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wshewfelt

What to say to derms to get accutane prescribed?

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So I've had extremely oily skin for the past 2 years and my acne is getting worse but it's definitely not the severe type yet. Basically, I went to the doc today and she wants me to go on tetracycline and retin-a. She won't even consider accutane anytime soon. She doesn't think very oily skin and moderate acne are serious enough. She recommends just washing my face 3 times a day. IS SHE CRAZY!!!! thats the same shit ive been hearing for years. Do you think I should just go check out some other dermatologists and see if they'll prescribe accutane? What kinds of things should I say to them that might help me to get it prescribed? Would it be a good idea just to call them up and see if they prescribe accutane for oily skin?

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I don't think there is any magical phrase to have it prescribed. Personally, I think demanding it of them has a tendency to put the doctor off.

I do sympathize with you because I am in the same boat. I have moderate cystic acne which many others do not think is bad but to me, it's awful! We are our own worst critics!

My derm has been working with me on and off since 2004 ( some time lapses of several years due to relocation).

As you probably already know - Accutane is reserved for only severe cases or those that have not been helped by other therapies.

I started Accutane last month. Is my acne severe? No. Have I , literally, tried everything on the market? Yes. Which is why my doctor put me on it.

What the dermatologist you saw did, did so responsibly. Instead of exposing you to severe health effects, they want to try other things first. Remember, you and your doctor are a team. Doctor shopping because you don't get the answer you want, is not the solution to your problem.

Work with your current derm, provide a list of all medications you've tried and for how long you took them. Remember Accutane is the last resort.

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hmmm.... the only reason i was prescribed Accutane was because my acne was persistant and wasn't clearing up with any medication. my acne wasn't severe at all, just moderate. So chances are if the Retin A and Tetracycline doesn't work then you'll be given Accutane.

I know it's tempting but please don't rush into Accutane. I have PERMANANT side effects from it. did it clear my acne ? yes. did it also give me awful facial eczema and hypersensitive skin ? yes as well.

Give these pills a try first, they might work well. :)

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Thanks for the replies and concerns:) Well, my infatuation with accutane is because my sister was prescribed it 2 years ago and her acne was identical. She had gone through all kinds of treatments but accutane was the one for her. It made her look amazing and her only side effect now is dry lips. I don't see how antibiotics and low percentage retin-a are gonna help my oiliness and acne. I really don't want to have to constantly apply topicals and take antibiotics when I could go on accutane and have my problems gone permanently.

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What I would suggest is discussing your condition with your current dermatologist a little more, let her know how it's affecting you and be stern. But before I suggest that, what other treatments/medications have you tried? I'd really have to know that first.

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All you really have to do is express how deeply your self-esteem is being effected by your acne in a negative way, and tell your derm you've been depressed as result (And would therefore like to elect to go on Accutane as soon as possible in order to gain back drastically needed confidence).

If after telling your derm that stuff they STILL insist you go on Retin-a and crap.. You need to seek out a new derm and tell them that.

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@Renegade Angel well that's where the derm always gets me. I've done all the OTC stuff but not much prescription stuff. So far I've only done the retin-a and tetracycline stuff that I was just prescribed. I saw how long it took my sister and how many meds she tried before she finally got clear on Accutane and I just really don't want to have to go through that process when we could just jump past all the bs and get the Accutane. I know that's not how derms like to do things, they have their protocol where they must offer all the other treatments first, but that takes such a long time and I feel like its pointless. They want to protect me from all the horrible Accutane side effects, I know, but my acne and oiliness are so much more painful than any side effect could ever be.

@Jxr Thanks for the advice, but isn't that a bad idea? The last thing a derm wants to hear is that you're already depressed, right? Because they'd expect if they put you on accutane, you'll probably kill yourself lol. But I understand telling them how low my confidence has become, because that's definitely true. My line of thought is that if I weigh the "side effects" of accutane, and the way my acne makes me feel, acne beats side effects easily. It's just so hard to get through to derms that think they've seen it all and that I don't know what I'm in for.

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Demanding Accutane from your physician won't do you any good, or bad. She wants you to go through all the other treatments because Accutane is a dangerous drug, there is no denying it. She would rather go through all the other treatments and make sure nothing else works before prescribing you it, because Accutane is considered a "last ditch" effort to get rid of acne. My advice to you: Go through the treatments she gives you, until she gives you Accutane. Simplest and safest thing to do. If topicals, and anti-biotics don't work for you, she should prescribe you Accutane.

