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Ok, so I was told to start one of these guys. Let's see how it goes:

Problem: Acne on the face, back and chest. The face isn't the problem. The back and the chest (cystic stuff) have actually started hurting. It hurts to put on my seatbelt, it hurts to wear buttoned shirts, it hurts to shower. I've tried everything else, so this is the last straw. I really really hope it works.

Dosing:

Prednisone: 30mg for 5 days, then 20mg for 5 days, then 10mg for 5 days

Accutane - 1x 40mg, alternating with 2x40mg every other day (starting on day 4 of the Prednisone).

Vitamin E - 1x 400 I.U.

Day 1: Sunday, May 1. A little flush an hour after my first dose, but otherwise fine. This is my fourth day of the prednisone and everything's fine and dandy.

Day 4: Wednesday, May 4. Things seem to be clearing up. I'm prepping for the inevitable storm, but the anti-inflammatory steroids seem to be helping. I'm sure it's not the Accutane working yet. No side effects. Is that because of the Vitamin E, or is it just too early to tell?

Day 6: Friday, May 6. Starting to get a few whiteheads around my lips. I'm trying not to pick them or pop them with my comedone extractor, but it's tough. I'm afraid of scarring, so that's enough of a deterrent.

Day 7: Saturday, May 7. Definitely a few more whiteheads. There's also these nagging blackheads on my nose, but no picking!

Day 8: Sunday, May 8. Worse yet. Still no dryness or other side effects. Just the breakouts. I vaseline my nostrils in the mornings and at night before I go to bed after a few squirts of saline spray, so no nosebleeds (which I've been notorious for since I was a little kid.)

Day 9: Monday, May 9. Worst day yet. Lots of whiteheads around the lips and chin, and under my chin onto my neck. A few on my chest and back as well, but not as bad as my face, which is a good thing. On the one hand, I haven't had acne this bad since freshman year of college, but on the other hand, it's proof that the accutane is at least doing something! The way I look at it, for the Accutane to close up shop on my pores and sebaceous glands, it's gotta evict the squatters first! It ain't pretty, but it's happening. It's a relief with that in mind.

Day 10: Tuesday, May 10. Even worse, but I take it all as a good sign. Today, though, for the first time since college, i actually tried to avoid people because I thought I looked hideous. Ugh. I got over it after lunch though. All my friends at work kept stopping by and took me out to lunch. I'm not depressed or anything, but I'd just rather keep it to myself, know what I mean? Everything was made INFINITELY better with the purchase of my new iMac G5 tonight, though! My chin really really really hurts, so I've applied some Caladryl and I'm gonna sleep with it on. We'll see how it goes.

Day 11: Wednesday, May 11. Woke up in the middle of the night to wash off the Caladryl. Remarkably, I felt better. Woke up this morning to a few more cysts on my back, the back of my neck, and my scalp, but my face isn't worse than yesterday, I don't think. At the very least, it's exactly the same. We'll see. Big interview today, but hey, nothing I can do about it. Well, actually, I'm already doing everything about it that I can. lol.gif

With hope,

-Sav

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Day 13: Friday, May 13. The face cleared up a little yesterday, but I think it's a little worse today. The chin's drying up and scabbing, but the whiteheads have started spreading to my eyebrows and lower forehead. (Stop me if I'm grossing you out... Sorry. I figure the more detailed the better). It all hurts like a flaming pit in hell, periodically, but I'm not sure what I can do.

I've definitely started getting cysts all along my back, which hurt like HELL, but such is life. If I sit in one place and don't move, the pain goes away. I'll be happy when I get back to the way I was before! But I'm happy the Accutane is doing something. No real excessive dryness, and no other side effects at all (thankfully!). I haven't been using moisturizer, because applying it hurts like hell and I haven't been dry enough to warrant it. But I've always had fairly oily skin.

Also, I haven't shaved since the before the breakout (on Sunday night), because I use a Schick Extreme 3 blade, and I'm scared shitless of aggravating the breakout and/or rupturing what I already have on my face. I've considered moving to an electric razor, but doing research on it today, it takes 2-3 weeks of irritation before your skin gets used to it. The last thing I need right now is more irritation, so I'm just letting it grow. It itches (and sometimes hurts) like hell, but there's not much else I can do. Any suggestions from anyone else!?!?

At least I'm not depressed. lol.gif

That's kind of true though. At least I'm being optomistic about the whole thing. This whole brand new iMac kind of helps to dull the pain too. wink.gif

With hope,

-Sav

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i found my electric razor i have to push harder into my skin for it to cut the hairs anyway, and it irritates more... nothing wrong with a razor, i find they don't irritate at all if i do a careful job.

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Sav,

These personal logs are a great idea. (And yours is a very good read in particular.:-) It's interesting how differently people react to these drugs. I wish there was a way of putting all this info into a database. With thousands of members, this site could collect a lot of valuable information about side effects and initial break-outs vis-a-vis how skin looked when therapy was started and dosage etc.

Have you been on prednisone before? The timing of your initial break-out is real fast--especially as your 40/80 regimen is not especially high for a guy. Some of the small (weight-wise) girls here were started on 80mg a day.

