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Tales of flaky skin, purplish tones, and bleeding from weird places

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Very brief update: five days after my last pill I still experience most of the side effects. Dry skin and chapped lips are most obvious. If anything has dissipated, it would be the redness of the skin. There is still some redness, but people have commented my complexion seems to be more normal (though it could just be the lower sun intensity of autumn).


Day 179

Alright alright! I took my last pill today in rather unceremonious fashion in the parking lot of a Marriott hotel in Birmingham, Alabama.

Now, one of the questions I've had (with little success in finding an answer) was how quickly all the side-effects dissipate after the Accutane course finishes. I'll be updating this relatively frequently, commenting mainly on:

  • Dry lips/skin
  • Dry eyes
  • Nasal dryness
  • Joint pain
  • Sebaceous activity (i.e., skin oil production)
  • Acne...

Also, unfortunately my doctors suggested I have surgery on my shoulder to repair a torn labrum, an injury suffered from playing baseball. Firstly, the dermatologist said I shouldn't delay the surgery to allow for my skin to become more normal, since the surgery is arthroscopic and she says much of the skin's ability to heal is restored within about a month after stopping the drug.

However, I am curious if other people have had similar injuries, as I'm curious if Accutane played a contributing role in the injury (since there is less natural lubrication of the joints produced while on Accutane).


Day 160

So, an update after a lengthy break. After eight whirlwind weeks in California (Newport Beach!) I am back to recount some fun "tales-of-the-'tane".

  • Mr Kool Aid: My first day my client's security office took a photo for my ID badge. The bullet subject says it all. Like looking directly at a solar eclipse, one must shield their eyes to view this badge.
  • Dry eyes: Every successive month seems to bring a new side effect. Dry eyes seems to be the flavor of this month. Can make chatting difficult, as well as eyeing the cute marketing girls.
  • Chicken wings: My dermatologist noted my cholesterol reached 263 (it's been going up pretty steadily since month one). Only problem is...I really like those wings. No spine.

Perhaps most bizarre is the (very slight) signs of new acne on my face and around my collarbone. It's slight, but after the vitamin A onslaught my poor skin has suffered the past five months, I would have expected complete clarity.

Also, I've developed some odd attachment to my dear 'tane - it's part of my routine - and I sense some mild separation anxiety coming when I pop my ultimate dose in three short weeks.


Day 119

The groundhog came out of his lair and saw his shadow...and it had acne: two more months on Accutane. This will set a total course of six months on the drug. The dermatologist said progress has been made, but that a longer course will result in greater long-term results. Fine, but I really had been looking forward to dropping the facial redness and all the associated ills.


Day 112

Will next week be my last on Accutane?

Overall, no major changes in regimen/side effects since my last entry. Facial skin redness and dryness remain the most significant; the nosebleeds/dried blood in nose seem to have stopped.

A few questions for the group regarding what to expect as I stop the drug:

  • How long does facial redness persist once you stop the drug?
  • How long and at what pace does oil production in skin resume (I've had virtually no facial oil since day ~5)?
  • How long until I can drink alcohol safely (this question asked by my liver)?
  • How long until I can be less terrified of the sun?

That being said, there's a good chance my dermatologist will ask me to continue an extra month; I will just have to wait.


Day 85

Brief update post-vacation:

  • Sunburn: Despite applying 50 SPF at cloudy Cape Cod, I managed to get burns. The SPF seemed to be pretty effective at limiting the burns everywhere except my feet and ankles, presumably where it rubbed off more quickly. Almost two weeks later I still have some itchy peeling.
  • Nose bleeds: Have not had one in awhile, though still some bloody mucous (ick).
  • Blood test/derm appointment: I had a high triglyceride count last time, and so I've been a bit healthier with my diet (a very little...). However, I also drank a bit (no binging) on Saturday, so we'll see how that affects the liver reading. My next dermatologist appointment is on Thursday, so I should learn the results then.
  • Cold sore-ish thing: For whatever reason, the skin in one corner of my mouth tended to crack more than the other. I applied Vaseline extensively, and a couple weeks ago started to develop a bit of a sore. I shudder to think what people thought the sore might indicate. Anyway, it got much worse but now has cracked a bit and started to peel. I am curious to learn if anyone has had problem patches of skin (I also have a problem area on one ear.
  • Knees: Still hurt; jogging painful, baseball activities much more tolerable.
  • Facial skin: Still cherry red, very noticeable.

Potentially only one more month to go!


Day 69

A few non-side effect notes.