Be patient with it, and good luck.

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Demanding Accutane from your physician won't do you any good, or bad. She wants you to go through all the other treatments because Accutane is a dangerous drug, there is no denying it. She would rather go through all the other treatments and make sure nothing else works before prescribing you it, because Accutane is considered a "last ditch" effort to get rid of acne. My advice to you: Go through the treatments she gives you, until she gives you Accutane. Simplest and safest thing to do. If topicals, and anti-biotics don't work for you, she should prescribe you Accutane.

Be patient with it, and good luck.

Thanks for the reply. I understand her concern and yours in trying to avoid accutane. I know it's usually the last choice and it might be a better idea to use other, "safer" (less effective) treatments first. However, it's really a lifestyle choice. I'm not willing to keep trying topicals and antibiotics that you have to constantly use to control your acne. This type of treatment may last years. I NEED to get RID of it. I plan to begin traveling soon and I'm not planning on bringing topicals to lather on my face and antibiotics. I am absolutely set on accutane and that is the only option I have in mind. That being said, my real question is what are the most powerful statements I can make that will increase my probability of being prescribed accutane? If you tell a doctor you have used certain prescription treatments before to no avail, do they check medical records or contact other doctors? I really need help on this.

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Trust me, I understand what you mean, it's incredibly frustrating to have someone tell you to try dozens of products(and let's be honest, half the time, it is a waste).

You should really emphasize how your acne is effecting you emotionally, and let her know that the products you've tried so far have not worked for you. Also, express that you understand the possible effects of accutane, but that you believe it is a more aggressive medication that may provide you with permanent results, versus other medications that only work short term, or as long as you continue their use. Just be very clear that it is what you believe will be right for you without sounding arrogant or too stern.

If after this she still won't budge, I'd seek another dermatologist. I know some people may say that the doctors are only doing this to ensure that you've exhausted options, but in my opinion, accutane really isn't as dangerous as people make it out to be. Yes there are possible side effects, but how many people actually suffer from these extreme effects? Most only get dryness, or at worse, joint pain. I'd take both over acne and scarring any day, and I'm sure you would too. I just think these doctors either don't want to make the effort, or just like to jip you out of your money before resorting to a medication known for its high success rate. Just my two cents.

Edited by Renegade Angel

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Trust me, I understand what you mean, it's incredibly frustrating to have someone tell you to try dozens of products(and let's be honest, half the time, it is a waste).

You should really emphasize how your acne is effecting you emotionally, and let her know that the products you've tried so far have not worked for you. Also, express that you understand the possible effects of accutane, but that you believe it is a more aggressive medication that may provide you with permanent results, versus other medications that only work short term, or as long as you continue their use. Just be very clear that it is what you believe will be right for you without sounding arrogant or too stern.

If after this she still won't budge, I'd seek another dermatologist. I know some people may say that the doctors are only doing this to ensure that you've exhausted options, but in my opinion, accutane really isn't as dangerous as people make it out to be. Yes there are possible side effects, but how many people actually suffer from these extreme effects? Most only get dryness, or at worse, joint pain. I'd take both over acne and scarring any day, and I'm sure you would too. I just think these doctors either don't want to make the effort, or just like to jip you out of your money before resorting to a medication known for its high success rate. Just my two cents.

Thanks:)What I've been trying to do is compile a list of things that doctors look for most when prescribing accutane and address those. I'm planning on saying something to the effect of "I have extremely oily skin and acne, I've tried all the antibiotics and topicals like tetracycline, minocycline, retin-a, differin and they had no effect on my acne whatsoever. I need accutane. I've done lots of research, I know the side effects and I'm not discouraged. I'm not going to be persuaded from Accutane. Because of my acne I have very low self-esteem, it's shattered my confidence and its basically ruined the quality of my life. If you can't prescribe it, I'll go elsewhere."

Do dermatologists insist on contacting your past doctors and derms or do they take your word for prescriptions? That's what I'm worried about.

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Trust me, I understand what you mean, it's incredibly frustrating to have someone tell you to try dozens of products(and let's be honest, half the time, it is a waste).

You should really emphasize how your acne is effecting you emotionally, and let her know that the products you've tried so far have not worked for you. Also, express that you understand the possible effects of accutane, but that you believe it is a more aggressive medication that may provide you with permanent results, versus other medications that only work short term, or as long as you continue their use. Just be very clear that it is what you believe will be right for you without sounding arrogant or too stern.