I like your description of skin-gunk as squatters to be evicted. Someone else was describing the blackheads/whiteheads as seeds, about to grow into cysts. And yet another logger's description of Accutane pushing the blackheads out of his nose gave me a distinct vision of prairie dogs in their burrows, peeking out...

Good luck. Keep writing.

Clouds

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aeman,

I'm specifically concerned about cutting the whiteheads. Mine are prevalent all over my chin and neck, so I don't know how to go about shaving. Do you have a similar problem?

Cloudy, thanks for the response.

Yeah, I've been on prednisone before, but that was a fairly long course (2-3 months) about 5-6 years ago. Not since then though. It's amazing how the breakout completely coincided with the reduction of the prednisone. I started getting the breakout the day I moved from 30mg to 20mg. Coincidence? Maybe. I'm not sure.

-Sav

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Day 15: Sunday, May 15. The whiteheads have kind of gone away (there are still a few), but my entire chin/mouth area is covered with this really unusual dry skin. Halfway between scaling and scabbing. Big chunks (kinda disgusting... sorry). It hurts to open my mouth, I've started getting painful breakouts all over my back, and I'm not in a great mood, but oh well. What can ya do? I'm still hopeful...

Day 16: Monday, May 16. Today, the scaling was still pretty bad, and the idea of letting my beard grow out got a little annoying. It was so ridiculously itchy under my chin that I think it was just irritating the breakout further. It got so bad that I had to leave work (I was also feeling slightly under the weather. I had a 99.8 temp last night, mild, but annoying). I got home and in a fit, decided to shave as much as I could without cutting any cysts or whiteheads. God, it was annoying, but lo and behold, the shaving cream softened the scabs to the point where they started falling off! I didn't even have to scrub. My face looks significantly better now. It still hurts, but at least I look a ton better than this morning/this weekend!

Day 17: Tuesday, May 17. Well, after the horrible weekend of dryness and scabbing, my parents, concerned as they were, called a family friend who also happens to be a doctor. She talked to a dermatologist in her group and they recommended that I call my dermatologist, because although initial breakouts are common, they should have been repressed by the initial dosage of prednisone. Additionally, breakouts as significant as mine have been can cause scarring.

So I called my derm today for an impromptu appointment, and he said that the breakout shouldn't be this bad. He's only had 2 patients who have ever responded poorly to Accutane, and I would be the third if his follow-up treatment doesn't work. (God, I hope that ain't the case).

Follow up treatment as follows:

Continue the Accutane (40mg, alternating with 80mg).

Inject with 40mg of steroids (which should release into my body over the course of a month).

Take 40mg of Prednisone a day for 5 days while waiting for the shot to kick in.

Apply topical steroid cream to the scaling/scabbing areas to avoid additional scaling.

Moisturize, moisturize, moisturize! (I ditched the olay and I'm onto the Doc's recommendation of Cetaphil Facial Moisturizer).

Day 19: Thursday, May 19. Hot damn, I'm back in business! Most of the scaling's gone. Most of the whiteheads/cysts have retreated. And my face is so much remarkably better than it has been in 2 weeks! I'm feeling great! Let's hope this keeps up!

Still hoping for the best!

-Sav

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Day 45: I figured this was a landmark day enough to get back on the boat. Sorry I haven't been around, but things have been crazy at work and at home, etc...

So. Brief rundown of the last 26 days: I went back on steroids, along with a steroid injection, and everything was absolutely chipper! I hadn't looked better than I had in YEARS (since before acne). Perfect!

That lasted about 2 1/2 weeks, and in the last week and a half or so, I've had some mild flaring up/breaking out, but nothing nearly as bad or consistent as it was initially. So overall, I've improved. I'm gonna go back to the Doc this week to see if this breakout is normal (which I'm assuming it is, having read of all the 1 1/2-2 month breakouts on this board), not to mention the additional factor of the steroids wearing off. I probably don't have to worry, but after last time, I figure it's best if I nip this in the bud should it be a problem.

So that's my update! Everything's going great! Hope everyone's doing well!

-Sav

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Dude. So behind on this. But whatever.

Final rundown:

I kept on my 60 mg a day for another month and a half, ramping up to 80 mg by the end of 4 months. My dermatologist then abruptly left the firm, and I was left with another, far more experienced dermatologist. He let me know that the prior dermatologist had completely underdosed me. For my weight and severity, I should have been on at least 120mg if not 160!

He quickly ramped me up to 120, but he let me know he couldn't keep me on Accutane too long (22 weeks was the longest he'd ever kept someone on it... i quit at 23), and essentially I'd gotten a short shrift on my dosage. Had he been in charge from the get-go, he would have had me at 120 quickly, ramping me up to 160 if necessary. In order to compensate, he wanted to consider a second dose of Accutane 2-3 months down the line.

Well, being at 120 worked WONDERS! In a few weeks, my face had entirely cleaned up! Not a spot to be found! My back and chest got better, but not completely, but I finished up my first course of Accutane on the 14th of October, and I've felt great!

I went back today, with my major issue being my back and chest, and he said "let's try to finish this without a second course of accutane." So I'm moving to Bactrim DS (which I used before) as well as Retin-A on the face, chest, and back.

We'll see how it goes!

Thank you guys so much for your support! I hope this log helps some people out there!

Sav

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