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Mia88

Time For Accutane?

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Hi there,

I'm a 25 y/o female who has struggled with moderately severe facial and body acne on and off since I was 15. I'm currently on the combination of Yaz birth control, 125 mg aldactone, 200 mg doxycycline and Tazorac cream .05%, which has given me clear skin with very minor pre-menstual breakouts until recently. In December, I started breaking out much worse than usual; I had so many little bumps on my cheeks and chin that I couldn't even count them. They went away, but came back at the start of my next period. Does anyone think accutane could be a good option for me now that the combination of meds I'm on seems to have stopped working?

I know it's heavily disputed whether or not accutane works for well for women with the type of acne I have (menstruation-induced milia, skin-colored bumps, papules and pustules with the occasional cyst) because some women claim that the acne returns even after accutane clears them. Has anyone in my situation had success with accutane, or does anyone know someone who has? I'm thinking this is my only other option to (hopefully) permanently get rid of the acne bc I've used up most of the antibiotics (minocycline - caused skin discoloration, amoxicilin - became resistant and doxycyline - currently taking) and am already on the BC/spiro/topical combo. Any advice would be greatly appreciated!

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if you have hormonally induced acne, whether you take accutane or not, it can come back. You are just drying up your pores/closing them up with accutane. Sometimes its permanent, but you retain some oiliness after. I never took it so don't know, ive just heard and read of acne returning, it really is not a permanent cure. You will still have the issue of hormones even after accutane, it might even get worse. Even my doctor says she has patients returning, 12-18 months later and their acne has returned. I would say its good if you have bad bad, chest and all over the face severe acne, not mild acne. She also said there is new evidence that accutane causes the andorgen receptors to become extra sensitive, and that some patients get hairier (ladies) who are predisposed to hormonal issues like pcos etc. I wouldn't take it for mild acne. Maybe change your BCP if you feel its not effective? Also, instead of antibiotics, which i feel work short term (clears you for like, 1-2 months then it comes back) i suggest you take probiotics, and nurture your insides because all those antibiotics are just going to weaken your immune system. Some people say it just makes the acne more stronger and resistant (i can't attest to that, but yes, i feel the more i took, the less effective it got). Hope this helps!

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if you have hormonally induced acne, whether you take accutane or not, it can come back. You are just drying up your pores/closing them up with accutane. Sometimes its permanent, but you retain some oiliness after. I never took it so don't know, ive just heard and read of acne returning, it really is not a permanent cure. You will still have the issue of hormones even after accutane, it might even get worse. Even my doctor says she has patients returning, 12-18 months later and their acne has returned. I would say its good if you have bad bad, chest and all over the face severe acne, not mild acne. She also said there is new evidence that accutane causes the andorgen receptors to become extra sensitive, and that some patients get hairier (ladies) who are predisposed to hormonal issues like pcos etc. I wouldn't take it for mild acne. Maybe change your BCP if you feel its not effective? Also, instead of antibiotics, which i feel work short term (clears you for like, 1-2 months then it comes back) i suggest you take probiotics, and nurture your insides because all those antibiotics are just going to weaken your immune system. Some people say it just makes the acne more stronger and resistant (i can't attest to that, but yes, i feel the more i took, the less effective it got). Hope this helps!

Thanks for your response, LilyRose! My derm said the same thing you did, that my type of acne would most likely come back after a course of accutane :( However, my mom (who developed adult-onset acne) took accutane and remained clear afterwards, which makes me wonder if there is a slight chance it would work for me, too. Then again, I've had acne since I was 15, probably bc my dad developed acne as a teen. I thought my acne would go away by the end of college, like his did, but mine seems to be lasting..perhaps bc I'm a woman and have continuously fluctuating hormones due to menstruation, or perhaps bc I'm now developing the adult acne my mom suffered from.

Anyhow, I'm starting to wonder if the issues I referenced in my initial post are actually due to estrogen dominance caused by being on too high a dose of spiro. Along with the extra breakouts I've gotten during the post-ovulation portion of my past two menstrual cycles, I've also experienced spotting, extra hair loss (around 100 hairs/day rather than under 50, which is my normal amount) and pressure/headaches that let up after my period starts. In addition, I've gained almost 10 pounds since upping my spiro dosage from 100mg to 125 mg a year ago (prior to that, I was on 100mg for 8 months and 50mg for 2 months). 3 weeks after upping to 125mg, I saw a dramatic difference in my skin and attributed it to the new dosage, but now I'm wondering if that was the previous dosage finally kicking in..especially bc 3 weeks probably wouldn't have been enough time for the new dosage to kick in. Also, I've read that a dosage can take 9 months to kick in, and the difference I noticed happened a week before what would've been the 9 month mark for the 100mg dose (not to mention, these new side effects that started two menstrual cycles ago started at the nine month mark of being on 125mg). Given all this, do you think I could possibly benefit from lowering my dosage of spiro back down to 100mg?

