Intro (August 23rd,2018)
So, after scouring different forums regarding acne, acne treatments, and isotretinoin, I came upon the executive decision to start on isotretinoin. By no means is my acne categorized as severe and by no means am I considered the worst case of acne. If self-diagnosis was reputable, I would categorize my acne as "moderate." Yet, compounded by stress from college, the length with which I've struggled with this issue (currently 21 M and had acne since 14), and a brief respite I experienced in December that gave me a taste of "normal" skin, I decided simply that I had enough. I am tired of my skin being a lingering thought in my subconscious regardless of what I was doing and where I was. I was tired of having my mood dictated by how my skin was doing. To uphold something ephemeral such as skin as the basis of self-worth and mood is extremely deleterious to ones psyche and life-journey. I KNOW that I am more than what is on my face; I KNOW that I am defined by my relationships with those around and how I influence the said parties, but such a mental shift is easier said than done. So I figured that although working on this shift would be main priority, tackling acne physically would also help in this process.
I am currently on a low dose regimen of 10mg/day. Isotretinoin is easily prescribed in the country I am living in and I did not have to take a blood test. I simply told my dermatologist that I was getting tired of acne and it has started to influence other areas of my life. Of note, I also told her that I have previously experimented with oral and topical antibiotics including doxycycline and clindamycin, conventional OTC products including salicyclid acid and BP and avoided common diet triggers such as dairy products. For the first 2 weeks, I will be on 10mg/day and if side-effects are minimal or absent, we decided to increase the dosage to 20mg/day.
Looking ahead, I want to look back on this log by the end of my treatment to see the improvement not only in my skin but also my psyche. PLEASE feel free to ask me any questions and I promise I will update this log consistently every Thursday.
Week 1 (August 30th, 2018)
Today marks the end of the first week of treatment. Prior to taking the first pill on August 23rd, I was worried and excited; worried about the purported side effects of accurate, including bleeding lips, possible IB, mood changes but excited about, well, treating my acne. Thus far, given the extremely low dose of 10mg/day, I havent experienced any major changes. My skin isnt dry, my lips arent chapped, and no IB. I got a small breakout on my left chin but nothing out of the ordinary. Such a change was actually expected given the amount of travel Ive been doing, acclimating myself to the new country I moved to, and the 2 consecutive days where I ate greasy food. Of note, I did start getting some acne on my body: one major cyst below my belly button and small ones on my chest and shoulders. The latter was nothing serious or extraordinary.
No apparent mood changes observed. On the contrary, my psyche and mental state have improved greatly knowing that I am actively treating my skin internally. No blurred night vision, no dry hair, no dry patches in my body. Looking ahead, I will continue taking 10mg/day throughout the second week and if no side effects are further observed, I will increase my dose to 20mg/day. More to come.
Week 2(September 8th, 2018)
Sorry for not posting on the 6th! Was traveling around the country to visit relatives and what not. Anyways, given that I experienced 0 side effects, I decided to increase my dosage to 20mg/day on September 3rd, a Monday. No side effects observed: no dry lips/skin/hair, no mental symptoms, no musculoskeletal issues, etc. To maximize absorption, I am making sure to not mix any supplements in the meals I take isotretinoin (ex: omega-3 & magnesium in breakfast, isotretinoin in dinner, etc.) and have been increasing my fats in the meals that I do take isotretinoin.
In terms of progress, I have 0 active spots. I reckon that the small breakout in week 1 can be constituted as the "initial breakout," although in terms of severity is far milder than other stories in the forum. I am planning to visit my dermatologist this coming week to update her about my progress and to see whether I can partake in any in-house treatments to treat my PIH while taking isotretinoin. More to come.
Week 3 (September 13th, 2018)
Today marks my 3rd week on isotretinoin. From my last log, I was consistently on 20mg/day but for 2 of those days, I increased my dosage to 30mg/day to see whether there would be any exacerbated side-effects. Honestly, the low-dose regimen works. My skin is clear with no active spots and common dietary and lifestyle triggers that previously caused breakouts now have little to no bearing on me. I wrote last week that I will visit my dermatologist but decided to delay this to next week since I needed to come back down again to replenish my pills. I am still going to ask for possible-concurrent treatments to address the PIH on my cheeks and given the absence of any side-effects, I am hoping that the dermatologist will comply.
