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jon165

Low Dose Accutane (Second Course)

Hi everyone! I'm a longtime lurker but have only just recently created an account on here and since I've recently started a low dose Accutane course, I thought I'd share my results with you.

I did a "normal" course of Accutane in 2008. I don't remember my exact dose, but it was somewhere between 30 mg and 60 mg. I took it every day for 3 months and had amazing results. I probably should have stayed on it longer, but I left the country for study abroad right before month 3, and the derm wouldn't prescribe me enough for more than a month at a time (**** you, iPledge). Before that, like most of you, I had tried pretty much every treatment I could find. Oral antibiotics (doxycycline gave me horrible acid reflux), topical antibiotics (clindamycin), topical retinoids, BP, you name it. I stopped short of laser/light therapy though, since that would've been extremely expensive and there's no guarantee it would even work.

Anyway, I was clear or pretty close to it for quite a while. I started using Tazorac a little while after my course ended to maintain the good results and that seemed to work pretty well. In 2011, however, I had to have surgery (pilonidal cyst) and so neglected my face a bit. Then I moved to France and, silly me, thought that since I hadn't had acne in a while that I could live without the Tazorac. Tazorac is quite a volatile substance anyway, I always keep retinoids in the fridge ever since one of my derms told me to keep Duac and Retin-A in the fridge like they do at the pharmacy until dispensing, so I figured it wouldn't survive the extreme temperatures in the airplane.

Lo and behold, I started breaking out almost as soon as I arrived in France. Maybe it was stress, a change in the water, lack of Tazorac or maybe all three. But anyway, it wasn't too bad still. I went to a doctor and he prescribed BP. That kept it at bay, more or less, but it gradually got worse and worse. Fast forward a year, and I changed doctors. This one prescribed me zinc supplements which, surprisingly, seemed to help quite a bit. I was taking 30 mg a day for about two months and then bumped down to 15 mg a day. I was pleasantly surprised by the difference it made, but I still kept spot treating with BP and an AHA moisturizer (Avène Cleanance K). About a month and a half ago, I went back because the zinc had stopped working (despite increasing my dose back to 30 mg a day) and she prescribed me Skinoren (20% azelaic acid) and offered to refer me to a dermatologist. I said no. I figured I'd give the azelaic acid a try since I had heard good things about it, plus there would be the hassle of finding a derm who wasn't incompetent.

Well, the azelaic acid pretty much didn't do anything the BP wasn't already doing, so last week I decided enough was enough and started doing more research on here and decided I wanted to try Accutane again or, at the very least, oral antibiotics and a topical retinoid. I didn't even bother getting a referral. My insurance will cover less of the cost, but my doctor was on vacation and enough was enough, so I just started calling dermatologist offices in the area. The first two were closed for summer vacation. August is DEAD here, everything closes, so I wasn't too surprised. The third couldn't get me in until Sept. 6 which isn't that bad for specialists here, but I wanted something right then and there, so I called a fourth dermatologist office. Not only did they give me an appointment for the NEXT DAY, but it was a SATURDAY appointment. That kind of thing is unheard of here. I was ecstatic!

I saw the dermatologist and I started to tell him that I was there for acne (as if he couldn't tell!) and that I had already done a course of Accutane and without even going into any more detail, he said he wanted me to try Accutane again. SCORE! The only "catch", if you will, is that he wanted me to take a low dose every other day for two months. At the end of the two months, he said, we would have another appointment and, if all was going well, reduce my dose to 20 mg once a week! I'm still a bit skeptical, but I've seen a few low dose logs on here and a few medical papers on "intermittent dosing" that seem promising, so I'm willing to give it a shot.

I've been on 20 mg every other day since Saturday, so I guess that means I'm on Day Four.

Day One: I definitely noticed dry lips and had a headache, but nothing intolerable, maybe a bit more tired. 20 mg of Accutane taken with my biggest meal of the day (Chinese takeout, so probably pretty fatty).

Day Two: No headache, still have dry lips, still a bit tired. I am drinking a TON of water. I don't usually drink water, but lately I constantly have a glass of water next to me. Slathered on the lip balm before bed. Used some azelaic acid on my problem area as well and moisturized.

Day Three: Took my second pill today. Perfectly moisturized lips all! Putting a ton of lip balm on before bed definitely helps! Went out and bought more skin products - Avène Cicalfate Repair cream, Avène Cold Cream lip cream, Avène Cold Cream cleansing gel, Avène Cold Cream Nourishing body lotion. The saleswoman also gave me a free sample of "Anti-ageing restructuring serum." I'm only 24. Ummm, thanks? Before bed, I used azelaic acid on my problem area (chin/nose) and moisturized with Avène Cicalfate. It contains zinc, copper and sucralfate. It's supposed to act as a "regenerating" cream and is great for healing scars and (I hope) red marks. It's also a pretty good moisturizer, but it's reaaally thick. Not really the kind of thing to put on before leaving the house, so it will probably remain my night-time moisturizer for the time being.

