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Antony

Minimizing The Initial Breakout on Accutane

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It seems pretty unanimous on acne.org that among users of Accutane we break out-- and more often than not quite severely-- at least once, usually within the first 4-6 weeks of the course, sometimes further still.

Many have said that the so-called "initial breakout" is rarely any worse than the worst breakout you've ever had, though that probably gives little comfort to most of us.

As I am starting Accutane this coming Tuesday March 29 2005, I am bracing myself for what I've come to expect as the inevitable "initial breakout" within the first month, with possibly further breakouts thereafter.

What I would really appreciate from anyone with relevant experience is their recollection of what this initial breakout/s was like and, most importantly, whether and how any steps might be taken whether topically or systemically to pre-empt, minimize and quickly resolve the initial breakout/s.

Recognizing that the initial breakout is almost virtually inevitable and indeed an indication that the Accutane is successfully drying out and shrinking our sebaceous glands, how can we make the best of a necessary evil and minimize at least the APPEARANCE of the initial breakout on our face? (I'm a guy so NO make-up!)

Much thanks,

Antony

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Guest Craigems

My advice, dont stop the tane unless you desperatly have to. Dont loose faith, and you may be fortunate like me and not get an initial breakout. None the less expect the worst and dont change your attitude to life.

90% mental 10% physical, think of it that way.

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So did you just start improving and continue improving all the way through?

Are off now-- how long and have you broken out since?

always be aware that there IS a chance that you will notice NO initial breakout. This was my case.

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Welcome to the ride, buckle up and join the rest of us on the tane train!

My initial Break out was worse then I have ever had acne before. I had mild acne but could not get rid of it and I was starting to get a break out here an there on my chest and back. I am on 40mg a day. My first month started to suck about two weeks in. At my two month appointment my derm added 250gm of Zithromax to help get rid of the bacteria and what ever in there to help calm the initial break out. Now that I have finished all the Zithromax and am on month three my skin looks pretty damn good, no break outs anywhere (for now). The only thing that helped me through the emotions and zits thru the initial break out was my faith that Accutane was going to work for me as all else has already failed.

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Maybe I should PRE-EMPTIVELY minimize the breakout by having my derm prescribe a non-contraindicated antibiotic (erythromycin is essentially the only one safe with Accutane; your Zithromax is a derivative of erythro; tetra, doxy and mino are contraindicated).

This should minimize the bacterial infection stage of acne formation and thereby minimize the appearance of the breakout despite the fact that as Accutane begins drying out and shrinking the oil glands they initially resist by overproducing oil to compensate the increased dryness, in a sense putting up one last big fight before the Accutane overpowers them.

Most derms will prescribe an erythro-derived antibiotic alongside the Accutane IF you come in during a checkup having an initial breakout severe enough to warrant it; however, in my case I would like to explain to my derm that I want to PRE-EMPT the initial breakout and minimize it by starting erythro right away alongside the Accutane. Most derms may not be accustomed to patients being so proactive, informed and assertive about their treatment, but for me it is important to be as in control of this as possible.

What do you think?

Welcome to the ride, buckle up and join the rest of us on the tane train!

My initial Break out was worse then I have ever had acne before.  I had mild acne but could not get rid of it and I was starting to get a break out here an there on my chest and back.  I am on 40mg a day.  My first month started to suck about two weeks in.  At my two month appointment my derm added 250gm of Zithromax to help get rid of the bacteria and what ever in there to help calm the initial break out.  Now that I have finished all the Zithromax and am on month three my skin looks pretty damn good, no break outs anywhere (for now).  The only thing that helped me through the emotions and zits thru the initial break out was my faith that Accutane was going to work for me as all else has already failed.

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Good idea....maybe…

My derm would not give me anything at my first appointment cuz she wanted to see how it was going to effect me first, no need to over medicate someone if it is not needed, which I think is wise. Some people have no initial break out, and some do, everything effects people differently. Personally I would rather have it under control but then again is it worth dumping that much more stuff into your body if it is really not needed?

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I started Accutane on March 13, 2005 40mg twice daily, the doctor also put me on Steraped (prednisone), I didn't have a bad break out at first. Now since the prednisone is complete my face has bubbled up like never before. I'm glad to see that this is not uncommon for Accutane.

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80mg/day? How much do you weigh and what is your acne severity?

One thing I find most interesting about people's Accutane courses here is just how wildly the dosage varies, even among people with comparable weight and severity. The apparent lack of standardization among derms in treating an admittedly subjective condition is for me discouraging insofar as dermatology is a body of medical science.

I started Accutane on March 13, 2005 40mg twice daily, the doctor also put me on Steraped (prednisone), I didn't have a bad break out at first.  Now since the prednisone is complete my face has bubbled up like never before.  I'm glad to see that this is not uncommon for Accutane.

