Should I ask for low-dose Accutane?
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Wed May 04, 2011 8:45 am

I'm 28, male, Caucasian, fair skin. I had only minor problems with acne as a teenager and into my mid 20's. However, I have extremely oily skin and have always had a lot of blackheads and at least a few whiteheads per week. Since about a year ago, my skin has really acted up. I have rosacea, seb derm, pustules and papules, and lots of oil on my face. I was initially treating my problems with BP, SA, exfoliants, peels, etc. That was obviously a big mistake. My derm then prescribed Minocycline 100 mg, metrogel, and keto cream. That helped quite a bit, and my skin was pretty calm until February.

I then developed what looked like p. folliculitis on my forehead. I discontinued Minocycline, but still used metrogel and keto cream. I think metrogel is too irritating, as was the Cerave cleanser I was using (contains parabens). After stopping the antibiotics and maybe being too agressive with topicals, my rosacea is no longer under control. I experience flushing, irritation, burning, etc. The forehead is still no better, and I'm super oily.

So what do I do? Given the many concurrent issues, should I ask for Accutane and try 5-10 mgs a few times per week? That might solve all my issues: rosacea, oily skin, P&P's, folliculitis, and seb deem. I don't really see another approach because antibiotics are definitely worsening the forehead condition, and I need relief from the burning of rosacea.

free skin care · Wed May 04, 2011 9:29 am

You could definitely consult your doctor for this. Just know that p. folliculitis is a type of fungus, not a bacteria. So your monocycline (which is an antibiotic) will not help resolve it. In fact, it may be contributing to your folliculitis because the monocycline can also destroy the good bacteria on your skin which helps keep the population of other organisms on your skin under control. (In other words, destroying the bacteria will also decrease the amount of competition, so that the folliculitis can flourish more easily.)

I`m not so sure if accutane will help too much at a low dose because it really needs a high concentration to work effectively. But again, you should discuss it with your doctor

free skin care · Wed May 04, 2011 9:30 am

You could definitely consult your doctor for this. Just know that p. folliculitis is a type of fungus, not a bacteria. So your monocycline (which is an antibiotic) will not help resolve it. In fact, it may be contributing to your folliculitis because the monocycline can also destroy the good bacteria on your skin which helps keep the population of other organisms on your skin under control. (In other words, destroying the bacteria will also decrease the amount of competition, so that the folliculitis can flourish more easily.)

I`m not so sure if accutane will help too much at a low dose because it really needs a high concentration to work effectively. But again, you should discuss it with your doctor

Wed May 04, 2011 12:50 pm

Yes, recent articles saw that Acutane leads to stomack probllem:)

free skin care · Wed May 04, 2011 2:47 pm

Definitely consult your derm about accutane. He/she will know what will/won't work for you.

I took accutane in my 20's for cystic acne and oily skin and it was a life saver for me!

I know it's a rather controversial drug, but I had no side effects. I saw my derm once a month during the duration of my treatment and he constantly monitored my liver enzymes.

It won't hurt to ask!

free skin care · Wed May 04, 2011 3:17 pm

Accutane is a chemotherapy drug that downregulates telomerase & does permanent damage to the body. I'd work on diet first, perhaps lowering carbs a bit & eating cleaner. Make sure you get plenty of protein & essential fats. Use topical treatments a while longer. If you haven't used Retin-a I would try that first. Also, LED to calm the inflammation. Fish oil also, you likely have some kind of essential fats deficiency.

free skin care · Wed May 04, 2011 11:43 pm

I agree, asking your derm about this is a good idea. And I second cutting carbs (esp. sugar, and for that matter cutting dairy), and getting plenty of good fats.

Some other things to consider:
-low-dose aspirin for the rosacea,
-oral zinc picolinate and topical pyrithione zinc cleanser (e.g., Dr Bailey's Only the Best) for the acne and folliculitis and seb derm,
-cod liver oil with its EFAs and Vit A and D for the acne and reducing oil.

Thu May 05, 2011 5:35 am

I have changed my diet significantly recently. I don't see much improvement in my skin. Also, I already supplement with zinc and EFA's.

Regarding topicals, I simply can't tolerate them. They just irritate my skin. Retin-A would be a nightmare. I think I need to look into a few v-beam sessions, heal for a bit, and then jump on Accutane.

free skin care · Thu May 05, 2011 9:36 am

You should really get that p. folliculits checked by a derm though. It's a fungus, not a bacteria, and laser may not even destroy it.

Thu May 05, 2011 9:50 am

oasisjc wrote:

You should really get that p. folliculits checked by a derm though. It's a fungus, not a bacteria, and laser may not even destroy it.

