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Accutane 2nd course for moderate acne

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OK, what is the real deal with Accutane and moderate acne?

Here's my skin situation: I have had moderate inflammatory acne (the kind that can scar) and oil-choked skin since I was 14. I may have had a few deep nodules when my acne peaked in my teens, but I never had cystic acne. In other words, I had bad bad acne but it never crossed over the line to become the train-wreck variety that Accutane was originally intended for.

I have heard that for whatever reason, Accutane is somehow less effective for the moderate acne that I have than it is for severe acne. I did a full course and now a year after finishing, suddenly I am getting breakouts and oily skin. I thought one course would cure me, but it has not.

So my question is: Should I even bother with a second full course? Has anyone ever heard of a moderate acne sufferer getting permanent remission after a second course of Accutane?

Am I wasting my time and money?

Paul

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I decided when my course was over I wasn't going to use any topicals. I had theorized for years that constant use of topicals and the unavoidable attendant washing and scrubbing that comes with their use had only worsened my acne in the long run. So I took a shot at just letting my skin be for a while. Who knows, maybe if I had used Retin-A or something I would not be breaking out now. But then again, that would only have been serving to suppress the underlying disease.

After 15 years of topicals, pills and potions I am no longer interested in a daily death struggle with acne. I want to cure it. I'm done with it. Either Accutane cures me or I will low dose the rest of my life.

Or I will just give up and let it eat my face. I'm close to not caring anymore.

Paul

I would do a second course for a year of no acne.

I hope I am acne free for a year!

Did you use any topicals in that year?

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Only one way to guarentee you will be clear for a year: take a sufficient low dose for the duration.

That is my dilemma. Do I take the sure thing, low dose, or endure the misery of a full Accutane course and hope the remission is permanent.

See what I'm getting at? If I had low dosed instead of doing a full course last year, I'd still be clear, and I still would not have consumed the cumulative amount of Accutane that I did during my course. Not even close.

I would do a second course for a year of no acne.

I hope I am acne free for a year!

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how many mg's did you take daily and for long during your original coure?

I took a total cumulative dose of 8400mg over a period of seven months. I did the ramping up thing for the first month but was on 60mg daily for most of the course. I weighed 66kg at the time so I reached 124mg/kg total, which is within the recommended range known to bring about remission.

I felt like shit on this dose, so if I have to take a higher dose this time, it's going to be brutal.

Paul

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I decided when my course was over I wasn't going to use any topicals. I had theorized for years that constant use of topicals and the unavoidable attendant washing and scrubbing that comes with their use had only worsened my acne in the long run. So I took a shot at just letting my skin be for a while. Who knows, maybe if I had used Retin-A or something I would not be breaking out now. But then again, that would only have been serving to suppress the underlying disease.

After 15 years of topicals, pills and potions I am no longer interested in a daily death struggle with acne. I want to cure it. I'm done with it. Either Accutane cures me or I will low dose the rest of my life.

Or I will just give up and let it eat my face. I'm close to not caring anymore.

Paul

I would do a second course for a year of no acne.

I hope I am acne free for a year!

Did you use any topicals in that year?

See, I am unsure if I should use a topical for maintenence. My derm says I should, but like you, I feel it may make it worse. I don't want my skin irritated and red. But I am afraid I'll break out if I don't use anything. Also, retinoids really help you look young nad help with wrinkles.

It seems that the people who have stayed clear the longest, i.e., greater than six months didn't use any topicals after tane whereas the ones who did use something brok-out sooner. It is hard to determone this, because most people don't answer the question. I do feel that the people still posting about topicals after 'tane seem to be breaking out and can only surmise that the one's that don 't break out don't use anything after 'tane.

I wish I knew. Someone should conduct a study.

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I'd say go ahead and use it.

Look at it like this. If Accutane successfully "cures" you, no topical is going to bring your acne back (maybe it will cause a little nuisance breakout from irritation, such as a normal-skinned person might experience, but that is a different thing).

On the other hand, if using a little Retin-A causes your acne to explode, it means you still have the underlying disease (acne). Time for Accutane round 2, or back on the skincare merry go round.

What we are all looking for from Accutane is to have normal, healthy skin. Part of having normal healthy skin means you can put a little Retin-A on and not wake up a week later with severe acne. When that happens it is an indication that there is a problem with you and your skin, it's not the topical.