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My question is- During the initial for you girls- obviously there is dryness as well... Did you wear make up? if so, what kind- and did it look flakey all the time? I have to be able to cover it up because of the type of work I do, and the need to look decent all the time, and fashionable= which SUCKS when you have acne. So hopefully since I am on Retin A Micro and Doxy- that my pores are somewhat clear and I wont break out everywhere- but with my luck, I will.. Only time will tell.

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Antony-

I'm nearing the end of my first month, 40mg/day, (I weigh 120lbs).

I, too, was anxious about the initial break out. I could not imagine my skin getting any worse, and I was living in a constant state of dread my entire first week on Accutane. I pleaded for help from my derm so he prescribed a topical antibiotic called Evoclin, (clindamycin phosphate 1%). I also followed some advice I read about on message boards regarding icing your face, etc.

Everything proved to be fruitless.

The break-out started slowly--one or two pimples here and there at the end of the first week, and then, just days later (a week and a half into Accutane), my skin broke out terribly. A new cyst, several new pimples -- EVERYDAY! Absolutely the worst my skin has ever been, EVER.

But strangely enough, it was almost a relief. No more anxiety about when or how or if it was going to happen. It just did. And I resigned myself to thinking that it was a necessary process of what is hopefully a miracle drug.

I stopped the Evoclin and didn't bother with any newfangled treatments--just cleanse and moisturize. The Accutane is what you're taking to treat your acne so let it do its job. To me, trying to stave off the initial break-out is like trying to stop a flood with a paper towel.

My derm had warned me about this initial break out, stating that "these next few weeks will be very difficult...your skin will win the battle, but you will win the war." Not much comfort, I know. But when I went to see him a week ago, and reported that the initial "blitz," as he had called it, did happen and IS happening, he said I was proceeding exactly on schedule and that I should "be better" after one month (only a week away so who knows?). I asked him about folks who don't get an initial break-out, get one that is extremely severe, and those who get the break-out late in their treatment which lasts the entire treatment, and he responded with the following:

*People whose acne had been getting worse pre-Accutane will more likely have an initial break-out.

*People whose acne is more severe will get a more severe initial breakout.

*People whose initial break-outs are so severe and last longer than a month might have started on too high a dose - some studies have found that a high dosage can sometimes have a paradoxical effect.

*As for folks who get their break-outs later in the treatment (2 or 3 months in), they might have never gotten the "initial blitz."

My only advice is, fear if you must, but unless you have mild to low-moderate acne, expect that you will get an initial break-out and if and when it happens, it shouldn't last for more than 3 or 4 weeks. In the mean time, keep cleansing and moisturizing, and put off social plans! Yes, some people say, live your life, go out, etc etc, but staying in and waiting this period out worked for me. You don't stress about it as much if you don't need to see people, and basically, you can just cope.

Not sure about adding oral medications to the treatment. As someone stated earlier, Accutane is so powerful that ingesting any more drugs doesn't seem like a good idea, contraindicated or not. It might not even work. For some whose orals did seem to work, they started experiencing clearing after a couple of months, which is the "normal" expectation on Accutane anyway, so who knows if the antibios really did do anything.

The only quick fix I have found to be EXTREMELY helpful during this horrid period is the cortisone shots by my derm. I was getting cysts every day, and so once a week, I'd go in to see my doc who shot those guys down to nothingness.

Good luck.

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Your insights have been immensely informative and are greatly appreciated.

Thank you so much Karen.

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has anyone tried a megadose of b5 [10gr/day ] while starting accutane to avoid the initial breakout???

is this safe or will it cause TOO much dryness??

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I had stubborn moderate/mildly cystic acne despite antibiotics and topical retinoids. Had considered 'tane in my early 20's but it kinda cleared up but then in the last 18months came back (27-28y).

Started at 90mg (1mg/kg) and after 10 days had a horrific inflammatory breakout...well horrific to me but im sure no worse than other peoples'. I cut back to 45mg and took a course of prednisilone for several weeks (initially 20mg for 2 weeks and then very gradual reduction). The breakout was bad enough for me to take a few days off work but thankfully didn't leave me with new scars.

I went up to 90mg again about 9 weeks later, and I've got 4 weeks of treatment left. I am counting down the days, but having said that, it's the best thing I've ever done. I've not had anything other than a tiny pustule maybe post shaving for several weeks and the closed comedones and macrocomedones are slowly but surely dissapearing leaving smooth skin behind.

Ok, the side-effects are rough...particularly the fatigue, aches, dry skin and damn redness, but damn it's worth it. How many other therapies can offer such a high chance of "cure". Certainly few that I currently give my patients. I'm also told that the last month is when you really see the benefits and that it continues beyond the end of the course in many people.

Thinking back, I remember how much reassurance I got from reading this forum. It's true....it does get better. Patience is oh so much a virtue. Best of luck with it and all other newbies.

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