd develop serious side effects and whether the results would be permanent. I didn't develop any serious, unexpected side effects and we'll see whether the results will be permanent (knock on wood!).

Below is a log of my results:

Week 1: 4 new zits (3 small, 1 medium)

Week 2: 5 new zits (3 medium, 2 small)

Week 3: 3 new zits (1 large, 2 small)

Week 4: 1 new zit (1 medium)

Week 5: 1 new zit (large and oozy)

Week 6: 0 new zits (bug bite)

Week 7: 2 new zits (both tiny)

Week 8: 2 new zits (one tiny and one large)

Week 9: 0 new zits (bug bite)

Week 10: 2 new zits (1 tiny, 1 medium)

Week 11: 2 new zits (2 small)

Week 12: 1 new zit (small)

Week 13: 0 new acne

Week 14: 0 new acne

Week 15: 1 new zit (tiny)

Week 16: 1 new cyst (small)

Week 17: 1 new zit (tiny)

Week 18: 2 new cysts (small)

Week 19: 0 new zits

Week 20: 1 tiny zit (maybe razor bump)

Week 21: 0 new acne

Week 22: 0 new acne (2 new razor bumps?)

Week 23: 0 new acne

Week 24: 0 new acne

Week 25: 0 new acne (2 razor bumps?)

Week 26: 0 new acne (2 minor under-the-skin bumps)

Week 27: 0 new acne

Currently, I have no active acne and I haven't had a legitimate, certifiable papule, pustule, nodule or cyst since Week 11. I have had some minor red bumps around my chin and jaw but I believe they were razor bumps (which I never got pre-Accutane) because I noticed a hair follicle in them and when I switched from a blade to an electric razor, this solved 80% of the problem.

I have many minor PIH spots that probably won't go away but I'm okay with this. I have 2 moderate sized PIH spots – one from a cyst that died the day I started Accutane and one from a major pustule that I popped around Week 6. So it seems clear that Accutane makes your PIH spots last longer.

My current side effects are moderate flushing (which comes and goes), dry flaky skin (addressed with constant moisturizing), dry eyes (I apply drops maybe every 3 days), minor hair shedding, some eczema-like patches on my arms and hands (addressed with moisturizing), dry insides of nose (addressed with Aquaphor), and dry peeling lips (recently, even Aquaphor hasn't helped with this, this is the worst side effect for me). These side effects began within a few days of treatment and stayed constant throughout. The only side effects that were one-off temporary ones were a minor stomach pain and itchy skin.

Post-Treatment Update

I will update my long periodically (moreso in the next few weeks) to describe how long it takes for the side effects to diminish and to document any post-treatment relapse of acne. I CANNOT WAIT until my lips turn to normal. From everything I've read, it seems that it takes anywhere from 3 to 6 weeks for Accutane to leave your body and side effects to disappear. My final update will probably be around mid-March 2010, since Feb/March is when I've tended to have my worst outbreaks.

Advice for People Considering Accutane

1. Severity of Acne and Effect on Self-Esteem

I started Accutane at age 33 because, although I had mild to non-existent acne throughout high school and my 20s, I only started developing serious, persistent nodulocystic acne around age 31. I knew it was serious because it affected my self-esteem and adversely influenced my social life and work, like avoiding social engagements and work situations. Everyone reacts differently to acne and some may freak out even if they only have mild acne that prevents flawless skin. But because Accutane is such a serious drug, I'd recommend that you only consider it if you have persistent, nodulocystic acne that affects your life in more than a marginal way.

2. Go to a Dermatologist Immediately and Stay Consistent with Other Treatment First.

I say this not because I think other treatments are really effective. I tried oral antibiotics, topical antibiotics, topical retinoids (like Retin-A, Differin, Tazorac), and other OTC stuff like ProActiv and they only worked for a limited period of time. But typically, the only way a dermatologist will prescribe Accutane is if everything else has failed. I recommend that as soon as you think acne will be a problem, go to an Accutane-prescribing (some don't because prescribing Accutane is a bureaucratic headache for them) dermatologist immediately and get set up on a NON-Accutane treatment. It may take a year for you to discover that stuff like Retin-A doesn't work but at least at that point, you can tell the dermatologist that you've tried everything.

