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Hormonal Acne and Accutane

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I have a question: Besides the pill what else can we do to prevent huge breakouts before or during our pms weeks? It really ticks me off b.c for 3 weeks out of a month my face has become manageable, I still get the occassional pimple but it's not a big deal but during my pms week I end up breaking out all over the place. Just to give u an example last month I ended up getting 5 big zits that hurt and 3 little ones. That's a total of 8! So then I have to battle clearing them up without scaring them and u know how it is, it takes forever for the big ones to shrink. I just finished taking my last b/c pill yesterday so who knows what ugly zits are lurking under my skin and waiting to come out all next week.

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Yup. I have this. I actually have to have surgery to take care of it soon, but I am an extreme case, so don't worry.

Emma,

If you don't mind answering a personal question--what made you suspect one of these conditions/how was it diagnozed? I.e. what tests did you have done?

Thanks,

C.

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Tired: ask your gyn. You can do menstrual supression - taking an active pill every day - but she has to write the prescription that way, AND it has to be the right kind of pill or you could have problems down the road.

:o)

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Emma,

thanks. And sorry about that. Operations are never fun. Warm thoughts.

Karma,

do you think it would make any sense to take Spiro just when the testosterone levels spike in mid-cycle? Enquiring minds want to know though they are well aware it normally takes up to (a couple of) months to see any effects from Spiro.

I thought this ( "pulsed" use) was an original idea of mine (the endo had never heard of anyone using it that way) but just yesterday I happened on some year-old posts in the Sprinonolactone thread here where someone had found a derm discussion board where derms claimed to have used Spiro in just the week before the period, with great results. I googled but couldn't find anything.

The endo is heartily recommending Yasmin first, Spiro to follow if needed but I'd rather try blocking the androgens first, before messing with the ovary-pituitary loop that seems to be working pretty OK in this case.

P.S. Searching again, I found a couple of mentions. This is from a Canadian source (SkinTherapy) :

Quote

The Use of Spironolactone To Treat Acne

Spironolactone: (Aldactone 50-200mg)

This drug is used as a diuretic and has weak anti-androgen effects, it may be of value if your patient combines it with a birth control pill and uses it for one week before their period to minimize a premenstrual flare of acne.

Uses for which this drug have been found to be effective, but which have not been recognized by government regulatory agencies:

Acne

Androgenetic alopecia

Hirsutism

Hidradenitis

Suppurativa

Side Effects:

Menstrual irregularity

Unquote

Edited by cloudy

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Presumably nobody responding to Carys' question has an MD his or herself? I think it is irresponsible to critique a MD's diagnosis or opinion based on one's own personal experience. Carys: I have hormonal acne and do not have PCOS. I have tried seven different forms of birth control and my "doctor" also suggested that Accutane was the right treatement (after weighing every other med, including those discussed here by others). I spent tens of thousands of dollars visiting "famous" dermatologists around the country (outside my insurance network) - they ALL suggested Accutane. I did try every topical med and antibiotic and suffered years of bad acne before finally deciding to take Accutane.

You cannot know whether YOUR acne will return following a course of Accutane. This drug permanently alters the shape of your sebaceous glands, which directly impacts the the source (albeit not necessarily the cause) of your acne. If the "source" is altered, there is a very good chance your acne will not return, hormonal or not. Also, if it's any help, my best friend used Accutane to treat TERRIBLE hormonal acne. She DOES have PCOS and following a course of Accutane, she has been acne free for 3 years - and just had a healty happy baby (and no pregnancy breakouts).

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Presumably nobody responding to Carys' question has an MD his or herself?  I think it is irresponsible to critique a MD's diagnosis or opinion based on one's own personal experience.  Carys: I have hormonal acne and do not have PCOS.  I have tried seven different forms of birth control and my "doctor" also suggested that Accutane was the right treatement (after weighing every other med, including those discussed here by others).  I spent tens of thousands of dollars visiting "famous" dermatologists around the country (outside my insurance network) - they ALL suggested Accutane.  I did try every topical med and antibiotic and suffered years of bad acne before finally deciding to take Accutane. 