Oh, and thanks for the advice about probiotics! I've taken them before and will definitely follow your advice and try them again until I taper off Doxycycline, which my derm wants me to do asap, since we're guessing I'm resistant to it at this point anyway. My OCP (Yaz) has worked well for almost 6 years now, so I'm a bit afraid to change it, especially bc hormones take so long to adjust : / Thanks again for all your advice!

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if you are taking YAZ then that should be balancing out your hormones. Why are you taking Spiro on top of it? Accutane works for ALL types of acne, and you will clear on it, thats not even debatable. What is debatable is not knowing if its going to come back. My doctors told me i could take it if i want to, but given the hormonal imbalance it would be better to tackle it on the hormone side. I agree with that because when you have hormone issues you need to basically balance it out for the rest of your life. Accutane is like taking a super strong medication for short term relief, you might get lucky and never have acne return but with accutane you never know what side effects etc you will get apart from dry lips and skin etc.

Usually when you change hormones, it will take about 2-3 months for the body to get used to it. I take Belara which is supposed to be really good for acne, oily skin, and hair, its the so called' beauty pill' I was a bit scared of YAZ because they said it has a higher incidence than deep vein thrombosis, and i was scared because i developed that from diane 35 and just didn't want to take the risk with that one. My doc said a lot of people are very happy on belara.

you are not resistant ! you just have to find the treatment that works for you, whether its topicals or facials and a pill, or changing your pill. Maybe you need to switch to a different pill if you are experiencing spotting and so on ?

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if you are taking YAZ then that should be balancing out your hormones. Why are you taking Spiro on top of it? Accutane works for ALL types of acne, and you will clear on it, thats not even debatable. What is debatable is not knowing if its going to come back. My doctors told me i could take it if i want to, but given the hormonal imbalance it would be better to tackle it on the hormone side. I agree with that because when you have hormone issues you need to basically balance it out for the rest of your life. Accutane is like taking a super strong medication for short term relief, you might get lucky and never have acne return but with accutane you never know what side effects etc you will get apart from dry lips and skin etc.

Usually when you change hormones, it will take about 2-3 months for the body to get used to it. I take Belara which is supposed to be really good for acne, oily skin, and hair, its the so called' beauty pill' I was a bit scared of YAZ because they said it has a higher incidence than deep vein thrombosis, and i was scared because i developed that from diane 35 and just didn't want to take the risk with that one. My doc said a lot of people are very happy on belara.

you are not resistant ! you just have to find the treatment that works for you, whether its topicals or facials and a pill, or changing your pill. Maybe you need to switch to a different pill if you are experiencing spotting and so on ?

My derm suggested that I try spiro in addition to Yaz bc the combo of Yaz, Tazorac and antibiotics (minocycline for a about a year and then amoxicillin for about 2 years) got me clear and kept me clear for almost 3 years until I became resistant to amoxicillin about 3 years ago, in May of 2010. I stayed on the Yaz and Tazorac and tried a series of six laser facials to kill the bacteria that the amoxicillin was no longer killing, but my skin never returned to the perfectly clear state it had been in during the 3 years before I became resistant to the amoxicillin.

One year later, in June of 2011, I switched to a new derm who kept me on Yaz/Tazorac and started me on spiro and said that if the combo of birth control and a topical wasn't enough to keep me fully clear without an antibiotic, I should try spiro so as to no longer have to continue relying on antibiotics in addition to birth control and a topical. In addition, she put me on Doxycycline (which cleared me up within two months) and kept me on it to give the spiro time to kick in. She said that once we had given the spiro enough time, she would taper me off the doxy. However, this was almost two years ago and I'm still on both medications. She still wants to taper me off the doxy, but wants to wait until we adjust my spiro dose to fix these weird pre-menstrual side effects that started 3 months ago (extra frustrating that this started happening bc things had been working well for 9 months -after waiting for them to start working for almost 11 months - and my derm was about to taper me off the doxy!).

Sorry, that was a long answer to your first question haha, but that is why I'm on the spiro in addition to the Yaz. I'm really sorry to hear that you got a deep vein thrombosis on Diane 35, but am glad to hear you're doing well on Belara. I had never heard of that birth control until you mentioned it in your post, so I'll definitely ask my derm if it's an option for me at my next appointment. I am a bit afraid to switch birth controls though, just because I don't want to have to wait the 2-3 months for my hormones to adjust to the new pill. I think I'll probably try lowering my dose of spiro and if I don't see these pre-menstrual side effects letting up after a couple cycles at the lower dose, I'll change my pill.

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