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DaveJTR

Isotretinoin. I'm about to start a low-dose long-term regimen.

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I'm about to start a low-dose long-term treatment.  I have completed 3 courses in the past (80mg a day).  Oily skin and acne and large pores keep returning.  

Any of y'all currently on a maintenance program?  How is it going?

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four rounds wouldn't that be much? Try to cure acne with diet and exercise. Apparently you are resistant to isotretinoin but I think you could be overloading your body with accutane a lot, for something your acne has not disappeared.

In any case, you can perform hormonal tests or other aspects of analysis that show that it is causing your acne.

If you do, try to follow a demanding regimen to avoid acne, good luck in your fourth round !!

Edited by george20
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On 7/21/2021 at 9:26 PM, DaveJTR said:

I'm about to start a low-dose long-term treatment.  I have completed 3 courses in the past (80mg a day).  Oily skin and acne and large pores keep returning.  

Any of y'all currently on a maintenance program?  How is it going?

Due to the potential for serious side effects from  Accutane/Isotretinoin, there are 2 other possibilities you should get tested for before starting a long term treatment with that drug.

Did the doctors test you for microscopic demodex skin mite overpopulation?  If not, get them to test you before starting a long term regimen with Accutane/Isotretinoin.     Large blackheads (large pores) are a major sign of a demodex overpopulation.    Demodex mites eat skin oil and possibly skin cells.   Accutane/Isotretinoin can appear to make your skin better while taking the drug since it greatly reduces oil output.  Reducing the oil, starves the mite population down.  But Accutane/Isotretinoin doesn't directly kill the mites. It just treats the symptoms, it doesn't cure the disease.   After you stop taking the Accutane/Isotretinoin the mite population can rebound and the skin problems return.   That situation happened to the patient in the following medical study.    2 once a week doses of Oral Ivermectin solved his issue.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489393/

In many cases the demodex get overpopulated due to Small Intestinal Bacterial Overgrowth (SIBO) which suppresses something in the immune system that controls the demodex skin mites population.  In that case, adding an antibiotic that is effective against SIBO can also clear the issue up in just 2 weeks.  Oral Metronidazole and Rifaximin have been used successfully to clear people with SIBO.  Choice of antibiotic depends on which bacteria is causing the overgrowth.   An endoscope test can collect a sample of fluid to test for the specific bacteria.   Rosacea Subtype 2 with papules and pustules is frequently misdiagnosed as bacterial acne.  It is the diagnosis if demodex skin mites are overpopulated.  Rosacea Subtype 2 also very frequently coexists with SIBO.  Here are 2 medical study papers discussing treatment for demodex and Rosacea with SIBO.  First paper studied taking Oral Ivermectin vs. a combined treatment with Oral Ivermectin + Oral Metronidazole.   The combined treatment is the one that worked for me after having been misdiagnosed with bacterial acne for decades.  It uses 2 inexpensive, generic drugs.  Cost was just $13.03 with drug insurance copay.  The right treatment cured me in 2 weeks.

https://www.sciencedirect.com/science/article/pii/S120197121201315X

The second medical study paper discusses treating Rosacea and SIBO with the expensive antibiotic Rifaximin.  Only problem with this study is that they just used that one antibiotic without testing each patient for the bacteria causing their SIBO.  Rifaximin is great against E. Coli but not effective against other types of bacteria known to cause SIBO.

https://www.jaad.org/article/S0190-9622(12)02330-4/fulltext

As the previous response suggested, if demodex is not the problem, then get your hormone levels tested to determine if that is the underlying cause of your skin condition.

It is crucial to eat a healthy, well balanced diet, low in sugar.  Taking Probiotics or eating food high is probiotics can also be very helpful.

 

 

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9 hours ago, george20 said:

four rounds wouldn't that be much? Try to cure acne with diet and exercise. Apparently you are resistant to isotretinoin but I think you could be overloading your body with accutane a lot, for something your acne has not disappeared.

In any case, you can perform hormonal tests or other aspects of analysis that show that it is causing your acne.

If you do, try to follow a demanding regimen to avoid acne, good luck in your fourth round !!

I took Accutane 17 years ago, 10 years ago, and now 1 month ago. I have never had a hormonal test done.  That could be it.  I just know my face leaks oil constantly.  
 

I exercise every (other) day by running and eat very healthy.  
 

I think I’m just part of the low percentile that needs it long term.  

3 hours ago, ElaineA said:

Due to the potential for serious side effects from  Accutane/Isotretinoin, there are 2 other possibilities you should get tested for before starting a long term treatment with that drug.