You cannot know whether YOUR acne will return following a course of Accutane.  This drug permanently alters the shape of your sebaceous glands, which directly impacts the the source (albeit not necessarily the cause) of your acne.  If the "source" is altered, there is a very good chance your acne will not return, hormonal or not.  Also, if it's any help, my best friend used Accutane to treat TERRIBLE hormonal acne. She DOES have PCOS and following a course of Accutane, she has been acne free for 3 years - and just had a healty happy baby (and no pregnancy breakouts).

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I'm going home to MI in a few days for my husband's high school reunion and will be visiting my sister-in-law who happens to be a pharmacist. I think we'll have a sit-down and talk this drug over, as she would know fairly well what the real deal is regarding this particular medication.

Thanks, everyone, for your information and input. I really appreciate it. At this point, I'll probably end up going on the Accutane, as I don't have the luxury of shopping around for a doctor and the one I have will not refer me to anyone else. I've dealt w/the acne for far too long and the excess oil is about to drive me insane. If it seems that the acne comes back a few months after treatment, then I will do whatever I have to do to find another doctor (as this one has already made it plain that she won't give me another course of the 'tane or try Sprio) even if it means going into my own pocket for the expenses incurred.

Anyway, thanks again everyone. You've certainly given me much good advice to consider! smile.gif

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Presumably nobody responding to Carys' question has an MD his or herself?  I think it is irresponsible to critique a MD's diagnosis or opinion based on one's own personal experience.  Carys: I have hormonal acne and do not have PCOS.  I have tried seven different forms of birth control and my "doctor" also suggested that Accutane was the right treatement (after weighing every other med, including those discussed here by others).  I spent tens of thousands of dollars visiting "famous" dermatologists around the country (outside my insurance network) - they ALL suggested Accutane.  I did try every topical med and antibiotic and suffered years of bad acne before finally deciding to take Accutane. 

You cannot know whether YOUR acne will return following a course of Accutane.  This drug permanently alters the shape of your sebaceous glands, which directly impacts the the source (albeit not necessarily the cause) of your acne.  If the "source" is altered, there is a very good chance your acne will not return, hormonal or not.  Also, if it's any help, my best friend used Accutane to treat TERRIBLE hormonal acne. She DOES have PCOS and following a course of Accutane, she has been acne free for 3 years - and just had a healty happy baby (and no pregnancy breakouts).

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After reading this post I'm on the same dilemma...I can't believe my mom never had problem with her acne when she wa my age. I really hate myself..Now I have this horrible nodule that barely pop today..and yesterday I was looking at my skin and realized I look like shit. I have a lot of scars and red marks...I ask myself if I would of know about accutane when I was 21 I know my skin wouldn't look this bad. My boyfriend always told me that he hated to see me sad. That he will help me pay for the derm visits. I always refused. But, now...I decided to go to one. Now that my skin looks worse than before:( Next week I have my first appointment ever and I really don't know what to tell her. I'm afraid they might put me on creams and stuff. I really don't want that. I've done it and it doesn't work. I really want to get rid of this shit. I've tried birth control pills before. It work wonders...But, now I really don't know what to take...It's either spiro or accutane...I'm just confused...

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Claud,

I don't think it needs to be either or. All I am saying is that it is important to know (as far as we can) what causes adult acne, especially in women. If there is a clear hormonal component (extra androgens), it pays to try and balance the hormones first, before embarking on the "Accutrain." You'll have to be on BCP anyway if you want to go on Accutane. Why not see what e.g. Yasmin does all by itself, first. The progesterone component in Yasmin works the same way as Spiro -- it is actually said to be equal to 25 mg of Spiro a day.

