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Think I'll Be Prescribed Accutane? (With Pics)

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I'm a 24 year old male living in the UK. I've been struggling with acne for almost 10 years now. I've tried:

  • benzoyl peroxide (prescribed)
  • differin (adapalene cream)
  • tetracycline
  • the acne.org regimen
  • doxycycline
  • azealic acid (skinoren cream)

Some have worked with moderate short term success, others have made things worse. Nothing has worked long term. I'm currently using no oral antibiotics or prescribed topical treatments. I wash my face 2x daily with mild facial cleanser and that's it. My acne is only mild/moderate but it's very persistent and I'm sick of it, especially because I'm now 24 and I've tried everything! It really lowers my self esteem. I have a professional job where I'm constantly meeting new people and all I can think about is them looking at my horrible skin. I'd really love to go on Accutane. I've an appointment with my GP in a few weeks and I'm praying that he'll give me a dermatology referral. However, I'm really worried he's going to say its nowhere near severe enough and I'll be back trying some stupid antibiotic or cream again sad.png . I've attached pictures of my skin. What do you guys think? What are your experiences with mild/moderate but persistent acne?

post-60454-0-95479800-1382284215.jpg

post-60454-0-60134400-1382284232.jpg

post-60454-0-41929400-1382284247.jpg

post-60454-0-95479800-1382284215.jpg

post-60454-0-60134400-1382284232.jpg

post-60454-0-41929400-1382284247.jpg

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A derm will prescribe you isotretinoin even if you have mild or moderate acne, as long as you`ve tried the main prescription treatments and they haven`t worked. Looking at your list, you haven`t tried topical antibiotics (clindamycin) and the strongest retinoids (tretinoin and tazarotene). The derm would probably make you go on these first. I can`t recommend the antibiotics myself because I don`t see them as long-term treatments. But you should definitely give the stronger retinoids a go before you try isotretinoin. Try 0.1% Retin-A Micro to start.

If you really really want isotretinoin and you understand and accept the risks then I guess the thing to do would be to lie to the derm and say you`ve already tried the treatments above and they haven`t worked. Then you`d get isotretinoin for sure.

I`m suprised a GP wouldn`t refer you to a derm if you specifically asked for it. Especially if you`ve been dealing with your GP about your skin problems for quite a while. Maybe things work differently in the UK.

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probably not just because your acne looks really mild in those pictures and there doesnt seem to be any scarring but every doctor is different. Just let them know how much its affecting you mentally and given how persistent it is they might refer you, but thats not to say the derm will definitely prescribe roaccutane.

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Your acne doesnt look too bad, but you definetely have to make a case for going on it. Your acnce alone wont get you on Accutane. Tell the doctor you have exhausted every possible option and it really is affecting you. If the doctor says something along the line, "it doesn't look that bad", inform them that this is one of the rare occasions that your acne isnt flaring up.

If the doctor does finally recommend you to the dermatologist, they will 100% say your acne is too mild. You will then have to put forward another case as to why you need to be on it.

I'm speaking from experience beacause I had to do the same.

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I went off all (except fish oil) treatments for a month before going to the derm, to make sure I got prescribed Accutane. It worked.

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Thanks for all your replies.

I went to see my GP (family doctor) . I said I had tried everything for my acne and I wanted a dermatology referral. He did infer that my acne isn't that bad but seeing that it was persistent (and I was persistent!) he said that he would send a referral. This is through the NHS here in the UK and he says I'll probably not be seen by a dermatologist until March! In the mean time he prescribed by the oral antibiotic Erythromycin which I've never tried before (I've used doxycycline and tetracycline in the past). So far Erythromycin is clearing me up quite well, but I know it'll probably only be a temporary fix. By the time I see a dermatologist I will know how well erythromycin is going to work long term.

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Thanks for all your replies.