Side-effects wise, again, absent. No chapped lips, no blurred vision, no joint stiffness, and no mood swings. I will say that my face and hair do seem a "bit" drier than usual but again, it isn't conspicuous and seems to fluctuate daily. More to come! Feel free again to comment or shoot me any questions!
Week 4 (September 21st, 2018)
It has nearly been a month since I started the low dose regimen for isotretinoin. All in all, I am very pleased with the results. I can truly say that the drug works. My skin has cleared up alot with the occasional mild flare up around the mouth and jaw. I would not consider my skin to be completely clear as of yet but the progress is truly noticeable. I was on 30mg/day the last week to finish the last box of pills before visitng the derm, which caused a minor breakout, definitely nothing conspicuous though. I will still be on 20mg/day from here on out.
Side effect wise, the same old. Weirdly, my lips are not that chapped and my skin and hair are drier but not to the extent of peeling. Perhaps, my skin was just so oily before that the isotretinoin is helping fix it to an actual normal level. Other than this, no photo sensitivity, no blurred vision, no joint pain, nothing. I will also be undergoing some laster treatment for my PIH in two weeks as there is a major national holiday here right now. Ill try to post some pictures in the future as well to compare my current state with how I was before. As always, feel free to ask me any questions and more to come.
Week 5 (September 29th, 2018)
Sorry for the late post! Was busy hosting a couple of guests the past week. Nothing drastically different in terms of skin clearance but enough has happened for others to comment that it looks much better, so I am very content with the results thus far. For once, I have begun to experience the side effects. The most noticeable is the dry skin but not to the extent of my skin peeling. My face feels rather tight after washing and I found that I need to apply far more moisturizer than usual, which is very different from the oily skin I was accustomed to: learned this the hard way after I woke up one morning feeling like there was a fish net pressing down my entire face. Weirdly, my lips are not too chapped maybe as I already developed a habit of applying chapstick before starting the treatment.
Other than that, no adverse side-effects noted. No blurred night vision, slight lower back ache, unaffected energy levels, no mood changes. Still awaiting my next appointment in two weeks when I can hopefully treatment my PIH but until then, more to come!
Week 6 (October 4, 2018)
Today marks week 6 of my isotretinoin-low-dose treatment at 20mg/day. So far no drastic difference from the last week. I dont know if this is more of a mental thing or behavioral thing but my skin seems to have adjusted to the dryness. No doubt, my skin is significantly dryer compared to when I just started but I adjusted my skincare routine accordingly to minimize the side effects. Again, my skin has cleared up significantly. I am mainly dealing with PIH as a result of breakouts that occurred before the start of treatment.
In terms of side effects, the same old. General skin dryness did not exacerbate but interestingly, my eyes do seem much dryer than normal. I still have some minor back pain which only seems to happen in the mornings. Lastly, I began to notice I am getting these small cuts around my body that take ages to heal. I do not know if the delayed healing is more of a result of how cold the weather has become lately or as a result of decreased sebum production. All in all, the side effects are far from being intolerable and raise no alarm bells. More to come!
Week 7+8 (October 17th, 2018)
Sorry about not posting last week; just completely left my mind that I needed to update my log. So, rather than waiting until Thursday for another post, I figured that I would just post a day early to document my progress for the last and current week. I had a weird experience with melatonin pills on week 7. I've only taken this sleep-aid on 5 occasionsbut after each time, I would breakout with deep, cystic acne. I tried sifting through any academic literature investigating the link between melatonin pills and acne but was unsuccessful, with the exception of personal anecdotes on online websites such as iherb, etc. So at least for me, I am going to avoid taking melatonin as I did not have any breakouts for a good month until week 7 when I did take a pill. I had a pretty nasty cyst on my right cheek but had it injected with a corticosteroid at the dermatologist which quelled the infection in less than 3 days. Other than this brief episode, week 7 and 8 have been going smoothly.