Using or avoiding topicals post Accutane is not going to be crucial to maintaining long term benefits from Accutane, in my opinion. It might help a bit one way or the other, but at the end of the day, you are either gonna get a long term remission (or drastically reduced severity) or you're gonna crash and burn. I just find it very hard to believe there is someone out there post-Accutane who is holding a case of cystic acne at bay by applying Retin-A or Duac or whatever. Maybe I'm wrong.

Paul

I decided when my course was over I wasn't going to use any topicals. I had theorized for years that constant use of topicals and the unavoidable attendant washing and scrubbing that comes with their use had only worsened my acne in the long run. So I took a shot at just letting my skin be for a while. Who knows, maybe if I had used Retin-A or something I would not be breaking out now. But then again, that would only have been serving to suppress the underlying disease.

After 15 years of topicals, pills and potions I am no longer interested in a daily death struggle with acne. I want to cure it. I'm done with it. Either Accutane cures me or I will low dose the rest of my life.

Or I will just give up and let it eat my face. I'm close to not caring anymore.

Paul

I would do a second course for a year of no acne.

I hope I am acne free for a year!

Did you use any topicals in that year?

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OK, what is the real deal with Accutane and moderate acne?

Here's my skin situation: I have had moderate inflammatory acne (the kind that can scar) and oil-choked skin since I was 14. I may have had a few deep nodules when my acne peaked in my teens, but I never had cystic acne. In other words, I had bad bad acne but it never crossed over the line to become the train-wreck variety that Accutane was originally intended for.

I have heard that for whatever reason, Accutane is somehow less effective for the moderate acne that I have than it is for severe acne. I did a full course and now a year after finishing, suddenly I am getting breakouts and oily skin. I thought one course would cure me, but it has not.

So my question is: Should I even bother with a second full course? Has anyone ever heard of a moderate acne sufferer getting permanent remission after a second course of Accutane?

Am I wasting my time and money?

Paul

Your skin problems sound like my history -- bad and persistent as heck, but never cystic. I haven't found that Accutane ever cured me (on my fourth round now). I would never discourage anyone with skin problems from going on it cuz it's a great way to clear you up. It's a tough uphill battle to even get close to decent looking skin when all you have to work with are antibiotics and topicals. If you can use the accutane to get you clear though, and then start something else right after when you finish, that (IMHO) is probably the best way to go. If you're older like me (I'm 35), and you've been fighting this battle for a while, it's probably not ever going completely away. Unfortunately it will always be a constant battle. Luckily, Accutane makes things better long term (even if not perfect) enough to deal with things.

So ... I would do a second course. Why not? It'll clear you. Assuming their aren't other factors preventing you from doing it -- like money -- and assuming you didn't have any horrible side effects the first time. What would make you not want to do a second course?

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You make a lot of good points! However, I'm afraid that the retin-a will make me go from clear to red and/or have breakouts. I know there must be some stuff still under my skin and RAM will definately bring it out.

Also, normal people don't have to use topicals and most of the older people who use it for wrinkles haven't had acne in a long time.

I agree with you in that I feel I will either use the topical and breakout and need a 2nd course or I will not use the topicals and breakout and need a 2nd course. It's the luck of the draw. My major concern is this: I want to stay clear for as long as possible in between courses and I wish I knew the best thing to do (or not do) to make that a reality. :think:

I'd say go ahead and use it.

Look at it like this. If Accutane successfully "cures" you, no topical is going to bring your acne back (maybe it will cause a little nuisance breakout from irritation, such as a normal-skinned person might experience, but that is a different thing).

On the other hand, if using a little Retin-A causes your acne to explode, it means you still have the underlying disease (acne). Time for Accutane round 2, or back on the skincare merry go round.

What we are all looking for from Accutane is to have normal, healthy skin. Part of having normal healthy skin means you can put a little Retin-A on and not wake up a week later with severe acne. When that happens it is an indication that there is a problem with you and your skin, it's not the topical.

Using or avoiding topicals post Accutane is not going to be crucial to maintaining long term benefits from Accutane, in my opinion. It might help a bit one way or the other, but at the end of the day, you are either gonna get a long term remission (or drastically reduced severity) or you're gonna crash and burn. I just find it very hard to believe there is someone out there post-Accutane who is holding a case of cystic acne at bay by applying Retin-A or Duac or whatever. Maybe I'm wrong.

Paul

I decided when my course was over I wasn't going to use any topicals. I had theorized for years that constant use of topicals and the unavoidable attendant washing and scrubbing that comes with their use had only worsened my acne in the long run. So I took a shot at just letting my skin be for a while. Who knows, maybe if I had used Retin-A or something I would not be breaking out now. But then again, that would only have been serving to suppress the underlying disease.