I went to see my GP (family doctor) . I said I had tried everything for my acne and I wanted a dermatology referral. He did infer that my acne isn't that bad but seeing that it was persistent (and I was persistent!) he said that he would send a referral. This is through the NHS here in the UK and he says I'll probably not be seen by a dermatologist until March! In the mean time he prescribed by the oral antibiotic Erythromycin which I've never tried before (I've used doxycycline and tetracycline in the past). So far Erythromycin is clearing me up quite well, but I know it'll probably only be a temporary fix. By the time I see a dermatologist I will know how well erythromycin is going to work long term.

Have you ever had a full set of tests/acne specific tests?

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Thanks for all your replies.

I went to see my GP (family doctor) . I said I had tried everything for my acne and I wanted a dermatology referral. He did infer that my acne isn't that bad but seeing that it was persistent (and I was persistent!) he said that he would send a referral. This is through the NHS here in the UK and he says I'll probably not be seen by a dermatologist until March! In the mean time he prescribed by the oral antibiotic Erythromycin which I've never tried before (I've used doxycycline and tetracycline in the past). So far Erythromycin is clearing me up quite well, but I know it'll probably only be a temporary fix. By the time I see a dermatologist I will know how well erythromycin is going to work long term.

You have to wait 5 MONTHS to see a dermatologist? Are you freaking kidding me???

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don't know about the NHS, but here in Romania, almost all the dermatology clinics will tell you that their schedule is full and you can come 3+ months later, unless ofcourse you want to pay the urgency fee which is obviously 3 times higher than a regular visit and by miracle they find those 15 minutes for you. :)

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What are your experiences with mild/moderate but persistent acne?

Hi,

I am from the UK as well. I was only able to isotretinoin privately, but have had good results so far. If you don't get anywhere with NHS treatment (which is all too real a possibility, unfortuntately) then you will certainly be able to get isotretinoin the same way I did. It will cost you a bit, but more than worth it in my opinion. If you want to know anything about my experiences feel free to ask.

Best of luck to you,

Steve.

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Hi,

I am from the UK as well. I was only able to isotretinoin privately, but have had good results so far. If you don't get anywhere with NHS treatment (which is all too real a possibility, unfortuntately) then you will certainly be able to get isotretinoin the same way I did. It will cost you a bit, but more than worth it in my opinion. If you want to know anything about my experiences feel free to ask.

Best of luck to you,

Steve.

Thanks for your reply Steve. Yea, I'm aware it's very unlikely I'd get Isotretinoin on the NHS. So far things are going good with the Erythromycin and it seems to be reducing the acne's severity. My plan is to try the NHS route first and if my acne gets worse again (i.e. when it becomes resistant to Erythromycin) and the NHS won't prescribe me roaccutane then I'd consider the private route. How much did it cost you Steve? And how did you get on with the side effects of Roaccutane?

In reply to the others, yes, it is 5months wait to see a dermatologist on the NHS where I live in the UK. Everything is like this on the NHS but that's the price you pay for a free health service. Obviously I could pay privately and be seen next week, but currently I'm happy to save my money and try the Erythromycin first.

Andrei11: I've never had any acne specific tests, I'm not really sure what you mean by this? Do you mean allergy testing or something?
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yeah, blood tests, bacteria, fungus, parasites, endocrine, testosterone, DHEAS, estradiol, prolactin, LH/FSH ratio and many others tests for kidneys, liver, stomach, allergies etc. + VISIA too.

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How much did it cost you Steve

Consultations generally cost somewhere between £150 - £250 a time, depending on where you are in country (most expensive in London and the south east, of course). The drug course itself was about £400.

Side effects for me have mainly been lip sensitivity/soreness, and a bit of peeling on arms and shoulders from the sun over the summer. From what I've read I've been fairly fortunate in this respect.

Anyway, I always try to go to references in the medical literature when thinking about side effects, and there are many given here:

http://en.wikipedia.org/wiki/Isotretinoin

Best wishes,

Steve.