Side effects are the exact same: dry skin, mildly-chapped lips, mild-lower-back pain only in the mornings, and dry hair. To make sure that everything is in check, I will be going in for a blood test tomorrow out of my own volition as none of the dermatologists or clinics here actually require you to do so before you are prescribed with isotretinoin. My dosage has consistently been 20mg/day and I have no intention of increasing. However, I have begun to wonder whether staying on this drug at this dosage for a duration of 1 to 2 years to complete the recommended cumulative dosage would be safe. I am curious to see whether any of you were under a low-dose, long-term regimen so please let me know if you did and how you found the experience! More to come!
Week 9 (October 27th, 2018)
Oops, sorry for the late post again! I was busy with work and what not this week and updating this log slipped out of my mind. Week's 9 been a bit of an up and down but a learning experience overall. As I was having some difficulty with sleep, I was prescribed anti-anxiety medication by a certified psychiatrist: etizolam and trazodone. Like melatonin, it seems that my body just outright hates medication that affects my circadian rhythm! The hangover effect of etizolam was just ridiculous and more interestingly, after 2 subsequent nights of taking trazodone, I began breaking out around the cheek area. I visited the dermatologist to have the acne extracted and injected with cortisone, which have helped a ton. Looking online, again I saw that trazodone can cause acne flare-ups in certain individuals (fine print: I didn't see this in any academic journals and more so in personal anecdotes). So, lesson taken: at least for this season, the only medication I will take, with the exception of when I fall sick and supplements, will be isotretinoin.
Other than that, progress has been slow but steady. My face is much dryer than it was pre-treatment but I have gotten used to it that it is a non-issue to me. Other side-effects seem to have diminished or again, I may have just gotten used to them. No fatigue, no joint pain, no mood swings, no decreased night vision, etc. So far, I have no complaints about the drug; in fact, the only "complaint" I have is to to perhaps increase my dosage to 30mg/day given that I weigh 73kg as a guy. I will raise this up to my dermatologist the next time I visit! As always, more to come and feel free to shoot me any questions!
Week 10 (November 1, 2018)
So it's already week on isotretinoin. I've heard that your time on this medication is truly a journey with its fair share of ups and downs and I can definitely say that for me, that is the case. Starting from October 28th, I have increased my dose to 30mg/day given how much I weigh and how the rate of progress was lately. 20mg/day was good to "maintain" but personally, I wanted more noticeable outcomes of the medication. As expected, increasing the dosage caused a breakout on my right cheekbone and left jaw which is slowly healing. If I find that This is the first "breakout" I've had for a couple of weeks which was somewhat disheartening. Given that the breakout itself is now healing, I'm trying to keep my head up high knowing that my body has now acclimated to the higher dose. So from here on out, I'll be on 30mg/day for maybe another month or two, assess my progress, then determine whether I will go back down to 20mg, maintain 30mg, or go up another 10mg to 40mg/day.
Side effects wise, everything is very manageable. Even the dry skin and hair does are barely noticeable. Over the course of treatment, my skin has never flaked from the dryness or peeled from sun exposure. Lips are still dry but not to the extent of cracking and bleeding. My side-effects have basically been a non-issue since the day I started the drug. To be very honest, it boggles my mind to think that isotretinoin is associated with severe side-effects such as depression ( https://www.sciencedirect.com/science/article/pii/S0190962216312890?via%3Dihub ), IBS, erectile dysfunction, etc. Then again, I have only been on the dose, and a low one on that, for only 10 weeks. If anyone's been on a low-dose regimen please let me know how your progress was/is doing and how long it took you to get that clear face you was dreaming of. As always, more to come!
Week 11 (November 8, 2018)
It's week 11 on isotretinoin today. I've continued the dosage increase of 30mg/day with no side-effects. As I thought, the small breakout last week was most likely due to this increase given my track record: in the previous times I've increased my dosage, I would breakout literally the next day but that would be it. In general, I'm quite happy with my progress! Progress is truly slow and steady but I know for a fact that given my lifestyle and habits, my face would have broken out far worse should I have stopped the medication midway or decided to not take it altogether from the beginning. So, i'm keeping my head high with the realistic expectation that there may be breakouts here and there but as long as the overall trend demonstrates a considerable/significant improvement on my skin I will be content.
