Day 55

Had a couple of small pustules in the last couple of days. 2 above my lip, 1 on my chin and 1 small papule on my right cheek. Skin is a bit like whack-a-mole atm - as soon as a spot heals up on part of my face, another one pops up to take its place. Got my 2 month follow up appointment with the derm on Monday. Gotta get blood tests and stuff.

Day 62

Had my 2 month follow up appointment. Blood tests were fine, derm bumped my dose up to 100mg week (20mg/day, 5 days out of 7 a week). The pimples on my lip/chin have healed up/are post inflammatory hyperpigmentation now.

I have 3 new inflamed spots along my left jawline/cheek area. Interested to see what effect the increased dose has.

Day 66

Of the 3 spots along my left jawline, 1 never erupted and the other 2 developed into pustules, 1 smallish one and 1 medium one. They are still shrinking at the moment. Aside from that I have 3 new smallish papules along both of my jawlines/facial hair area. Plus 1 new pustule at the bottom of my chin.

Now on my 10th day of taking 100mg/week.

Hi JJ!

I am stuck in a rut of not being totally clear too. Although it seems logical to me that it will take a bit longer for you at such a low dose. So far as I can tell, cumulative dose is what matters. We will get there!

I am on 40 mg/day, same as my first course. I can't handle much more as it makes me nauseous. I am planning to stay on it until I reach the highest cumulative dose that is reasonable for me. I am DONE with this acne! Well, probably not, but hopefully at least done for a good while.

Hi Kim

Thanks for the message. I'm not sure what cumulative dose I'll end up with. There is a school of thought now that it is the length of time (suppression of the sebaceous glands) that is the important thing, moreso than the cumulative dose (which is 120/150mg per kg/bodyweight). My derm was talking about taking it till I no longer am getting any acne, staying on it for another 2 months and then coming off it to see if it is in remission.

Anyhoo, at Day 68 (Week 10), pustule on my chin is persisting, the 2 on my left jawline are still in the process of shrinking/flattening out. Got a couple more absolutely tiny papules on the right side of my chin/under my lip today.

Hey there! I was just reading an article last night about sebaceous gland suppression! Lol! I am doing a Master's degree, so I have access to all the medical journals through my University. This is a blessing (can actually get real info from peer reviewed journals) and a curse (often just as contradictory as the stuff you read here!)

Last night I was reading an article about the length of time you suppress your sebaceous gland, and another about using much higher doses (above 200 m/kg). I did a little more research into the studies and found that both of them were done with people working for pharma companies that sell a version of isotretinoin. I had a hard time finding any 'real' info on this that wasn't sponsored by a maker of the drug, who obviously wants to see you use MORE of it.

Despite the conflicts of interest in the studies, I am somewhat convinced that staying on this for a good while might help me to avoid any more courses. Sucks to this acne.

Hi Kim,

Thanks for the info. I haven't heard so much about the higher cumulative dose. I was looking at low or even ultra low dose which wouldn't really involve taking more of the drug. The first 2 months when I was on 60mg/week, I was taking the same dose as I took per day on my other 5 month courses. My derm is looking at a lower cumulative dose than 120mg/kg cause on my current dose of 100mg/week it would take ages to reach 120-150mg/kg. But yeah it's hard to know if it's unbiased when it's sponsored by the pharmaceutical companies - good results are in their best interests! It's also tough when different derms have different consensuses as well - some are dead against low dose, some swear by it and believe standard dosing is far too high.

Hope your course is and continues to go well.

JJ! What's the update?

Personally, I think you are onto something. Why not take it for a really long time, have fewer side effects, and end up with the same amount in your system? Studies with higher cumulative doses ALSO had the patients taking it longer, so it stands to reason duration may be more important. We often have a 'get it over with' approach, which may have steered us wrong on this drug?

Hmmm.

Hey Kim,

I am at the end of day 70 (10 weeks down; 2 weeks down on an increased dose of 100mg/week). Skin is about the same really, maybe a bit drier. No great outbreak of acne, but it's still like whack a mole, one flattens out (leaving a beautiful red mark and possible scarring) and then another pops up. It waxes and wanes really. I can be almost totally clear for a few days and think I'm on the improve and then bang I'll get another 2 or 3 blemishes.