  • Sun exposure: I had quite a bit of sun exposure today with no major issues (thank you No-Ad SPF 50), and am off to Cape Cod tomorrow for my first "beach" vacation of the summer. I leave bearing a trace amount of dread about a big blistering burn, but I'm toting my SPF 50 bottle with me. I will provide an update on how things go (I am sensitive to the sun even without Accutane, so I should be a good case study).
  • Ex-girlfriends and other observers: I saw an erstwhile girlfriend of a longtime at her grandmother's funeral on Tuesday. She commented on how well my skin looked (with only a facial view). Secondly, a decidedly negative baseball teammate of mine made a rare and similar comment about the clarity of my facial skin. So, even though I did not go on Accutane principally for the face, apparently it is doing good things. And I suppose I notice it as well -- there seem to be very few "imperfections" of any kind in the facial skin, although it's still pretty cherry red. All-in-all, good news!

Last item - my pharmacy is telling me they no longer carry Sotret (a generic Accutane), and may switch me to another generic brand. Anyone else facing similar issues? Also, should I expect any issues with respect to switching brands?


Day 63

A few brief things to note regarding my latest Dermatologist office visit.

  • Progress: The dermatologist observed improvement on the chest/neck, notably the smaller and more dried-out nature of the acne there. Face is clear (though still pretty cherry red).
  • Bloodworks: As expected, my glucose levels were high (because I ate before the test). She did not express any concern about this. However, the triglyceride count was about 2x the normal level (my reading was 293 vs. 150 target of whatever measure was used). She told me to cut out the burgers and other fatty foods, but that she would not reduce dosage unless the reading reached 600. My response? I promptly ate macaroni and cheese and steak in successive dinners. I have no spine.
  • Side effects: Same as before, still not fun.
  • Barbecue: Last night I went to a barbecue and could not drink. I'm starting to yearn for the days of when a mini-binge was acceptable.

Also, I had not seen one of my office Accu-confidants, who finished her treatment about six weeks ago, for about two weeks until Friday. When I glanced at her her skin radiated (in a good, non-Chernobyl way), so I'm encouraged that my skin might look half as good when I'm finally done with this drug.


Day 54

Closing in on the halfway mark.

No major changes to report.

  • Dosage: Remains 2 x 40mg (80mg) per day
  • Side-effects: Reddened facial skin (I hate this side-effect), dry skin all around, nose bleeds (one every other day or so), significant decrease in facial oil
  • Coping with side-effects: Using Neutrogena facial moisturizer with SPF 15 (sensitive skin) in the morning, regular SPF 15 on other exposed skin (including the dome; damn you dad), and Vaseline on the lips every few hours and on other dry areas of the face
  • Acne: Face is clear (it has been for some time now), except for what appear to be some sores at the corners of my mouth. I think these are from the Vaseline. Neck had a minor breakout, but the acne is smaller and drier than usual. This is the principal reason I went on Accutane so I'll be monitoring this quite closely. Chest is pretty clear.
  • Alcohol consumption: None. What will power!

Other notes: I went to get bloodworks done at Quest. I had eaten that morning (supposed to fast), but they guy at Quest didn't seem to care (I suppose I wouldn't either if I were him). We'll see if it spoils the test. Additionally, I cut my knee/ankle playing baseball about two weeks ago. It seems to be healing somewhat slowly, but not that much more slowly than normal. It's hard to tell whether the cuts weren't severe of whether the Accutane simply isn't slowing healing that much, but it's a positive sign.


Day 40

Day 40

The one-third progress mark. That doesn't have a terribly catchy ring.

A few additions:

  • Dosage. Remains at 80mg (2 x 40mg) of Sotret (generic) per day. The dermatologist did not mention anything about changing dosage.
  • Nosebleeds. I had one or two during the first month of treatment. The past few days they have flared-up and occur nightly. I had one at dinner out today, which was a bit embarrassing, despite my attempt to pass off the blood as ketchup. Most are pretty mild (i.e., not the gushers that require ice and tipping your head back) but prompt me to put a towel over my pillowcase. For whatever reason a lot of the blood dries inside the nose. The subsequent decomposition of this blood produces a less-than-pleasant smell, and obviously is not well located. Gross.
  • Red skin. My facial skin ordinarily has a pinkish tint. The Accutane definitely has exacerbated the redness. My dad, who I had not seen since starting Accutane, came to town and commented that I look "three shades pinker" than usual. Others who I have not seen in awhile ask me if I got a sunburn. Often I try to trip these people as they walk away from me. This helps me feel better.
  • Clear facial skin. The face was not the main area of outbreaks, but typically I did get some pimples around the mouth. This is now pretty clear (another observation from my dad).
  • Time to invade Kuwait. Since puberty my skin has rivaled Saudi Arabia in aggregate oil production. No more. Early on in the treatment the oil secretions decreased dramatically. Even in the evening my skin is not oily, when it used to be by 10am. While a positive development and ostensibly common, I am curious to learn if anyone has seen a resumption in oil production (and to what extent) post-Accutane.
  • Chest and neck acne drying out. I still have a few red cysts/nodules (whatever they are), but they are definitely drying out. I don't appear to have many new ones. I will provide an update on these in the next entry, but overall is a positive sign.
  • Hair. My hair is thinning. And by thinning I mean my hairline is retreating like the French Army. I don't think the Accutane has accelerated the retreat, but I cannot tell for sure. I will do my best to monitor progress for any similarly afflicted males out there.