3. Accutane May Sound Scary But DO IT!

I started Accutane about a year later than I should have because (a) it sounded scary and (b) I let my non-Accutane prescribing dermatologist dick me around with other topical treatments. There are always risks in life but clear skin and improved self-esteem is worth almost any price. There are hundreds of thousands of former acne sufferers who have benefited from Accutane so the evidence is clear that it works and the medical community approves of its use.

4. The Cumulative Dosage of Accutane is Key.

Most medical studies show that the factors that may increase the chances of acne relapse after your Accutane treatments end are: (1) young age at initial treatment, (2) acne on both face and body, (3) severity of acne, (4) family history of acne, (5) history of prepubertal acne, (6) cumulative dosage lower than 120 mg/kg, and (7) high sebum excretion rate. The ONLY factor you have any control over is cumulative dosage so focus on that.

120 mg/kg means that for every kilogram you weigh, you need 120 mg of Accutane. For example, I weigh 57 kg and I took 40mg for the first two months and 80mg for the last four months. 40mg x (60 days) + 80mg (120 days) = 12000 total mg. 12000mg/57kg = 210mg/kg cumulative dosage. You can see that 210mg/kg far exceeds the recommended minimum of 120mg/kg. But since cumulative dosage is the only thing I have control over (dermatologist willing), I made sure I took as much as I could.

My dermatologist, who was one of the pioneers of using Accutane for acne, says that typically 40mg over 6 months should be enough for the average acne patient. But if your dermatologist is willing and you are as well, I'd recommend the highest dosage, especially for people who weigh more. The side effects may be slightly worse but wouldn't you rather deal with slightly higher side effects and be done with it in 6 months rather than have a higher chance of relapse down the road?

Best of luck to everyone!

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Thanks for the support.

My derm has prescribed Differin and Cleocin (topical antibiotic) for maintenance after Accutane -- I wonder how many of you post-Taners are on a post-treatment topical regime?

I feel absolutely great and you'll have to trust me since I don't have pics, I'm looking good too.

Let's see how soon these chapped lips and other side effects disappear!

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Week 1 Post-Accutane


This past week, I've had one tiny pustule on my chin that was gone in a day and a small cyst on my left jawline that just formed today. This cyst is NOT an auspicious start to my post-treatment period -- especially since I've haven't had a jawline cyst in about 4 months. Let's see how this one progresses -- it's red and small in size but it doesn't hurt and is not inflamed.

Side effects

Dry, flaky skin around mouth and arms still going strong. The severity of chapped lips has gone down maybe 40%.

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Week 2 Post-Accutane


Still clear. A couple minor blemishes around my chin that disappear in a day.

Side effects

I went one day without moisturizing to see what would happen. At the end of the day, I had some dryness around my mouth, it looked like I had just eaten a powdered donut. Other than that, I'm okay.

I still have dry eczema like patches on my arms and neck.

Joker lips disappeared on Day 7. My lips are about 80% normal now, I only apply light aquaphor in the mornings and evening and I don't have to worry about reapplying during the day.

My ankles are still sore when I get up and walk around.

Overall, very happy with the results. I was prescribed Differin and Clindamycin for maintenance but I didn't get the Differin yet (it costs too much!) and I've only applied the Clindamycin once.

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Just wondering, how did you convince your derm to give you that dosage? I was prescribed Accutane from my family doctor and my cumulative dose only ended up being 116 mg/kg. There's no way she would have given me more than that, haha.

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I didn't need to do any convincing. My derm, who was one of the pioneers of Accutane usage for acne treatment, initially put me on 40mg for 5 months -- he says that this dosage is the average amount for a successful treatment. After two months, however, I still had some current actives so he increased the dosage to 80mg.

Some dermatologists may be more conservative in how much Accutane they prescribe. But if they ever give you the option of increasing the dosage or extending the course another month, go for it -- unless you're responding really well to the current dosage amount. Ultimately, you want to shoot for 120-150mg/kg. I think I may have overdone it at 210mg/kg but I was handling it okay and I wanted to make sure that I never get acne again. Good luck!

