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DRmcarthur

A Few Questions Regarding My Current Accutane Treatment

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Hi all, I was not originally planning on posting anything on this website as I prefer to keep to myself but unfortunately I have some questions that I would like to see if anyone scouring these forums could answer. But, before I continue perhaps a little background information will be helpful (in point form for simplicity/laziness):

- I am male, 25 yrs old, 6 ft 3 in tall, ~230 lbs (I don't own a scale), and I have red hair (prudent for skin type -- "nordic" as my dermatologist would say)

- I did not have acne in high school, my first encounter with pimples occurred in my undergraduate university experience 2nd year, throughout the remainder of my degree I had at most 3-4 active at a time and often none at all.

- I began to have some stomach issues in my 3rd year of university (way too much subway) and my stomach became much more sensitive to what I ate.

- Shortly after graduating (2 Mo.) the facial acne really started to progress to a more serious state ( I also began to have some very poor stomach conditions which lasted 1 Mo. -- Barium enema confirms I am normal -- all of a sudden I feel better [ Mag-Cit wonderland?] (though would likely be classified as mild-moderate by a hardcore reviewer). This persisted for 7-8 months upon finally dying down and becoming non existent.

- Almost 1 year later (march 2013) the facial acne began to make a resurgence ( note that my stomach began acting up again shortly after I started to get pimples again).

-Since this most recent resurgence I have not had any remission whatsoever and as such I sought a dermatologist, completed a 4 month course of Doxycycline- to no avail- and have since ( Feb 25th 2014) begun Accutane (generic brand 80mg/day from day 1)

- In addition to the current treatment, for the last 8.5 Mo. I have put forth considerable efforts to eat gluten free and "mostly" dairy free -- only in the last month have I completely nixed any dairy from my diet.

Note that I do not have any active inflammatory acne on my forehead, front of neck/below jaw . The vast majority of my active acne is located along my jaw line with major "epicenters" around the area between the corners of my mouth and jawline. I have had some acne crop up on my upper shoulder area and occasionally the back of my neck (on the hairline). More recently I did have some crop up along my spinal cord at roughly the middle of my back. I would also on occasion have some actives located in the crevasse between my chest pectorals.

Also note that during my undergraduate university degree I was required to take antibiotics for sinus infections at least 2-3 times a year for generally two weeks at a time ( I am aware that amoxicillin and some other antibiotics have been noted by many to have beneficial effects on facial acne) .

Before I broach the subject of my questions and concerns I would like to give a brief synopsis of my treatment experience to-date:

- The first month was not particularly eventful, I had minimal breakouts, lots of facial redness (so called accutane flushing) , a considerable amount of blackhead removal from the bridge/ sides of my nose, but could still see tonnes of "time bombs" (non-inflamed closed comedomes are the medical term I believe).

- The beginning of the second month/ end of the first month I saw a fairly significant surge of moderately continuous breakouts for a period of 2 weeks. Following this large surge I have had lower but fairly consistent breakout activity of a few new problems each week.

- The trend of the latter half of the second month has continued fairly steadily to date. Also note that any actives that I had on my back and or chest are completely gone.

Observed side effects:

- Lips are chapped almost from day 1 onward

- Face is dry and peels unless moisturized from week 1 onward

- Rashes on fore arms and hands appear mid month one but are fixed via nightly Vaseline application

- Some discomfort in knees and lower back

- Some relatively significant hair shedding

- I am allergic to house dust and hence blow my nose frequently as such I have had many bloody nose issues (never a big deal)

- I had one maybe two headaches the first two weeks, none since

I have several concerns/ questions that I would love to field to my dermatologist but not only is he impossibly busy but in addition to that he is VERY skilled in dictating a conversation so even when I come prepared with boatloads of questions I end up walking out with almost none of them answered. So without further ado, here are my questions:

- I am somewhat suspicious that my moisturizing/ cleaning routine is lack luster. In the first month I would only wash my face once a day with cerave hydrating cleanser for normal to dry skin ( since traditionally when I didn't have acne I had normal to dry skin) thinking that I would dry my skin out way to much If I did it twice a day. In the second month (from what motivation I cannot recall) I decided to start doing it twice a day, once when I wake up and once when I go to sleep. In both cases I have been moisturizing with cerave moisturizing lotion for normal to dry skin. My concern is that as I mentioned earlier in this post, I had a fairly significant almost complete clearing of blackheads from my nose bridge and sides however as of late many of the smaller ones seem to be regenerating on a regular basis. I am wondering if I am doing something to cause this as most of the testimonials I have found suggest that once the blackheads go, they more or less remain that way for the course of treatment.