You're right. I have an appointment on Tuesday. I'm going to ask for a swab. If it's definitely a fungus, I suppose I'll have to go the oral antifungal route. I still think I need v-beam because I have a lot of broken capillaries and light background redness. Hopefully, it will also help with burning.

free skin care · Sat May 07, 2011 12:48 am

rockhugger wrote:

I agree, asking your derm about this is a good idea. And I second cutting carbs (esp. sugar, and for that matter cutting dairy), and getting plenty of good fats.

Some other things to consider:
-low-dose aspirin for the rosacea,
-oral zinc picolinate and topical pyrithione zinc cleanser (e.g., Dr Bailey's Only the Best) for the acne and folliculitis and seb derm,
-cod liver oil with its EFAs and Vit A and D for the acne and reducing oil.

The food tip is really good.
I also think that if you eat foods with too many chemicals and preservatives it can be bad for your skin too.

like all the ingredients in cold cuts,bacon,sausages,processed foods.

I am not only buying bacon and smoked meats from some farmers and not the regular grocery store and I have much less itchyness and skin issues.

I buy organic bacon made only from pork,sea salt and maple syrup. sausages made just with chicken and vegetables-no preservatives.
same for bread-only bread made with no chemicals are preservatives.

-it is kind of annoying to pick up these foods as it is far from my house...but very worth it

Wed May 11, 2011 7:01 am

Update: I saw my derm yesterday and he immediately suggested that it was time to start isotretinoin to resolve burning, P&P's, and oily skin. He wants me to start at 20 mg per day, but I'd rather start at 10 mg. Does this sound like a good approach? I want to get as much clearance as possible without exacerbating flushing. I eventually would like to take 10 mg only a few times per week.

My concern is with the length of treatment. I know I shouldn't be using any harsh topicals on my face while taking isotretoin, but what about something like mandelic acid? As I mentioned in another thread, I have a decent amount of sun damage that I wish to correct. Now that I'm starting isotretinoin, I can't think about laser or light treatments until a minimum of three months after stopping isotretinoin. This is going to test my patience. I hope the drug itself will benefit my skin texture, but I'd like to do more.

Would using mandelic acid a few times per week be dangerous? What about topical niacinamide? Finally, do you have a recommendation for a zinc oxide product that isn't incredibly messy to apply?

free skin care · Wed May 11, 2011 8:35 am

Did he prescribe anything for your folliculitis?

Mandelic acid is usually used to help reduce oily skin - I'm not sure if this is a good idea if you're taking isotretinoin since it pretty much dries up your oil glands anyways.

Topical niacinamide can be helpful as it improves blood flow and is just good for skin health. But before you apply anything at all, you need to consult your doctor for possible interactions and side effects.

And do you mean zinc oxide as in physical sunscreen? If so, you should look into Burnout or Ecological brands.

free skin care · Wed May 11, 2011 3:00 pm

Olosir,
I would stick with your derm's advice. I think 20mg is still a pretty low dose -- even though you are taking it daily. Sometimes, with accutane, your skin can get worse before it gets better so don't be discouraged if this happens.

My skin was the absolute best in my early 20's after my round of accutane. Good Luck!!

Wed May 11, 2011 7:15 pm

@oasis: He thinks the Accutane course will clear the folliculitis too. Regarding mandelic acid, you're right - it might be superfluous. However, I'm really concerned with the sun damage/poor skin texture. I know I have to treat my skin gently while I take Accutane, but I want to do SOMETHING for the sun damage. It's hard for me to wait this out for the duration of Accutane plus three months. That's why I'm considering mandelic acid or niacinamide. My derm was vague when I mentioned this subject.

@kims: Yeah, 20 mg is fairly low considering I weigh 175 lbs. I'm just apprehensive of the possibility that I'll flush more.

free skin care · Wed May 11, 2011 8:38 pm

Be patient. I think you'll be very impressed with your skin once you've completed a round of accutane. It will definitely help with acne, cysts, oiliness, and texture. Also, don't forget sunscreen. If you're wanting something with niacin, you could try NIA 24 as a sunscreen.

Tue May 24, 2011 5:19 pm

I suggest you use a regular full course of accutane. You'll be more likely to get rid of this problem for good.

free skin care · Wed May 25, 2011 6:57 pm

I have heard of many dermatologists prescribing low dose accutane to their patients for "flawless skin" and a "pore less" look. You should talk to your dermatologist, he/she will know the best option for you.

Fri Jul 15, 2011 10:59 am

@Olosir - how is the low-dose Accutane treating your Rosacea? I'm in the same boat...going on low-dose Accutane in 30 days. I have lots of inflammation, background redness, enlarged pores, oily skin, etc. I also have quite a bit of pain (burning) in my forehead, cheeks and chin.

Are you currently taking Accutane? How is it going?

Thanks!

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