Side effects are virtually non-existent. Maybe I am just one of those lucky cases where the drug just confers its positives on me without the negatives or then again, maybe it is just a matter of developing a certain cumulative dose before the drug bites me in the a**. My hair and face are dryer than pre-treatment but not to the extent of peeling or requiring multiple rounds of moisturizing a day. Lips are not too chapped, no mood swings, no photo-sensitivity (literally never got a sunburn the entire time and the weather has been very sunny the last few months). I realized that I never talked about my products. I'm using a gentle pH face wash, a calendula toner from Kiehl's, an oil-control moisturizer from Kiehl's, a vitamin-c serum from Clinique, and sunscreen from Avene. The plan is sto stay on 30mg/day for another month and assess my progress. If the rate is slower than desired, I will bump the dosage to 40mg/day. As always, more to come!
Week 12 (November 15, 2018)
It's already week 12, so almost 3 months into isotretinoin! I've continued the 30mg/day doage with no exacerbated side-effects in any way whatsoever other than that mild IB 2 weeks back. My face virtually has 0 actives and I am extremely grateful with the progress thus far. I've changed the products I use which makes it feel as though my face is actually normal and not dry. So here's my routine:
Cleanser: Gentle pH cleanser
Toner: Thayer's Witch Hazel Rose
Serum: Ceramidin Serum
Moisturizer: Dr. Jart Ceramidin Cream (saving grace in all of this)
Sunscreen: Avene Mineral Cream SPF 50+
In terms of side-effects, like I said, they are basically non-existent. Lips are semi-dry but still hasn't cracked despite the cold weather here. Lower back pain is gone, which is great given that I lift heavy (squats, deads, etc.). Interestingly though, my elbows have started to ache and I know for a fact that it is not due to gym-related injuries. I can feel discomfort and a general feeling of "dryness" in my elbow joints even when I'm doing push-movements equivalent to my warm up set. I honestly don't mind though and it hasn't deterred me from exercise. No photo-sensitivity, no mood swings, no rashes on the body, no hair loss, no decreased night-vision, etc. Seems like things are looking up from here! I'll continue on this 30mg/day regimen for another good month and reassess whether to stay on this dose or increase it to 40mg/day, which is going to be the max dose I am willing to go on. As always, please feel free to ask me any questions and more to come!
Week 13 (November 22nd, 2018)
This week marks the end of my 3rd month on isotretinoin! In the thick of it, time seemed to pass too slowly as I was looking for improvements on a daily basis; trust me this is not the right mentality to have since being on this drug is truly a journey more than a short-term thing. Both jawline areas, chin, nose, forehead, and basically the entirety of the left side of my face are clear! The only problem area I have is my right cheek, right around the cheek bone. This area has always been the most acne prone by a HUGE margin. Within the last week, a pretty nasty cyst popped up here and I visited the dermatologist to get an extraction and cortisone injection. Its still inflamed but has been improving a lot.
Like I wrote in my earlier posts, my country is rather lax when it comes to isotretinoin maintenance i.e. patients are not required to take blood tests, etc. Out of my own volition, I did so and my results were more than superb. My liver enzymes were in fact lower than the normal range and my physician attributed it to my frequent exercising. Essentially, I have not experienced almost any side effect on this drug. My face has never peeled once, my eyes do not seem as dry (or maybe I am just accustomed to it), lips are only somewhat chapped, no photosensitivity, no blurred night vision, no mood swings, etc. The only side-effect I am experiencing is elbow joint pain, which I feel the most during tricep extension exercises. My lower back pain has basically subsided. This is not to say that isotretinoin isnt working for me. My face is considerably dryer compared to when I just started the regimen and I attribute the absence of these side-effects to my low dose at 30mg/day.