Day Four: No Accutane today. So far so good. My former actives (they were pretty much gone when I started Accutane, to be honest) are still red and not totally healed, but the redness seems to be receding gradually. I have a tiny, tiny whitehead on my chin that seems to be getting every so slightly smaller, but I wish it would just go away! I swear I can already see a difference in my skin, this is crazy, but I'm LOVING it! I will probably still use some azelaic acid tonight since my skin isn't that dry and it isn't burning my skin at all.

Regimen:

20 mg of Accutane every other day

Cleanse with Avène Cleanance Gel (a little drying, but so far I don't really have much facial dryness)

Avène Cold Cream lip cream throughout the day, but ESPECIALLY at night

15 mg of zinc with my morning coffee (not sure if it really helps, but it's just a little zinc and I still have a giant box of it, so I might as well)

400 mg of ibuprofen (as necessary for headaches and bringing down inflammation of actives)

AM:

Avène Cleanance K Hydrating and Exfoliating Gel (moisturizer with AHA) / Avène Clean-Ac Moisturizer (depends how dry my face is)

PM:

Azelaic acid (20%)

Avène Cicalfate Repair cream

I might still spot treat with a little BP at night if necessary

EDIT: Looks like I might have spoken too soon about the Avène Cleanance K moisturizer in the morning!!! I just washed my face and put applied it. After a few minutes, I started feeling a very minor tingling/stinging feeling, so I took that a sign to cool it on the AHA! I rinsed it off and put on the Clean-Ac moisturizer since there's no AHA.

Edited by jon165

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Days 5-10:

Overall, no major issues, a bit of fatigue and some headaches, but nothing major. I definitely can't keep using anything with AHA (Cleanance K moisturizer) in the morning. For some strange reason, AHA makes my skin tingle and burn, but azelaic acid is not a problem at all. I've been using that less frequently since I simply don't need it and, to be honest, the less creams I need to use, the better. My lips are dry though, that's pretty annoying, but using Avène Cold Cream lip cream at night helps a TON.

I even went to an amusement park for an entire day. I was in the sun all day and didn't get the slightest bit burned. I made sure to use SPF 50 sunscreen, and I was perfectly fine. I still have blackheads on my nose, and I've had a couple of tiny whiteheads, but they go away within a day or two, which is nothing compared to the pimples I had before. It's amazing what a difference I've noticed on such a small dose and in such a short period of time! I'm honestly amazed and, obviously, QUITE pleased.

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Day 14

Large pustule appeared last night. Tried some azelaic acid (no burning), but it was still bigger this morning. Took some ibuprofen to take the swelling down, but this wasn't terribly helpful. My eyes have been quite dry lately, and my contacts made my left eye burn when I put them in, so I've been wearing my glasses more lately. I hope this isn't the start of an IB...

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Wow, it's been a long time since I've updated this.

Yes, I'm down to 20mg TWICE a week, usually Monday and Thursday. I've more or less stopped breaking out, but I do occasionally have some pretty small zits. Even my back and neck which were breaking out quite a bit around the 3-4 week mark have calmed down a lot. When I went to my second appointment with the dermatologist, he recommended continuing the 20mg every other day regime for another two weeks, which I did. And he prescribed me enough Accutane to last me something like two years. cool.png

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Thanks for the info John, am gonna go back on it myself at some stage in the new year.

I was on 60mgs a week for about 5 months during the year. Worked great - had a good few side affects though.

If I go back on it would like to try a lower dose, maybe start at 40 then down to 20 a week.

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I'm tempted to drop down to 20mg once a week, honestly, but I might wait a while longer yet before I do that. This low dose has made such a difference, but I'm afraid dropping down even further will bring my acne raging back. Honestly, I don't even do anything to my face anymore... I wash in the morning when I shower and then moisturize. When I was still getting some minor acne, I'd use tea tree oil to spot treat, but I haven't had any of that for a while. I don't even shower every morning and my face is fine! It's really incredible.

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Yeah it really does the trick alright, its just a pity that when you stop - the oil comes back.

After coming off accutane Ive kind of controlled the blackheads with retin A - theyre not as bad as before - but the oil is back with a vengeance.

What kind of side affects you getting on 40mgs a week Jon?

Does your derm think you will be able to use accutane indefinitely?

Cheers mate

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