Did the doctors test you for microscopic demodex skin mite overpopulation?  If not, get them to test you before starting a long term regimen with Accutane/Isotretinoin.     Large blackheads (large pores) are a major sign of a demodex overpopulation.    Demodex mites eat skin oil and possibly skin cells.   Accutane/Isotretinoin can appear to make your skin better while taking the drug since it greatly reduces oil output.  Reducing the oil, starves the mite population down.  But Accutane/Isotretinoin doesn't directly kill the mites. It just treats the symptoms, it doesn't cure the disease.   After you stop taking the Accutane/Isotretinoin the mite population can rebound and the skin problems return.   That situation happened to the patient in the following medical study.    2 once a week doses of Oral Ivermectin solved his issue.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489393/

In many cases the demodex get overpopulated due to Small Intestinal Bacterial Overgrowth (SIBO) which suppresses something in the immune system that controls the demodex skin mites population.  In that case, adding an antibiotic that is effective against SIBO can also clear the issue up in just 2 weeks.  Oral Metronidazole and Rifaximin have been used successfully to clear people with SIBO.  Choice of antibiotic depends on which bacteria is causing the overgrowth.   An endoscope test can collect a sample of fluid to test for the specific bacteria.   Rosacea Subtype 2 with papules and pustules is frequently misdiagnosed as bacterial acne.  It is the diagnosis if demodex skin mites are overpopulated.  Rosacea Subtype 2 also very frequently coexists with SIBO.  Here are 2 medical study papers discussing treatment for demodex and Rosacea with SIBO.  First paper studied taking Oral Ivermectin vs. a combined treatment with Oral Ivermectin + Oral Metronidazole.   The combined treatment is the one that worked for me after having been misdiagnosed with bacterial acne for decades.  It uses 2 inexpensive, generic drugs.  Cost was just $13.03 with drug insurance copay.  The right treatment cured me in 2 weeks.

https://www.sciencedirect.com/science/article/pii/S120197121201315X

The second medical study paper discusses treating Rosacea and SIBO with the expensive antibiotic Rifaximin.  Only problem with this study is that they just used that one antibiotic without testing each patient for the bacteria causing their SIBO.  Rifaximin is great against E. Coli but not effective against other types of bacteria known to cause SIBO.

https://www.jaad.org/article/S0190-9622(12)02330-4/fulltext

As the previous response suggested, if demodex is not the problem, then get your hormone levels tested to determine if that is the underlying cause of your skin condition.

It is crucial to eat a healthy, well balanced diet, low in sugar.  Taking Probiotics or eating food high is probiotics can also be very helpful.

 

 

Oh wow.  That’s really interesting.  I’m gonna do some research on that.  
 

I heard long-term studies at lower doses were okay so long as bloodwork checks out.  I do eat very healthy and exercise.  
 

As mentioned above by another poster, my hormones could be a major issue.  

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1 hour ago, DaveJTR said:

I took Accutane 17 years ago, 10 years ago, and now 1 month ago. I have never had a hormonal test done.  That could be it.  I just know my face leaks oil constantly.  
 

I exercise every (other) day by running and eat very healthy.  
 

I think I’m just part of the low percentile that needs it long term.  

Oh wow.  That’s really interesting.  I’m gonna do some research on that.  
 

I heard long-term studies at lower doses were okay so long as bloodwork checks out.  I do eat very healthy and exercise.  
 

As mentioned above by another poster, my hormones could be a major issue.  

Of course, you should know where your acne comes from, hormones, food, probiotics, there are endless things that are inside our body that the body tries to warn us in the form of acne.
If you can't find another solution, you can opt for accutane but know that it may have an associated risk.

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I had greate experience from long term (5 years) low dose (10mg) accutane with pauses in between courses. Up until the age of 27, where I increased the dose to 40mg and basically impacted my skin in a way that it cracks, fissures and wrinkles strongly so I couldnt handle isotretinoin any more. I don't know if it is my age that is causing me to not tolerate isotretinoin any more, or that increase to 40mg.

 

Again, with 10mg/day (with intermittent pauses) I was clear for 5 years completely (from age 21 till age 26) , but not cured.

Edited by rapharapha
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6 hours ago, george20 said:

Of course, you should know where your acne comes from, hormones, food, probiotics, there are endless things that are inside our body that the body tries to warn us in the form of acne.
If you can't find another solution, you can opt for accutane but know that it may have an associated risk.

I appreciate the response.  I agree.  I hope my blood work checks out each time.  

2 hours ago, rapharapha said:

I had greate experience from long term (5 years) low dose (10mg) accutane with pauses in between courses. Up until the age of 27, where I increased the dose to 40mg and basically impacted my skin in a way that it cracks, fissures and wrinkles strongly so I couldnt handle isotretinoin any more. I don't know if it is my age that is causing me to not tolerate isotretinoin any more, or that increase to 40mg.

 

Again, with 10mg/day (with intermittent pauses) I was clear for 5 years completely (from age 21 till age 26) , but not cured.

Did you end up stopping completely?  Did your acne come back?  Why did you not just go back to 10mg?  

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Now even 10mg is too strong for me and destroys my skin. Especially during winter. Even 10mg every other day is too strong. I'm 31, how old are you?

I might try 5mg every other day now.

Yes, acne always comes back. I basically want to stop isotretinoin forever, cause my skin cannot tolerate any more. I'm doing antibiotics, but my derm pushes isotretinoin instead.

Edited by rapharapha
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On 7/25/2021 at 9:36 PM, rapharapha said:

Now even 10mg is too strong for me and destroys my skin. Especially during winter. Even 10mg every other day is too strong. I'm 31, how old are you?

I might try 5mg every other day now.

Yes, acne always comes back. I basically want to stop isotretinoin forever, cause my skin cannot tolerate any more. I'm doing antibiotics, but my derm pushes isotretinoin instead.

I, too, am in my 30s.  I wonder if your cumulative dose has gotten so high that even a small amount of isotretinoin sets you off. 

Your derm probably understands your frustrations and wants to rid you of your acne.  If isotretinoin is all that has worked, then that’s probably the reason for the push.  

 

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