My dermatologist also suggested that I incorporate some form of topical retinoid so prescribed me adapalene. I bought the gel but am hesitant to start it immediately given that whether I can feel it or not, my skin is most likely more sensitive and thinner than pre-treatment. The main reason Im interested in using adapelene is to mitigate the redness from PIE. Ive read some studies where patients were prescribed 10-20mg/day of isotretinoin with nightly retin-a use. The study reported a significant improvement in acne lesions compared to cohorts that used only isotretinoin or only retin-a. Let me know if any of you have done anything similar or your general thoughts about this. As always, more to come and feel free to shoot me any questions!
Week 14 (November 29th, 2018)
Apologies for the late update. I recently moved back home and have steadily consumed 30mg/day of isotretinoin during that time. The great thing about home is that the environment is far less dry and remains cool year round. My forehead, chin, and left cheek areas are practically clear. The right cyst has also healed completely. The only issue now seems to be the PIE and as an Asian, I understand that our skin tone is more prone to redness, at least, according to scientific literature.
Side effects are practically absent. My dry eyes and lips have actually subsided and I honestly can not think of a single side effect I am currently experiencing. More to come!
Week 15 (December 6th, 2018)
Truly, roaccutane is a journey isn't it. Everything seemed to go uphill in a good way from the last week but I partially relapsed. Another cyst developed but on my left cheek and I haven't gotten a cystic pimple in that area for more than 4 months, even before consuming isotretinoin. I am both surprised and not surprised that it occurred. I'm surprised that I developed a cyst here of all places but also not surprised given how I was eating for a few days prior. I went on a dessert binge for 3 consecutive days as I was visiting old friends and going out every day and night. I need to make the mental shift that although isotretinoin is doing all it can to help me internally from breaking out, it does not make me immune in any way to getting acne. The risk of getting acne has dramatically gone down but the risk is always there. Sugar and seafood have always been my triggers so this is a good learning experience for me to remember in the coming weeks.
As stated in the previous week, side effects are absent. My dry eyes and lips have gone away since last week and to be candid, I can not think of a single side effect that is bothering me. I am currently consuming 30mg/day, which is still a relatively low dose in regards to my body weight. I am considering upping my dosage to 40mg/day in 1-2 weeks if progress is slow or if I continue breaking out. As always, more to come!
Week 16 (December 13th, 2018)
It's been a good week! With the exception of the cyst, which is healing, I got in week 15, I currently have no actives. Week 15 offered a crucial lesson that I will live by: isotretinoin will reduce the likelihood of breakouts especially as I am several months but will not make me immune to them so make an effort to avoid triggers such as high GI foods such as dessert and dairy.My dose is still the same at 30mg/day and fingers crossed, it is an uphill from here. My complexion looks increasingly better by the weeks, and my scars and PIE have been healing quite substantially compared to where I was in week 1. The key players in my skincare regime have been a gentle cleanser, Dr. Jart's ceramidin and centella asiatica creams, and a niacinamide serum. Personally, Vitamin C did not do too much for my complexion but niacinamide has! I also incorporated differin 0.1% at night which has made my skin more dry. Due to the low dose, my skin is fortunately not irritated from this topical retinoid and I hope that this really is the nail in the coffin in terms of resolving my PIE and redness.
Side-effects are virtually non-existent. My skin has never once peeled during this treatment, my chapped lips are gone, no mood swings, etc. Skin and hair are still dryer than pre-treatment and lower back pain is gone. The only noticeable side-effect is joint pain in my elbows and again, I only feel this in cable tricep extensions but not day to day. Overall, the low-dose regimen does indeed tune down the side-effects, albeit skin improvement occurring at a slower rate than presumably a higher-normal dose. I still have a loooong way to go to reach my cumulative dose and unless some severe side-effect pops up down the line, I intend to continue on this 30mg/day treatment until I reach that dose. Several people I have known took a low dose but decided to stop visiting the dermatologist well before the optimal cumulative dose was reached given how much their skin improved. Without fail, each and ever one of them relapsed. As I already invested so much time in this treatment, might as well finish the recommended dose despite how long it will take. As always, more to come and feel free to ask my any questions or leave feedback/critiques/suggestions!