After 15 years of topicals, pills and potions I am no longer interested in a daily death struggle with acne. I want to cure it. I'm done with it. Either Accutane cures me or I will low dose the rest of my life.

Or I will just give up and let it eat my face. I'm close to not caring anymore.

Paul

I would do a second course for a year of no acne.

I hope I am acne free for a year!

Did you use any topicals in that year?

See, I am unsure if I should use a topical for maintenence. My derm says I should, but like you, I feel it may make it worse. I don't want my skin irritated and red. But I am afraid I'll break out if I don't use anything. Also, retinoids really help you look young nad help with wrinkles.

It seems that the people who have stayed clear the longest, i.e., greater than six months didn't use any topicals after tane whereas the ones who did use something brok-out sooner. It is hard to determone this, because most people don't answer the question. I do feel that the people still posting about topicals after 'tane seem to be breaking out and can only surmise that the one's that don 't break out don't use anything after 'tane.

I wish I knew. Someone should conduct a study.

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What about the oft quoted statistics on Accutane's long term remission rate?

60% = cured after one course

80% = cured after second course

95% = cured after third course

Is this just hokum? What are we doing wrong people?

Your skin problems sound like my history -- bad and persistent as heck, but never cystic. I haven't found that Accutane ever cured me (on my fourth round now). I would never discourage anyone with skin problems from going on it cuz it's a great way to clear you up. It's a tough uphill battle to even get close to decent looking skin when all you have to work with are antibiotics and topicals. If you can use the accutane to get you clear though, and then start something else right after when you finish, that (IMHO) is probably the best way to go. If you're older like me (I'm 35), and you've been fighting this battle for a while, it's probably not ever going completely away. Unfortunately it will always be a constant battle. Luckily, Accutane makes things better long term (even if not perfect) enough to deal with things.

So ... I would do a second course. Why not? It'll clear you. Assuming their aren't other factors preventing you from doing it -- like money -- and assuming you didn't have any horrible side effects the first time. What would make you not want to do a second course?

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What about the oft quoted statistics on Accutane's long term remission rate?

60% = cured after one course

80% = cured after second course

95% = cured after third course

Is this just hokum? What are we doing wrong people?

Maybe they are using only teens and not including adult acne patients in their studies.

Here's a study from Pubmed on remission rates, etc.

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.

PMID: 10393453 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------------

Oral isotretinoin. How can we treat difficult acne patients?

Leyden JJ.

Department of Dermatology, University of Pennsylvania, Philadelphia 19104, USA.

Isotretinoin (Roaccutane/Accutane) therapy (120 mg/kg) normally results in complete clearing of nodulocystic acne followed by prolonged remission, and many patients remain free of disease. Four groups of patients respond poorly or have a high rate of relapse. Preteens and young teenagers show a high rate of relapse and several courses of treatment are usually needed; 14 of 20 under the age of 12 years, 21 of 47 aged 12-14 and 23 of 66 aged 14-16 relapsed within 1 year. Individuals with linear lesions consisting of undermining tracks of follicular epithelium often show only a partial response. These individuals typically have a history of other 'sinus track' disease such as pilonidial sinus and hidradenitis, either themselves or other family members. Hemorrhagic or crusted lesions can be exacerbated by full doses of isotretinoin and patients develop pyrogenic-granuloma-type lesions and even acne-fulminans-like eruptions. Women with adrenal or ovarian syndrome associated with elevated androgens commonly relapse with 6-12 months after isotretinoin therapy.

Publication Types:

Review

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Well, I love Accutane as much as the next guy or gal, but if it's not going to keep me clear, what's the point? A few months of clear skin? I'd just as soon take a lower dose continuously and avoid the toxicity of a full course.

Do you feel like you have been getting the correct cumulative and daily dosage on your courses? How long do your results last. I'm a guy, will be 27-yrs-old in a few months. I'm hoping against hope that my skin problems begin to subside at some point.

Did your derm tell you you had any chance of a permanent remission? What does he say about Accutane and moderate adult acne like ours?

Paul

My derm said if Accutane hasn't "cured" me by now, it isn't going to. My acne is SOOOO much better than it was when I was a teenager. The point for me is that every round of accutane improves things. Plus I get back to clear and I start back over trying to maintain with other stuff. My acne seems to be mostly hormonal as my skin goes crazy around that time of the month. They have me on b/c to try to help with that, but I don't notice any difference w/the b/c. Other options include things like trying to mess w/my hormones, which kind of scares me. I don't know how the whole hormone thing plays out with guys.