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I'd consider paying those prices if necessary in the future. Thanks for the info. I work in the medical profession and I've read quite a bit in the medical literature about Isotretinoin and it's side effects. I've no desire to rush into taking it but if I really feel the benefits outweigh the risks I'll go for it in the future.

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I'd consider paying those prices if necessary in the future. Thanks for the info. I work in the medical profession and I've read quite a bit in the medical literature about Isotretinoin and it's side effects. I've no desire to rush into taking it but if I really feel the benefits outweigh the risks I'll go for it in the future.

Well it's interesting that you have some professional experience in medicine; I'm sure that helps the decision making process.

There's been some recent work on different dosing regimes for isotretinoin; have you seen this?

http://www.ncbi.nlm.nih.gov/pubmed/22909370

Cheers,

Steve.

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I've just been prescribed Accutane. You have the same problem as me, I'm almost 23 and while my acne isn't severe it is very persistant, I haven't had a clear face in over 8 years. Your skin looks like it produced alot of oil, as did mine, and that could be the problem. Accutane is supposed to shrink the oil glands.

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Hi,

I am from the UK as well. I was only able to isotretinoin privately, but have had good results so far. If you don't get anywhere with NHS treatment (which is all too real a possibility, unfortuntately) then you will certainly be able to get isotretinoin the same way I did. It will cost you a bit, but more than worth it in my opinion. If you want to know anything about my experiences feel free to ask.

Best of luck to you,

Steve.

Thanks for your reply Steve. Yea, I'm aware it's very unlikely I'd get Isotretinoin on the NHS. So far things are going good with the Erythromycin and it seems to be reducing the acne's severity. My plan is to try the NHS route first and if my acne gets worse again (i.e. when it becomes resistant to Erythromycin) and the NHS won't prescribe me roaccutane then I'd consider the private route. How much did it cost you Steve? And how did you get on with the side effects of Roaccutane?

In reply to the others, yes, it is 5months wait to see a dermatologist on the NHS where I live in the UK. Everything is like this on the NHS but that's the price you pay for a free health service. Obviously I could pay privately and be seen next week, but currently I'm happy to save my money and try the Erythromycin first.

Andrei11: I've never had any acne specific tests, I'm not really sure what you mean by this? Do you mean allergy testing or something?

I finished my 5 and a half month course of Roaccutane 2 weeks ago and I got it on the NHS. Yes, it took a few months to get an appointment and there were a few problems with disorganisation BUT, the doctors I've seen have been FANTASTIC and I didn't have to pay a penny.

I've seen people get an NHS derm appointment in 3 weeks in some areas of the country, it depends where you live.

All I'm saying is that the service on the NHS I've experienced has been second to none and don't give up on it too soon.

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I wouldn't be to concerned about being prescribed accutane on NHS. A lot of members on the board are taking the medication, paid for on NHS. With no multiple appointments or anything. I do not suggest going to the dermatologist and lying about try topicals and failing them in the past, like another member suggested. Have a plan and go into the dermatologist with a list of EVERYTHING over the counter from drug stores or whatever, and a list or everything prescribed. If you have failed enough ( which will vary between doctors ) you should get prescribed the medication. Good luck to you

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Thanks for all your replies.

I went to see my GP (family doctor) . I said I had tried everything for my acne and I wanted a dermatology referral. He did infer that my acne isn't that bad but seeing that it was persistent (and I was persistent!) he said that he would send a referral. This is through the NHS here in the UK and he says I'll probably not be seen by a dermatologist until March! In the mean time he prescribed by the oral antibiotic Erythromycin which I've never tried before (I've used doxycycline and tetracycline in the past). So far Erythromycin is clearing me up quite well, but I know it'll probably only be a temporary fix. By the time I see a dermatologist I will know how well erythromycin is going to work long term.

You have to wait 5 MONTHS to see a dermatologist? Are you freaking kidding me???

Yeah, that's outrageous. Where I am in Ontario, Canada, it's 2-3 weeks. We also have completely subsidized health care like the UK.

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Thanks for all your replies.