Note #1: I've been pretty forthright telling friends and colleagues about my treatment. I've found a surprising number of people who also took Accutane and who have provided comforting support as I cope with the side-effects (even if it's just sharing what they were). Others, particularly two pretty girls from the marketing department at my firm, have provided comic relief about my symptoms. I encourage others to share their story with others as well.

Note #2: As a precaution to others, make sure your pharmacy has your drug in stock when you drop off the prescription. I failed to confirm when I dropped-off the prescription on a Friday. The pharmacy did not fill the prescription until Wednesday. I gave myself a three-day buffer of pills, resulting in only one missed day. This would have been a more severe issue had my buffer not existed.


And so begins another blog recounting the travails and triumphs of an adult Accutane user. Firstly, a few facts about myself:

  • Age/gender: 28, male
  • Height/weight: 6' 1", 170 lbs
  • Acne: Light on face and back, moderate on chest, more severe on neck
  • Residence: New York, NY
  • Dosage: 2 x 40mg (80mg total daily)
  • Favorite animal: Yak

    I started Accutane principally because of outbreaks on my neck. These outbreaks are both unsightly and uncomfortable for a dude like me who has to don a shirt and tie now and then, causing abrasion on the neck. My acne started as a teen on my face but, in more recent years, has become more concentrated on the neck. I had not seen a dermatologist for several years, but after recounting the regimens I had been on in my early 20's (tetracycline, plenty of benzac washes), she recommended Accutane.

    My first experience with Accutane was dismay about the prejudicial double-standard applied to men and women. Why can't I answer questions about the appropriate response of an Accutane-user to propositions for unprotected sex? While must such fantasies be allowed only to women? A boy has to dream, particularly when coping with the visible side-effects of Accutane. Which brings me to the original point of this post -- a brief retrospective on the side-effects:

    • Day 1: Nothing, other than some trepidation about starting the drug
    • Day 5: Start to sense some drying of skin, plenty of preventive sunscreen applied, lots of time in the sun but no major burns. I notice some reddish hues in my facial skin.
    • Day 10: General skin dryness, but typical non-comedogenic daily moisturizers remain effective when applied extensively. I notice a strong thirst, particularly in the morning (when I take the pills). It looks like I'm sunburned, but it's rained and been overcast since I started treatment.
    • Day 15: Human no more, now reptile. People, mainly women, have called me a snake before, and never have they been so right. Facial molting begins. The area around the mouth becomes extremely flaky, and is very painful when I open my mouth to eat or even speak loudly. This is impossible to conceal with moisturizers (I am a dude so I do not use makeup, except for that one night in college which is a subject for another blog). The corners of the mouth crack and bleed lightly after meals. Lips become excessively chapped.
    • Day 18: In a high-power meeting about corporate strategy, I split a lip and bleed. I am thrown of my game. That company is doomed!
    • Day 20: A friend's girlfriend lends me the remainder of her chapstick and advises me to purchase a tub of vaseline for refills (apparently chapstick is basically petroleum jelly, which is what vaseline is. Who knew? And a tub of vaseline costs about $5 whereas a tiny chapstick tube costs $2.) The chapstick works on the lips within hours. In the evening I apply to my lips and to the flaky areas around my mouth.
    • Day 21: Wow. While the facial redness persists, the vaseline is supremely effective in improving the chapped lips and the flakiness. My new routine is to apply chapstick every 2-3 hours, and vaseline around the mouth before bedtime.
    • Day 27: Blood drawn. Took eight minutes in/out the door. Quest Diagnostics may be evil, but they sure are efficient.
    • Day 30: The skin side-effects seem to have steadied. However, I run and play baseball quite a bit, and I'm noticing some soreness in the knees. I could be searching for excuses to deflect the reality that I'm getting old, but I read that Accutane can cause joint swelling. So I blame the Accutane. Forever young.

    I should note that none of my entries mentioned my acne. This is because, by and large, it hasn't really changed. Some of the "nodules" on my chest and neck seem to have dried-out a bit, but some new ones have formed and, on balance, I do not observe much change. I am not discouraged as I've heard it's common for acne either not to improve or even worsen during the first month. And while I'm not thrilled with the skin and joint side-effects -- or the constant need to have vaseline and sunscreen handy -- I am not discouraged, and look forward to my next 30-day supply.

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