I'm not too sure if I'm on to something with the low dose or not. I just figured that I'd had 2 courses at 60mg which failed to give me remission, so having a third normal course seemed like it would only result in relapse again (admittedly I took the courses around 12 years and things might be different now). It's a lot more popular in Europe than the States. I also liked the idea of taking a continuous low maintenance dose which you can't do on a standard dose. I'm really struggling with the patience and optimism side of things, I was hoping it would work in 1 or 2 months like it has for some people and then I could look at tapering down my dose. No such luck.

Who really knows though? The exact mechanism of how roaccutane works isn't even known, nor is it known why some people get permanent remission from 1 course, some get it after several, and some never get remission.

Day 72

2 pustules from my jawline are both almost flat and red now. Pustule at bottom of chin almost flat and red as well. The stuff I've been getting in the last week is all either comedonal or very small papules - no pustules or papules of significant size. Hopefully no more of those, and eventually no more comedones and papules. Time shall tell.

Day 74

One comedone on right side of my chin has turned into an inflamed pustule. That's the only real spot of note in the last 2 days. Still getting tiny papules and non-inflamed comedones.

Day 78

Feeling very discouraged and frustrated today. I really am putting all my faith into this treatment - failure simply isn't an option. I thought things were going well until I shaved last night. I hadn't shaved for about 5 days and when I did I uncovered about 4 new pustules/papules on each side of my jawline. Also today I have had another inflamed spot pop up under my lip on my chin (left side).

Starting to question whether this dosage is enough, whether my final results will be good and whether remission is even possible for me. Some more clogged pores on my cheeks too.

Acne simply steals all the joy from my life - 18 years of this crap, I need it resolved. I no longer have the emotional reserves to deal with this on a daily and ongoing basis.

Hang in there JJ! I have a twin of your left side under the lip on the chin one - mine is on the right side and it hurts like a bitch! I hate how the ones by your mouth hurt every time you try to talk or eat - an ongoing friendly reminder that you have a zit.

I'm frustrated right now too - day 64 for me and this feels far from over. I'm still getting a new thing every few days, so even though I know it is not as bad as it was, I JUST WANT IT TO STOP ALREADY! I can't even grow facial hair to cover it up - but I guess I can get away with a lot more makeup than you!

I decided to try to remain calm until day 100 and that is helping my mental state. If things continue to get better, I think I have a good chance of seeing some clarity by then. My derm insists it is not unusual to still be struggling into month three, but that month 4 should be full of progress.

So let's give ourselves another month without judging ourselves too harshly.

This WILL work, and when it does, we will have a dance party together. Not sure how, but we will.

Hey Kim,

Thanks for the support. Continuing to wish you luck on your course. I'm even more sceptical than usual I guess because I'm on a lower dose than my other courses. Even I get there I might have to wait longer than month 4.

Dance party sounds great - I'll be ecstatic beyond words if I can achieve remission.

Hi JJ. I am on the exact same dose as you! I was supposed to be on 10mg a day but the chemist could not get hold of anything less than 20mg a day so I take 60mg a wk (3 tablets) I went on it end of last November.Reading your log was very interesting, I am much like you.. I feel like I am getting there and then bamn a few more appear! Right now I have about 4 or 5 spots. No cysts- which is a massive bonus for me! Nothing really in the way of side effects yet? Dry lips that's about it really. The overall quality of my skin has massively improved and my blackheads have gone. My derm wanted to me to go 20mg a day but I requested less because I was a bit worried about the side effects. I am going to give it to March and will re evaluate then. How are you going on??

you JJ I think you stopped by my blog before. Nice to see you blogging and keeping us posted. Hang in there...I completely understand how frustrating it is when you think all is well but then blemishes appear. The exact same shit happens to me and I don't know what else I can do. I am on ultra low dose, have been for 241 days, and I still get random blemishes that come out of nowhere. My skin is a lot better for sure, a lot less oil, a lot less serious acne, but the blemishes do appear. I think it is because we are on such a low dose, the purge is slow and the results come by very slowly. I don't know. Just hang in there, I will too, and we will see if this is really something others can do. I am in the same position as you, doing ultra low dose, so I hope we can help each other. Laters.

Day 86

Thanks for the support guys. I have 2 inflamed spots at the moment - one is under my chin on the left side and has a head, the other is along my left jawline. Other than that nothing of note I can see although I haven't shaved for 4 days, and shaving seems to always reveal blemishes that are hiding under my facial hair.

I have noticed in the last couple of days that my chin is a tiny bit flaky which is the first time I've had flaking on the course. Side effects still remain very minor though - lips drier, skin dry, that's it.