I went to see my GP (family doctor) . I said I had tried everything for my acne and I wanted a dermatology referral. He did infer that my acne isn't that bad but seeing that it was persistent (and I was persistent!) he said that he would send a referral. This is through the NHS here in the UK and he says I'll probably not be seen by a dermatologist until March! In the mean time he prescribed by the oral antibiotic Erythromycin which I've never tried before (I've used doxycycline and tetracycline in the past). So far Erythromycin is clearing me up quite well, but I know it'll probably only be a temporary fix. By the time I see a dermatologist I will know how well erythromycin is going to work long term.

You have to wait 5 MONTHS to see a dermatologist? Are you freaking kidding me???

Yeah, that's outrageous. Where I am in Ontario, Canada, it's 2-3 weeks. We also have completely subsidized health care like the UK.

That is better, though here in the U.S. I can see a dermatologist next day most of the time. I have a busy, fluctuating schedule and rarely am able to schedule a doctor's appointment even a few weeks in advance. I mean hell, I scheduled major intensive surgery only a month in advance without a hitch.

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I'm in the UK and I only waited a month to get an appointment. It's the price you pay for getting 2 months worth of drugs for £7.85 and no other fees! Too many patients and not enough staff, I work in the nhs and it's a nightmare, but there's just not enough money.

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Thanks for all your replies.

I went to see my GP (family doctor) . I said I had tried everything for my acne and I wanted a dermatology referral. He did infer that my acne isn't that bad but seeing that it was persistent (and I was persistent!) he said that he would send a referral. This is through the NHS here in the UK and he says I'll probably not be seen by a dermatologist until March! In the mean time he prescribed by the oral antibiotic Erythromycin which I've never tried before (I've used doxycycline and tetracycline in the past). So far Erythromycin is clearing me up quite well, but I know it'll probably only be a temporary fix. By the time I see a dermatologist I will know how well erythromycin is going to work long term.

You have to wait 5 MONTHS to see a dermatologist? Are you freaking kidding me???

Yeah, that's outrageous. Where I am in Ontario, Canada, it's 2-3 weeks. We also have completely subsidized health care like the UK.

That is better, though here in the U.S. I can see a dermatologist next day most of the time. I have a busy, fluctuating schedule and rarely am able to schedule a doctor's appointment even a few weeks in advance. I mean hell, I scheduled major intensive surgery only a month in advance without a hitch.

It seems to fluctuate a lot. My current doctor told me people get seen in eighteen weeks. Eighteen being the maximum, worst case scenario. I checked the nearby NHS dermatology department and they're advising 4 weeks for an appointment. My other doctor was really rude and dismissive about my acne, and said 'probably six months or so.'

My doctor said that unless I'm looking for accutane (which is starting to become a possibility), there's not much point seeing a dermatologist really. She's pretty sure certain I have acne as opposed to anything else, and she said she can prescribe pretty much anything a dermatologist can. Tretinoin is no longer prescribed here and you seem to be able to get the synthetic retnoids from your GP -- mine prescribed me epiduo and I got it as soon as I walked out of the office and into the pharmacy next door.

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So I didn't have to wait until March to get a dermatology appointment, I think my GP was just preparing me for the worst possible scenario. I have an appointment with a dermatologist on the 17th December. That's about 6 weeks after the referral was sent so for the NHS that ain't too bad! I'm really sick of my acne, it's not severe by any means but it just won't go away and I'm prepared to give Roaccutane a try as I've had enough of my spotty, red, blotchy face for almost 10 years!

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I'm just back from the NHS dermatologist and I've been prescribed Roaccutane. She didn't have any problem at all prescribing me it, as even though my acne could be alot worse, I've basically tried everything over the last 9 years. Obviously she went through the side effects. I have a 6 week course inititally, 30mg once a day. Providing my bloods are ok I start tomorrow. I'm excited! It's not going to be an easy few months with the side effects but I'm feeling hopeful for a good outcome at the end.

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