If after this she still won't budge, I'd seek another dermatologist. I know some people may say that the doctors are only doing this to ensure that you've exhausted options, but in my opinion, accutane really isn't as dangerous as people make it out to be. Yes there are possible side effects, but how many people actually suffer from these extreme effects? Most only get dryness, or at worse, joint pain. I'd take both over acne and scarring any day, and I'm sure you would too. I just think these doctors either don't want to make the effort, or just like to jip you out of your money before resorting to a medication known for its high success rate. Just my two cents.

Thanks:)What I've been trying to do is compile a list of things that doctors look for most when prescribing accutane and address those. I'm planning on saying something to the effect of "I have extremely oily skin and acne, I've tried all the antibiotics and topicals like tetracycline, minocycline, retin-a, differin and they had no effect on my acne whatsoever. I need accutane. I've done lots of research, I know the side effects and I'm not discouraged. I'm not going to be persuaded from Accutane. Because of my acne I have very low self-esteem, it's shattered my confidence and its basically ruined the quality of my life. If you can't prescribe it, I'll go elsewhere."

Do dermatologists insist on contacting your past doctors and derms or do they take your word for prescriptions? That's what I'm worried about.

That's a great way to get your point across! As far as the last bit, I have no clue whether they go through your background. Hopefully someone else will chime with that answer (I'm curious as well)

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Man I just keep thinking about what it would be like if a derm said yes! I'd probably faint from joy. Or give the derm a bear hug. I can't even imagine how happy I'd be to see my face normal again...I'd probably talk to all kinds of people, get a girl, be more social...one can only hope:) Well, for now I just have to have unwavering determination to get accutane one way or another. I need to find all the derms I can and begin making phone calls. Work on my little accutane speech for the derm, making it perfect. Well thanks for all your help Renegade Angel!

And to reiterate my other question to anyone, before prescribing accutane, do dermatologists check with your previous doctors and dermatologists to see if you've actually taken antibiotics and topicals or do they just take your word for it?

Edited by wshewfelt

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Alright, I understand your situation now. Since you're set on Accutane, which isn't a bad thing, just be completely honest with your doctor. Renegade Angel put it nicely.

And to answer your question, yes, dermatologists and doctors all have access to your previous and current medical records. As in, they can see everything you have been prescribed to, so it's best to be honest with them, and not lie about using something that you haven't.

But remember, it doesn't matter how hard you try, if your physician/derm doesn't want to give you Accutane for some reason(s), then you most likely won't change their mind.

The best advice I can give you is to tell them you know all the side-effects of Accutane, what your responsibilities are while using it (Using lots of moisturizer, going in every month for check ups and blood tests, etc.), and tell him/her that everything else you have tried hasn't worked, and you don't want to suffer through another failed treatment, you just want to get rid of it already; you're tired of suffering from it.

Goodluck!

Edited by Wsx

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I had the same issue. I just pointed out to my doctor that there was permanent scarring being left by the acne, and I was not prepared to risk trying out topicals/antibiotics before accutane for fear of increased scarring...and I mentioned low self-esteem. She then prescribed accutane.

Edited by Cooool

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I'm just so scared that they won't prescribe it. I know that there are two paths I can take. Either go through the jungle of topicals and antibiotics that work for some but for others just make things worse. This approach takes so long and your acne is only under control as long as you continue on the medications and it's only a temporary fix. Or, I can go on accutane, weather the side effects which I'm fully aware of, and have permanently clear skin. To me it's no hesitation go on accutane. Living a happy life with clear skin and side effects is so much better than daily putting creams and potions on for semi-clear skin which is a long-term process.

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I'm just so scared that they won't prescribe it. I know that there are two paths I can take. Either go through the jungle of topicals and antibiotics that work for some but for others just make things worse. This approach takes so long and your acne is only under control as long as you continue on the medications and it's only a temporary fix. Or, I can go on accutane, weather the side effects which I'm fully aware of, and have permanently clear skin. To me it's no hesitation go on accutane. Living a happy life with clear skin and side effects is so much better than daily putting creams and potions on for semi-clear skin which is a long-term process.

Tell that exact same thing to your doctor, you nailed it on the head.

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I am set on Accutane just like you are because I believe it's the only permanent cure and I need a permanent cure, so I said every possible thing to my doctor that I thought for sure would make her prescribe me Accutane - literally everything mentioned above and more - and she's refused twice. So be prepared. However I haven't given up... I am going back in a week to ask again and I really hope she gives it to me. Let me know how it goes for you. And you're right not to mention the word 'depression'. It is pretty much guaranteed to make them hesitate.