My dosage has been 80 mg/day for what will be six months. I'm 135 lbs, so I think that's a pretty decent dose. I've been as high as 100mg/day before.

My derm said there were no studies on long term accutane use, so she was hesitant to go that route. I would consider that if that option was available, but it does seem like a seriously toxic drug to be on forever. I mean, it seems like your body would need a rest from it, particularly your liver.

Another thing my derm said was that accutane seemed to work best long term for teenagers with severe cystic acne, which makes sense to me. I have seen people with so much worse skin than me take accutane, clear up and never get another pimple, whereas for me it seems to be my lifelong curse.

I'm not sure I buy the %'s of people that remain clear after round one/two/etc....but I suppose there could be something behind those.

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Isotretinoin and acne in practice: a prospective analysis of 188 cases over 9 years.

Lehucher-Ceyrac D, Weber-Buisset MJ.

Department of Dermatology, St-Louis Hospital, Paris, France.

A total of 188 acne patients (113 male and 75 female) with a mean age of 25 years (range 15-42 years) were treated with isotretinoin in doses ranging from 0.5 to 1 mg/kg. The study lasted 9 years. The treatment was not terminated until 2 months after total healing. The patients were then re-examined at regular intervals. In the event of a recurrence greater than grade 2 (pre-nodular threshold grade), they underwent a new course of treatment. At the end of the study, three groups were distinguished: (1) immediate, long-term, stable remissions following one single course of isotretinoin (111 patients with an average follow-up period of 27 months); (2) stable remissions following 2 or 3 courses of isotretinoin (54 patients with an average follow-up period of 16 months); (3) immediate partial remissions or partial remissions following several courses of treatment in 23 patients who continued to present with at least grade 3 acne. There was no significant statistical difference between the first two groups with respect to the age and sex of the patients and the grade and prior duration of the acne. The third group differed from the other two in having a greater proportion of patients with microcystic acne (p < 0.05) and women with endocrinological problems ((p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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. Individuals with linear lesions consisting of undermining tracks of follicular epithelium often show only a partial response. These individuals typically have a history of other 'sinus track' disease such as pilonidial sinus and hidradenitis, either themselves or other family members. Hemorrhagic or crusted lesions can be exacerbated by full doses of isotretinoin and patients develop pyrogenic-granuloma-type lesions and even acne-fulminans-like eruptions. Women with adrenal or ovarian syndrome associated with elevated androgens commonly relapse with 6-12 months after isotretinoin therapy.

Publication Types:

Review

Could anyone translate this into English for me? I have a strange kind of "super-acne" on my chest, shoulders and back, they are kind of cystic, but small... Problem is that they stay for at least a year each.. I'm on Roaccutane for it now, and hope this study isn't saying that I have a strong chance of relapse... :(

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Okay, this is very interesting indeed. It seems to say, with respect to your chances of achieving a long lasting remission with an Accutane course, that

A. It doesn't matter how old you are, and

B. It doesn't matter whether your acne is mild, moderate or severe cystic/nodular.

Which flies in the face of other studies. What is the truth?

Does anyone know what is meant by "average follow up period 27 months"? Is that just indicating how long they kept tabs on the participants in the study? If so, where is the "9 years" figure coming from?

Paul

Isotretinoin and acne in practice: a prospective analysis of 188 cases over 9 years.

Lehucher-Ceyrac D, Weber-Buisset MJ.

Department of Dermatology, St-Louis Hospital, Paris, France.

A total of 188 acne patients (113 male and 75 female) with a mean age of 25 years (range 15-42 years) were treated with isotretinoin in doses ranging from 0.5 to 1 mg/kg. The study lasted 9 years. The treatment was not terminated until 2 months after total healing. The patients were then re-examined at regular intervals. In the event of a recurrence greater than grade 2 (pre-nodular threshold grade), they underwent a new course of treatment. At the end of the study, three groups were distinguished: (1) immediate, long-term, stable remissions following one single course of isotretinoin (111 patients with an average follow-up period of 27 months); (2) stable remissions following 2 or 3 courses of isotretinoin (54 patients with an average follow-up period of 16 months); (3) immediate partial remissions or partial remissions following several courses of treatment in 23 patients who continued to present with at least grade 3 acne. There was no significant statistical difference between the first two groups with respect to the age and sex of the patients and the grade and prior duration of the acne. The third group differed from the other two in having a greater proportion of patients with microcystic acne (p < 0.05) and women with endocrinological problems ((p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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