For those interested in the scientific side of this, here's the abstract of a French study of isotretinoin efficacy. Note that they'd made sure that patients with closed comedonal acne OR hyperandrogenism had been pretreated "adequately" before they were given Accutane.

Predictive factors for failure of isotretinoin treatment in acne patients: results from a cohort of 237 patients.

Lehucher-Ceyrac D, de La Salmoniere P, Chastang C, Morel P.

Service de Dermatologie, Hopital Saint-Louis, Paris, France.

BACKGROUND: The efficacy of oral isotretinoin in acne has been established, though the role of the mean daily dose (MDD) is still unclear. OBJECTIVE: To determine the predictive factors of resistance to oral isotretinoin and the role of the MDD of isotretinoin on relapse of acne while taking into account patient characteristics and the total cumulative dose (TCD). METHODS: Two hundred and thirty-seven patients treated with oral isotretinoin for the first time were enrolled by a single dermatologist. Patients with closed comedonal acne and with hyperandrogenism received adequate therapy prior to isotretinoin. RESULTS: Closed comedonal acne was the only predictive factor of resistance to isotretinoin with an adjusted OR = 2.7 (95% CI: 1.0-7.3). The estimated rates of relapse at 1, 3 and 5 years were 14, 40 and 48%, respectively. Age and grade of facial acne were the only predictive factors for relapse with adjusted relative risks of 0.6 (95% CI: 0.4-0.8) for age >/= 20 and 1.5 (95% CI: 1.0-2.2) for grade > 3. CONCLUSION: MDD, TCD, closed comedonal acne and hyperandrogenism that have been adequately treated prior to isotretinoin treatment had no prognostic value for relapse.

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Play it nice is a wonderful suggestion! These boards are supposed to be about personal experience, suggestions and encouragement. It simply seems irresponsible to critique the professional opinion of any MD - whether you agree with it or not.

It was wrong of me to come across as so "absolute" in my commentary earlier. I was offended by the "K-Mart" comment and, perhaps, overly sensitive, given my professional allegiance to the broader MD community. I am NOT an endocrynologist (nor a pharmacologist), so I should refrain from commentary on these fronts.

Carys, my point (which may have gotten lost): Take all the positive suggestions/feedback you've garnered on this board and go through your own due diligence process. Meet with different doctors and do your research. Find an option you are comfortable with. Whatever you, in collaboration with your dermatologist, decide, I hope that it works well!

The great news: it seems you have a wonderful cohort of MD's directly considering your concerns and responding according to their own experiences. Hopefully, we can all retain our professional integrity herein.

I appreciate Cloudy's points - well taken. It took me a solid two years of research (pouring over clinical journals, consulting colleagues and non-colleagues, trying every single "solution" suggested, and YES, borrowing the anecdotes of friends). I am a walking clinical trial at this point. Accutane was my last resort and whether it is the placebo effect or not, my acne is gone. I work in clinical trials, so I do recognize the validity around your discussion of placebo effect.

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I don't know if I have hormonal acne or not- but it does occur worst on my chin, and it does flare up the week before my period...and then stops the week after, but I am left with healing cysts for most of those weeks before it just happens again.

I am really tired of this as well. I am taking a birth control pill that is supposed to help with acne.. Called Estrostep. I've been on it since January- so I've given it adequate time to work and it has not. I am changing to a pill I took as a teenager and liked, but I am still scared beyond words that my acne will get even worse.

I was wondering what the symptoms are of a hormonal imbalance. I would think that if I had a hormonal imbalance, I would have symptoms besides acne,no?

Anyway.. Help is needed and appreciated. I want to take accutane but if it won't do anything for my condition- then is it worth it??

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I don't know if I have hormonal acne or not- but it does occur worst on my chin, and it does flare up the week before my period...and then stops the week after, but I am left with healing cysts for most of those weeks before it just happens again.

  I am really tired of this as well. I am taking a birth control pill that is supposed to help with acne.. Called Estrostep.  I've been on it since January- so I've given it adequate time to work and it has not.  I am changing to a pill I took as a teenager and liked, but I am still scared beyond words that my acne will get even worse.