I'm pretty sure they will check medical records though, so don't lie about what you've taken.

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Just my 2 cents...I think some doctors are reluctant to prescribe accutane, period. That being said, I *think* dermatologists, at least here in the US, follow a protocol with acne treatment. They start by using certain antibiotics and topicals, move onto different things if those don't work, and if all else fails, use accutane. I think some of this has to do with insurance issues, medical malpractice, etc. For example, if you have insurance, and your dermatologist doesn't try other treatments first, your health insurance might not cover any treatment related to accutane, including the multiple blood tests, which would add up quickly. Then you would end up getting the huge bill from the doctor's office or lab. Also, if you have a history of being on an antidepressant or even having ADHD or anything like that, they might not want to give it to you unless you have a psychiatrist who will give the OK via a note or letter.

My derm recently decided to try me on accutane. I think what motivated him was that I had been on a special time-released Cephalexin (the kind of antibiotic they use on hospital staph infections) and even THAT didn't work. My acne is not "cystic" in the typical sense, but it's deep and really widespread and won't react to even the most hard-core antibiotics or retinoid ointments. I had also started seeing him last May, but I had brought *ALL* my old records from two previous dermatologists going back to 1994, listing *ALL* the antibiotics and topicals I had previously been on. He also saw that I had been on accutane before. He asked that the psychiatrist who prescribes me Celexa write a note or letter stating that I would be stable enough to go on accutane, which the psych agreed to.

RE: Medical History*****I'm not sure about other countries, but in the US, a doctor can't demand records from another without your explicit permission (this might be different depending on your age-- in that case, they could get your guardian's permission instead). If you *say* you tried xyz, it would be up to the doctor to ask if he could get records from previous doctors if he/she felt that it was necessary to back up your claims. If your current derm even wanted to *speak* to your old derm or other doctor about your medical history, he or she would even have to get written permission from you first.****

Edited by JMTM18017

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I wouldn't lie about having tried all of the prescriptions. If the derm checks that out and finds you lied, she/he might lose all trust in you. she might think you aren't mature or responsible enough to use accutane. If she/he still has you go through all of the prescriptions, she might question whether you are in fact actually following all of his/he directions.

My opinion is give the Tetracyclin and Retin-A a month or two. Then, if it doesn't work, be completely honest. No OTCs have worked, combination of two of the top non-accutane acne meds didn't work, your confidence and self esteem are completely shot, your sister did wonderfully on it with the same condition as you (heredity is a big thing in medicine and siblings who have the same issue often respond similarly to medication), you understand the risks and side effects (be sure you can list the most common and some of the most serious to ensure she/he knows you are serious) and finally, you have gotten to the point where your whole life is kind of consumed by it...you are willing to do anything, including doctor jumping just to get something you know will work.

if that doesn't work...I'd see another derm.

I wouldn't lie about having tried all of the prescriptions. If the derm checks that out and finds you lied, she/he might lose all trust in you. she might think you aren't mature or responsible enough to use accutane. If she/he still has you go through all of the prescriptions, she might question whether you are in fact actually following all of his/he directions.

My opinion is give the Tetracyclin and Retin-A a month or two. Then, if it doesn't work, be completely honest. No OTCs have worked, combination of two of the top non-accutane acne meds didn't work, your confidence and self esteem are completely shot, your sister did wonderfully on it with the same condition as you (heredity is a big thing in medicine and siblings who have the same issue often respond similarly to medication), you understand the risks and side effects (be sure you can list the most common and some of the most serious to ensure she/he knows you are serious) and finally, you have gotten to the point where your whole life is kind of consumed by it...you are willing to do anything, including doctor jumping just to get something you know will work.

if that doesn't work...I'd see another derm.

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Any update on your Accutane search? I saw a dermatologist yesterday with the same goals as you, but they prescribed Retin-A again even though I told them I used it in the past (8+ years ago) with no positive results. Needless to say I was unhappy with how little they seemed to care about what I had to say. I asked what happens if I come back in 10 weeks with not much change using the Retin-A and she said they'll probably try antibiotics (which I also said I've used in the past with no results). I specifically asked for Accutane because I've tried everything else for the past 10 years. In case anyone was curious I was at the Geisinger Dermatology Center in Danville, PA.

Anyone know a good place in PA?

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