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Starting Accutane. Scared! (Acne, Seb Derm) Positivity?

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(Beware for the dreaded long long long post! I hope some of you have the patience to read and help! :) )

Hey guys, so in just over a week I will be starting Accutane. I'm, understandable, terrified and could really do with some advice, suggestions and, overall, positivity.

Some basic info; I'm a 23 year old guy from England. I've always suffered with mild acne (as in, I'd always have one or two spots somewhere on my body) and dryness/redness around my nose and the surrounding area (looked like rosacea). It never particularly bothered me.

So in August I went on holiday to Florida and, apart from having a lovely colour, it also seemed to fade my redness/dryness around my nose. This was fantastic! So after I carried on having weekly low-impact sunbeds to maintain the colour. (I'm incredibly incredibly pasty and white...to the point where a couple of years ago I went to a halloween party and everyone complimented me on my white face paint when, in fact, I just had temporary black hair-dye and guyliner...ouch). For the next two months I had the best skin of my life -- a lovely colour, no acne and the redness had subsided and for the first time in my life, I didn't have to sleep with vaseline on my nose/cheeks.

Well...after a pretty stressful month I noticed at the end of November that I had hundreds of tiny zits on my forehead...these then continued to develop on my temples and then to my cheeks. Before I knew it I had acne also on my arms, back of my neck and on my back. This was also the time that the redness around my nose developed and spread across my cheeks and up to my temples (constantly looking like a really really bad sunburn.) All the spots that had developed and now faded have left really big, horrible red marks that, somehow, even look worse than the acne. I now have the worst skin of my life and the depression it's caused is very very severe. I no longer want to go out with my friends, carry on with my life or, to put it simply, live. I feel like my life is over.

Every day I wake up to a new spot somewhere on my body, I'm extremely discoloured, red and blotchy. I've never felt so ugly. I can't even leave the house now without makeup on (yes...I;m a guy...)

So I went to the dermatologist and she said that I had developed moderate acne all over my body and that the redness was seb derm. She suggested accutane as the acne was starting to scar. I agreed as I have tried numerous antibiotics, countless OTC useless OTC products, duac and epiduo to absolutely no avail. However, I am terrified that accutane will make my look even worse.

From what I've red the Seb Derm could flare up horrible and the scars will just continue to get worse as the course goes on (more red and visible). However, as I'm developing more and more persistant acne it seems like it's the only step to take now to...well, kind of get me going in the right direction. It's just whether or not I can cope with basically a year of soul-destroying skin before I can undergo scar treatment/other treatments for the seb derm.

I've red that accutane has been used to control seb derm and that not everyones scars tend to get worse, with some saying it helps them get better. On close inspection I have a lot of blocked, large and congested pores within the seb derm area, which could possibly contribute to the redness, so it is completely possible that maybe the accutane could 'cure' everything by diminishing the blocked pores and blackheads as well...or maybe that's just false hope. Imagine if after 6 months I actually have clear skin? Or am I just looking at the start of my skin hell...

Basically guys I'm just looking to see if anyone else has had positive accutane experiences with previously dry skin/seb derm and acne scarring/red marks, and to what products you would suggest I use?

Right now I just use my Simple Moisturizing Facial Wash and Cetaphil Moisturizing Cream with Bare Minerals makeup, with nothing in particular for the acne/scarring/seb derm. Is there anything I can use to help the red marks/seb derm whilst I am on the accutane?

Thanks guys and I'm so so sorry about the long, tedious post -- I just feel like I'm at the end of the line right now and even the thought of Accutane terrifies me because I seem to have so many skin problems that, although it may eliminate the acne, it could potentially make me look even more hideous (if that's even possible).

I hope some of you have some positive stories to share/help and any suggestions on the products that helped you.

OswaldTheRabbit (not so lucky...) x

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Hey man, just read your post. Hoping I can add some value here as a second (soon to be third) time user of isotretinoin and a clinical research professional.

First, being terrified is OK. You don't need to be--but that doesn't matter. Use the anxiety to do good things with your isotretinoin regimen. Let it motivate you to buy the right products (little more below), try to avoid alcohol, drink plenty of water, and exercise within limits. There are very practical and useful tips I can offer. Also use your journey to help others :)

Second, seborrhooeic dermatitis can be helped by and also caused by isotretinoin. Theres no great link either way.

Now, on to the good stuff. Isotretinoin, taken correctly and at the right doses, can provide very effective and lasting results. I'm 34 now and started getting acne when I was 17. Out of those (almost 17) years since starting to get acne, I have spent about a year on isotretinoin (two separate occasions of 6 months each). That leaves 16 years. Out of those 16 years, probably 3-4 of them have been with acne. That means I was helped by isotretinoin for about 12 of those 16 years. Like I said, very effective.

There's so much to say really but let me hit on the basics. The traditional dosing is .5 mgkg to 1 mg/kg daily, divided into 2 doses. So, if you are an 80 kg person, you would be prescibed 40 to 80 mgs per day. This would be taken generally for about 4-6 months. Some doctors like to start off with a lighter dose and move to a higher dose. Some doctors like to also give upwards of 2 mgs/kg. It really depends on the acne and the person and the tolerance to side effects.