  I was wondering what the symptoms are of a hormonal imbalance.  I would think that if I had a hormonal imbalance, I would have symptoms besides acne,no?

  Anyway.. Help is needed and appreciated. I want to take accutane but if it won't do anything for my condition- then is it worth it??

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Karma - I don't disagree with you and I applaud your passion. My point was more that Carys seemed unsure as to whether her acne was hormonal or other. Without an evaluation from an endocrynologist, I would be hesitant to completely steer someone away from Accutane. At the same time, I agree that one should investigate all potential sources of acne before embarking on the great Accutane journey. I have my "miracle", and you have yours.

I'm doubtful that my training in internal medicine or the fellowship in ID qualify me to comment outside my own experience, so before anyone mistakenly takes any of this as absolute truth, I will cease and desist.

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Er, I couldn't agree with you more, and it's practically my mantra, that. Heck, I think everyone should see an endo AND flush their livers (try the lifestyle changes, I mean)!!! You know, just for S and G. eusa_dance.gif

You're absolutely right - many women mistakenly believe their acne is "hormonal" because of what they read in lay literature or hear from concerned friends or family, when in fact it isn't technically androgen excess or hypersensitivity (the hypersensitivity, though, is a bit of a diagnostic challenge; that's why cloudy recommended Dr. Redmond at the Hormone Center). The only way to know is due diligence in finding out...which means more doctors, fortunately or unfortunately.

It is becoming, by default, increasingly incumbent upon dermatologists (as the front line for spotting/treating the outward manifestation of this endocrinological problem) to be aware of the clinical signs of androgen excess. Ditto for gyns. It shouldn't be particularly difficult for a derm to learn about it and the necessary bloodwork, and to (oh my goodness) just get an endo consult if they're not sure how to interpret the data. Gosh, it would make life easier, if ya ask me. Delegation time!!!

Just bugs me, ya know? That lack of humility thing?

Heh. Yeah, like I should talk.

biggrin.gif

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Er, I couldn't agree with you more, and it's practically my mantra, that.  Heck, I think everyone should see an endo AND flush their livers (try the lifestyle changes, I mean)!!!  You know, just for S and G.  eusa_dance.gif

You're absolutely right - many women mistakenly believe their acne is "hormonal" because of what they read in lay literature or hear from concerned friends or family, when in fact it isn't technically androgen excess or hypersensitivity (the hypersensitivity, though, is a bit of a diagnostic challenge; that's why cloudy recommended Dr. Redmond at the Hormone Center).  The only way to know is due diligence in finding out...which means more doctors, fortunately or unfortunately.

It is becoming, by default, increasingly incumbent upon dermatologists (as the front line for spotting/treating the outward manifestation of this endocrinological problem) to be aware of the clinical signs of androgen excess.  Ditto for gyns.  It shouldn't be particularly difficult for a derm to learn about it and the necessary bloodwork, and to (oh my goodness) just get an endo consult if they're not sure how to interpret the data.  Gosh, it would make life easier, if ya ask me.  Delegation time!!!

Just bugs me, ya know?  That lack of humility thing? 

Heh.  Yeah, like I should talk.

biggrin.gif

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I was in a similar boat, emmanuel. I've had androgen excess since I was 17, but docs kept blowing me off. First, my periods were irregular because I "worked out too much." Then, it was because I didn't do it enough. The acne was just something I'd "grow out of" (at 25). The blood sugar dysregulation (or the manifestations of it) were "all in my head." My hair thinning? The darkening hairs below my navel, despite my very fair and almost hairless heritage? "It's nothing." My cholesterol kept creeping up, as did my BP, despite being a two-sport college athlete and an aerobics instructor, and being raised by the Food Nazi herself, lol. This went on for years.