- My second concern is that for the first 1.5 Mo. I took my medication with ~4-5 cheese strings ( my dermatologist had suggested to take it with milk or cheese, I chose the latter). After not only deciding that I no longer appreciate cheese strings, but also deciding to go cold turkey on dairy @ about the 1.5 Mo. mark I have been taking the medication with 2-3 massive HEAPING tablespoons of peanut butter (I estimate 30+ g of fat) usually after I eat dinner. I am concerned that this may not be enough fat, and or that the 4-5 cheese strings may not have been enough fat and my first 1.5 Mo. was mostly wasted.

- My third question is that for actives that I do decide to pop (yes-- always a bad Idea-- I'm only human) I have been "treating" the aftermath with polysporin ( I think this is the equivalent to Neosporin for people in the states) but am concerned that there may be better options that are far more effective, is there anything more effective or is this about as good as it gets?

- A long shot, but I am very suspicious that my digestive issues have played a role in my facial acne, but probiotics, gluten free etc seem to have no beneficial effects.

- Because there are very few videos/ posts that I have found of people in a close neighborhood to my body weight undergoing accutane treatment I have not been able to find much in the way of average cumulative doses that these people attained. This is a concern for me as I do not wish to repeat this treatment and as such would like to make the most of my first time around. My dermatologist currently has my regimen set to continue at 80 mg / day for the full six months but ( assuming I am clear @ the 6 month mark) I would most certainly be willing to continue for a 7th month or even 8th month if necessary to attain a higher cumulative dose (currently at this rate I will end up at ~ 138 mg/kg which I feel could be pushed higher).

My next appointment with my dermatologist is at the 6 Mo. mark (apparently he has a lot of trust in my ability to regulate myself as he has given me 3 month prescriptions at a time i.e. I do not go back to the pharmacy each month) which I suppose is one of my primary motivations for creating this post and asking these questions.

Thank you for your time,

Dan

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I would be concerned with the stomach issues starting around the same time. Also just to emphasis real quick... Accutane has a chance of making them worse.

Nobody is a doctor here, but let's still examine some things that may be causing the stomach distress. Now, have you considered lactose intolerance? Dairy is in almost everything, including hidden in pastries and breads so just as soon as you think you're not eating it, you are or even gluten-free free things can contain it sometimes.

So you had a barium CT I'm guessing. If you had something unusual they usually won't see it unless the institution has a very specialized CT that can see down to the centimeters or lower. Did you have this done with AND without contrast dye? This is important as sometimes what is missed beforehand is found after ( this is all personal knowledge, I have been through it all in the medical world).

If that finds nothing, then I suggest blood tests to detect an abnormality, usually starting with a basic cbc panel ( vital stuff like liver etc.) and mention throwing in a calcium level just for kicks. Pull your tests yourself also. Read them. Doctors in today's world are horrible as identifying worrisome labs. If could be you have nothing. But it seems more likely somethings up given acne started around the same time. If it's related a health issue I'm not sure how good Accutane will be in the long run although some people make it out just fine... Although in my opinion in the USA it seems like too much Accutane is prescribed ( in my opinion).

My tl:dr point: Even If you cure your acne with Accutane there's a chance it might have an underlying cause.

Edit : Let me clarify my half asleepness.. It says barium enema. I apologize. I have had these. Only a CT scan with /without contrast ever found anything for me. All the barium will do is visualize one area of your digestive system and for me personally they are largely useless unless there is colon related disease and in my experience it is poor at detecting even this but that's just me.

Edited by elkhoundgold
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Thank you for your response,

At the point of initiation in which my stomach issues became a real problem I did have blood tests, stool tests, urine tests, and lactose tolerance tests done. I may or may not have these results filed away somewhere however I do certainly recall that all of the results came back negative and I am not lactose intolerant (or so they say). My digestion symptoms at both instances in which my stomach acted up were largely bloating/constipation but on a fairly concerning scale.

As far as overuse/over-prescription of Accutane goes my dermatologist presented it to me as " well, we can either continue on various other types of antibiotics or creams which may or may not be effective and will certainly not have lasting effects once you come off them, or we can go the route of Accutane where I am confident that we can cure your level of acne" - paraphrased slightly. I chose the latter.

As I think about it more and more there could be something to the stomach theory but at the same time it feels very much like curve fitting and of course I want to make a connection to some definitive diagnosis , I think everyone does on some level.

None the less, thank you again for the response, It is nice to be able to bounce ideas off of another person, rather than just a wall.

Dan

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