Now, there is a lot of research that shows less than .5 mg/kg to work as effective for CLEARING the acne. So, that same 80 kg person could take 20-40 mgs per day and see very similar results. These results are how the acne is cleared while on the drug and varying doses do have very similar effectiveness. The question then becomes: how long do I stay clear? The big predictor here is cumulative dose. That is basically how much TOTAL you take in over your time on the medication. Cumulative dose tends to be a very good predictor of how long you stay clear. The number that most research has pointed to is 120-150 mgs/kg. That same 80 kg person would need 9600 mgs over the course of treatment to reach that amount. So, 40 mgs per day would get a person to that number in about 8 months. That typically is why the doctor would (generally speaking) increase the dose to around 60 or 80 mgs per day, to limit the amount of time they are on the drug. However, you don't HAVE to reach the cumulative dose--it just typically does help with the long term clearing of acne, but is by no means necessary.

Safety wise, isotretinoin is one of those medications that seems to have a lot of side effects but many of them can't be conclusively traced back to the drug. Why is this? Well, most people are on the drug for months and months, and a lot of things happen over that course of time. Knowing definitely if the drug caused whatever side effect(s) that person was having is very difficult to determine. What I can tell you is this: it is not a very fun drug to be on. You will have days where you hate it. Follow your doctor's advice and of course, report all side effects to him/her. Typically, the common side effects are very dry skin and lips. Other side effects that are decently common are dry eyes, some musle/joint pain, and fatigue. On occasion (about a 3-4% chance), someone will get some abnormal blood test results related to liver or pancrease issues. However, these issues resolve typically when the drug is stopped. Rare side effects are typically related to the mental issues you have probably heard so much about. Depression and anxiety can occur in people taking isotretinoin. They can also occur in someone eating an apple. Moral of the story is: there has been no causation between isotretinoin and anxiety/depression. Of course, it can happen at the same time (this is called correlation) but it doesn't mean the isotretinoin actually causes it. As mentioned before, report all side effects to your doctor and be very open about them. In summary: there will be side effects but they are manageable for most.

Couple quick tips and product suggestions.

-Dr. Dan's Cortibalm. Fantastic lip balm that has hydrocortisone (anti-inflammatory steroid) in it. Works tremendously well.

-CeraVe Cream (there is a lotion which is good too but the cream is thicker). This I always have around.

-Take the pill(s) with a fatty meal. THIS IS IMPORTANT and often overlooked. The availabilty of the drug in your body doubles when taken with a high fat meal. When I say "high fat," I am talking generally normal meal that the average person eats for lunch. A nice ham and cheese sandwich kinda thing. I would take my morning pill with an English muffin and peanut butter with milk and evening pill with a dinner which typically has enough fat to qualify. There will be days that you probably take it with just water and other days where you take it with the high fat meal. Don't worry too much about it but the likelihood of success goes up when you take with a high fat meal.

That's all for now. It's a very strong drug that should provide very good results. Good luck on the journey and keep us updated.

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Hey man I had horrible cystic acne aswell as underlying seb derm in certain patches. I went on 30mg of accutane daily and everything was perfectly fine. Seriously man don't worry yourself too much, isotrentoin gets a bad rap but as long as you drink plenty of water you will be fine. The worst that happened to me was by back became a little sore but that is long gone. I am now on 5mg of isotrentoin just to keep my face smoothe and completely rid myself of acne :) as for the seb derm I know have added sea salt to my diet aswell as incorporating it into a gentle daily exfoliating scrub and my face is damn near perfect!! :) I've found the lower the dose of isotrentoin the less it will cause redness and such to the seb derm. And by the way sea salt is the best treatment for seb derm I've ever come across.

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Similar situation as me, 23 yo male, I'm around 5 months into accutane now and it's worked wonders (I had moderate/severe acne including body acne that made me very self conscious about my appearance). Mine has literally cleared up completely and I've still got about 6 weeks left till I finish my course, the scars are healing up nicely as well as there's no new acne aggravating my skin. I started on 20mg, then 40mg on the second month, and 60mg from 3rd month till I finish, I'm quite skinny so 60 mg is maximum for my body weight. I was apprehensive at first, I'll give a quick overview from when I started:

  • First 2/3 weeks, flare ups, lot of yellow heads coming to surface, red, blotchy, worse skin than before treatment
  • Next month, skin healing slowly but surely, redness fading, mild flare ups every so often
  • 3rd month, significant healing, no longer getting cysts, odd spot here and there
  • 4th month, Get maybe one spot a week if that, old marks healing
  • 5th month, continuing improvement on 4th month, lot of faded hyper-pigmentation (some might call these the scars, though not true scars)

Accutane does not actually improve the scarring, as mentioned earlier, it prevents new acne forming, giving old scars the chance to heal properly, so to some it does give the illusion of improving scars, whereas the body is just naturally doing this itself without having to worry about new spots invading.

Generally by the time I've finished and continuing afterwards, I expect my skin complexion to carry on improving as the scars are now just left to heal uninterrupted, though this could still take upto 12 months on it's own. The side effects I've experienced are the very common dry skin and lips, so moisturise like a machine, also, nearer the beginning I found I was tired quite a lot, sort of just feeling drained of energy, but that has gone as my body has adjusted. You may feel a bit crappy at first as the acne gets worse but in the long run it's worth it, I have had people notice and comment on the vast improvement in my skin and it feels good knowing it is working.

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