There's more than my future health at stake, too (because I'm diabetic now, and have hardened arteries, despite taking such good care of myself). Three miscarriages. Failed relationships. Very moderate agoraphobia, at times. Missed opportunities because I was too drained doing all the work to figure it out on my own, when I was younger. Shame over having the symptoms of excess testosterone - trying to hide it. And oh, my, the terrible things I heard others say about women that had what I did, but worse (they were overweight and mega-balding and had beards, in addition to the acne!) For me, it wasn't just regular acne - for me, the acne was merely a symptom of everything that was so messed up. And I got to look at it every day as a reminder that my body was very, very sick. And I tried everything.

At the end of the treatment train, I also have the wacky pigmentation issues, and a great (even irrational) fear that I again will get as sick as I was. That's what happens once you've been that sick, you know? Could you imagine it happening to you again? Jesus. I can't. It was a nightmare.

There are doctors throughout my younger years that I would love to talk to, to tell them how their dismissiveness harmed me, and my mother (she had it too, and was treated terribly even though they knew about it then - it was just called Stein-Leventhal.)

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<SNIP>I just get especially angry when people - who happen to be doctors - ignore what they were taught (or should have learned), ignore the research, and (out of egotism or stubbornness, because they didn't bother to get informed before shooting off their mouths) mistreat and misinform innocent people.  It's unethical and harmful.

<SNIP>

in terms of getting good treatment and being better healthcare consumers - to recognize that doctors aren't God.  They're just people!  No magic about it.  Doctors work for you, not the other way around.  Some are good, some are quite definitely not. 

<SNIP>:o)

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I was in a similar boat, emmanuel.  I've had androgen excess since I was 17, but docs kept blowing me off.  First, my periods were irregular because I "worked out too much."  Then, it was because I didn't do it enough.  The acne was just something I'd "grow out of" (at 25).  The blood sugar dysregulation (or  the manifestations of it) were "all in my head."  My hair thinning?  The darkening hairs below my navel, despite my very fair and almost hairless heritage?  "It's nothing."  My cholesterol kept creeping up, as did my BP, despite being a two-sport college athlete and an aerobics instructor, and being raised by the Food Nazi herself, lol.  This went on for years.

There's more than my future health at stake, too (because I'm diabetic now, and have hardened arteries, despite taking such good care of myself).  Three miscarriages.  Failed relationships.  Very moderate agoraphobia, at times.  Missed opportunities  because I was too drained doing all the work to figure it out on my own, when I was younger.  Shame over having the symptoms of excess testosterone - trying to hide it.  And oh, my, the terrible things I heard others say about women that had what I did, but worse (they were overweight and mega-balding and had beards, in addition to the acne!)  For me, it wasn't just regular acne - for me, the acne was merely a symptom of everything that was so messed up.  And I got to look at it every day as a reminder that my body was very, very sick.  And I tried everything.

At the end of the treatment train, I also have the wacky pigmentation issues, and a great (even irrational) fear that I again will get as sick as I was.  That's what happens once you've been that sick, you know?  Could you imagine it happening to you again?  Jesus.  I can't.  It was a nightmare.

There are doctors throughout my younger years that I would love to talk to, to tell them how their dismissiveness harmed me, and my mother (she had it too, and was treated terribly even though they knew about it then - it was just called Stein-Leventhal.)

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I might know your uncle, Cashmira. Hopkins? Or Georgetown? I did some of my training at the former (and at Pitt), but do continuing ed and seminars with GU. Both have/had some really amazing characters.

:o)

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I'll miss your ovary with you, emmanuel. Okay? Do you want one of mine? It's probably polycystic, but I wouldn't know - I'm on the pill!

*sniff*

Seriously, I thank God it didn't kill you, too. You're a survivor, babe.

eusa_clap.gifwub.gif

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Emma,

I can only offer warm thoughts and cyberhugs from a stranger. Hopefully things won't turn out quite as bad as you are thinking. The waiting/not knowing is pits. Says someone who's been there.

C.

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