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Thanks for the nice words, folks.

Week 3 Post-Accutane


No current acne. One tiny pimple around my mouth during the past week. Seriously, this is the best I've looked and felt in the last 3 years!

Side effects

Okay, I'm gonna go through all the side effects I had during treatment and see if they've disappeared since ending treatment.

Blurry vision -- 100% gone

Back stiffness -- 90% gone

Sore ankle joints -- 70% gone

Dry hair -- Not sure. I cut my hair short so it's hard to tell.

Some hair thinning -- Seems to have stopped, not sure.

Dry, stinging eyes -- 80% gone

Dry patches of skin on neck, hands and arms -- 80% gone

Peeling, flaking facial skin around eyebrows, nose, mouth, chin, ear -- 80% gone

Dry insides of nose/bloody nose -- 80% gone

Irritated, cracked skin around edges of eyes -- 100% gone

Cracked edges of lips -- 100% gone

Dry, peeling lips -- 90% gone!

Flushed, red facial skin -- Let's say 80% gone but occasionally comes back at certain moments

I only moisturize once a day now and apply Aquaphor on lips in minimal amount once a day.

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It's been a little over 3 months since I stopped the Accutane treatment so I thought I'd provide an update.

The good news: I've been 90% clear during this time and the acne I did get were tiny ones that weren't inflamed and basically disappeared in 2 days. I am getting a few zits on my scalp near my hairline that are small and not inflamed but they last a week or so. Overall, I haven't gotten anything that made me think, I can't be seen in public like this! So I've been feeling fantastic and the best I've felt in a long time.

The bad news: This morning, I got my first acne in 3 months that was fairly significant. It's on my right lower cheek. It's also the first one where there is some minor pain involved and redness associated with it. The sky isn't falling just yet but I don't know yet if this one is just an outlier or exception or the start of a troubling return to acne. I guess I won't know for another few weeks. I'll provide another update once I get a sense of where this is going. The frustrating part is that I wanted to be 100% cured of significant acne but it looks like that may not be the case.

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It's been a little over 6 months since I ended my Accutane treatment so this will be my final update ever (unless some unforeseen disaster happens!)

I would say that I am about 95% cured -- not perfect but definitely acceptable. The frequency of acne has gone down tremendously (maybe twice a week) and the intensity has gone down as well. This means, even the acne I do get is always small and those that seem like they'd develop into massive cysts one year ago, disappear in a day or two. I have not had a single massive cysts or nodule in the last six months (and even longer since I didn't get a single large cyst or nodule in the last 3 months of my treatment). The pain of having acne is so ingrained that I still can't believe that it's been 9 months since I had a bad acne .

The oil has come back on my face but maybe only 33% of what it used to be like.

Overall, this whole process has been exactly what I bargained for. I knew there would be some rough moments, especially the red face, the peeling lips and skin, the lack of alcohol consumption, and the constant drinking of water -- but it has absolutely been worth it.

Good luck to everyone! Accutane has been a life saver and I will recommend it to anyone.

Edited by Paco
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Wow thank you so much and Congrats!!!!!!!! You have just inspired me with all your usefull information!! I have another 2 months to go and you just made it seem easier for me to plug through with it!!

Wishing you nothing but the best now and always!

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Oh I was going to ask you. I am about 52kg-53kg in body weight. fairly light!! I have been fighting with acne for a long time now. Started in my early twenties!

Im getting married in July this year, and of course wanted to be clear :) When I started accutane in february my derm put me on 40mg the first month, 2nd month was 40mg one day 80mg the next!! According to my weight, I need approx 6625mg of accutane to finish my day!

I asked her kindly to bump me up to 80mg daily as I wanted to be done my course well in advance before the wedding, in which case by doing this, I should be done the end of may!! This will give me about a month of recovery!!

Do you think its ok to be on 80mg daily according to my weight? I just thought it would essenitially speed up the process :) What do u think?

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