Nicolacat I was on 3 x 20mg/week for the first 8 weeks of my course. I've now been on 5 x 20mg/week for just over 4 weeks. Good luck with your course.

Hey JJ. Glad to hear things are going decently. I'm pretty flaky right now too - especially in the places I am prone to breakouts, so I hoping it is a sign of healing. Feels like my skin just wants to shed all the yuckiness.

Keeping my fingers crossed that when you shave there is NOTHING THERE! Wouldn't that be lovely! Day 100, here we come.

Hey Kim,

Well shaving did reveal some blemishes - it wasn't as bad as I feared, nor was it as good as I hoped sadly. Somewhere in the middle.

The spot along my left jawline has gotten quite inflamed and painful, with no head as of yet. I have no doubt it will leave an atrophic scar . I just hope it's pretty minor.

Today is day 89 for me.

I have also discovered a new problem in the last few days which I am concerned over. I have developed a hypertrophic scar on my left shoulder. I had a solitary hypertrophic scar on my back after completing my first course of Accutane 12 years ago, and body acne hasn't really been a concern for me since this course. I get the occasional blemish there and have been getting a couple on this course, but this hypertrophic scar concerns me. I know Accutane is linked to increased prevalence of hypertrophic and keloid scars. Having 1 (and now 2) isn't greatly concerning to me, but I don't want to get lots of them. Anyone with experience of hypertrophic scarring? I'm really hoping it's just a one off and not related to the tane.

Day 93

First day of my 4th month of Accutane. Feeling thoroughly discouraged. I have 3 of the most inflamed pimples I have had on the whole course at the moment. One is still the one along my left jawline, I have another one lower down on my left jawline and a very inflamed spot right under my lip on the left hand side. I had hoped I would have ceased breaking out by this point. Not sure if I just need to be patient with this low dose, or is this dose simply too low. The rest of my face only has very minor blemishes and comedones, it's just these 3 biggies that are making me miserable. There's a good chance all 3 with leave indented scars too - sigh.

Day 94

The 3 inflamed spots are getting smaller. I notice I have 3 or 4 clogged pores/slightly inflamed spots on my left chin ready and eager to spring up at any moment. Seriously so fucking fed up with this. WTF is Accutane actually doing for me. I have had more than 10 pimples on my chin in these 3 months on tane. It is normally the easiest place on my face to keep clear - I could go a year without a spot sometimes. I had high hopes that after 3 months or so most of the work would be done but I am breaking out no less than when I started. So jacked off. I'm starting to think that Accutane is not going to be the magic answer I had hoped for and that I am going to have to continue to suffer with acne and scarring well beyond the 18 years I have already suffered from it. This thought depresses me beyond belief. 18 years of torture with no respite in sight, I don't know what I ever did wrong to have to suffer so much.

Bad quality picture of my left side where I am broken out. 3 large zits - one under my lip, one on my jawline, one on my cheek/jawline. 2 small ones - one on my jawline, one on my chin. Hard to see extent with crap picture quality. Had an emotional breakdown today - cried, just feel so helpless. Am convinced now that I won't clear up properly as I had hoped.

No no no! You WILL clear up, it will just take a little more time due to your low dose. I have only just started to see some positive outcomes, and I am on more than twice the dose you are and only a week or so behind you.

I hate that you are feeling sad. Acne sucks so much. It blows my mind how much different of a person I have been just in the last couple weeks that I have not been in constant pain. I feel like myself again, and it is a self I didn't even know existed before my first course of Accutane.

You will find yourself again soon too. This course was so much harder than my first, and I almost lost faith in it working a lot of times. I still might, too. There isn't more than an hour that goes by that I don't imagine some itch and then feel a tremendous amount of fear. But this too shall pass.

Hang in there.

When is your next derm appt? Maybe they will have some suggestions to speed up your process.

Day 97

First up, thanks so much for the message of hope and support Kim28. I am in a little bit better frame of mind now although sadly my skin has not improved. I currently have around 7 actives, 6 are on the left jawline and left side of my chin. I have just the solitary pustule on my right face. My inflamed spots from day 93 are healing up slowly, but they will no doubt be replaced.

I am trying to be optimistic and believe that I will clear up, it will just take some time. I wish I knew roughly how long. I honestly have no idea how long I took to clear up on my other 2 courses of tane as it was more than 12 years ago now. I don't see my derm for another 7 weeks. I saw him at the 2 month mark and this next appointment will be 5 months since starting. Would be a lot easier if I saw my derm every month or so, so I could voice my concerns and get some feedback.