Too much Accutane?

[Noah_Goldstein]

I took Accutane for 6 months 2 years ago.  My acne was very mild but my dermatologist put me on 40mg per day in the first two months and 80 mg per day for the following 4 months. I was 165lbs at the time.  My acne was completely clear after the first week.  My experience on the drug was not pleasant and i feel completely irresponsible of the dermatologist considering my response to the treatment and the mildness of my acne. During my course, the corners of my mouth were completely cracked about an inch on both sides and my skin was peeling excessively.  To this day, my skin is still dry and flaky, my lips are still chapped, my eyes still burn, and my scalp is still extremely dry.  Sorry for this being so long, heres my question.  Do you think my dermatologist was wrong with his dosage and duration considering i was completely clear after one week and being that my condition was extremely mild? I feel like i was terribly mistreated and i feel awful about it.

[loiloi]

Hi. The usual dose for Accutane is 1mg X kg patients bodyweight/per day. 165lbs is about 75kg so the standard dose for a patient this weight would be 75mg. However, 5mg tablets are not available in all countries and it would be normal to prescribe 80mg to a patient weighing 75mg. Side effects are generally dose-related, but 5mg would not make a big difference.
Accutane has many potential side effects but this must be balanced against the fact it is the most effective acne treatment available. These side effects are described in great detail in the literature enclosed with the tablets. Were you given this?
It is licenced for severe acne, but may also be used for milder acne which is persistant, leaving scars or causing distress to the patient.
Accutane works by shrinking the sebaceous (oil) glands. These grow back very slowly, by which time the patient has nearly always outgrown their tendancy to acne. This is why your skin is still dry. I highly recommend either Cetaphil or La Roche-Posay products for skin fragilised by acne treatments. For dry lips I find Elizabeth Arden 8 hour cream much better than Vaseline.
Although your skin was clear after one week, Accutane must be taken for  16-24 weeks to lead to a permanent remission from acne. If you had stopped taking it before then, your acne would certainly have returned.
Best Wishes, Eloise.

[Noah_Goldstein]

Thank you for responding to my message. You are very kind.

I am getting very skeptical now that my oil will ever come back. I have been off accutane for almost 3 years and there is no oil ever on the surface of my skin. Pre-accutane, my skin was extremely oily.  I know you say the oil glands slowly come back, but they haven't comeback at all in 3 years.
Two questions...
1)  How do you the oil glands slowly grow back to the normal levels before accutane, did somebody inform you of this? just curious
2) Do you think its possible that they won't come back? I am very upset about this because i feel like i need some sebum on the surface of my skin to feel comfortable. Thank you so much and i hope to hear from you soon

[Noah_Goldstein]

Thank you for responding to my message. You are very kind.

I am getting very skeptical now that my oil will ever come back. I have been off accutane for almost 3 years and there is no oil ever on the surface of my skin. Pre-accutane, my skin was extremely oily.  I know you say the oil glands slowly come back, but they haven't comeback at all in 3 years.
Two questions...
1)  How do you the oil glands slowly grow back to the normal levels before accutane, did somebody inform you of this? just curious
2) Do you think its possible that they won't come back? I am very upset about this because i feel like i need some sebum on the surface of my skin to feel comfortable. Thank you so much and i hope to hear from you soon

[loiloi]

I am an expert on Acneic skin with lots of experience with Accutane.
Accutane shrinks the sebaceous glands but this effect is temporary. They grow back very slowly by which time the patient has nearly always outgrown their tendancy for acne. This is why the remission from acne is usually complete and long lasting.
You are right that a small amount of sebum is beneficial for skin, but at the moment you are going to have to use good products for fragilised skin. I recommend La Roche-Posay's Physiological cleanser for very dry skin followed by their Hydreane Riche moisturizing cream for sensitive skin. You can order these products online if there is not a stockist near you. Use Elizabeth Arden's 8 hour cream on your lips, its much better than other lip treatments I have tried.
I understand your frustration but I often hear from patients for whom the sebaceous glands have grown back too quickly and their acne has returned. It was not possible for your dermatologist to predict how a medicine you had not used before would affect you.
Best wishes. Eloise.

[Noah_Goldstein]

Thank you once again.  But if you had to say, would you say that my sebaceous glands are still growing in size, or is it possible that they have permanently been shrunk? And how long would you guess that it is going to take for skin to start have oil on the surface again? 1, 5, 10 years? Because I have ran out of patience here, i am starting to look into ways i can stimulate my sebaceous glands to produce more sebum.

[jenna44]

Hi!
Ive been on Accutane a few times during the years and I had not the worst type of acne but still bad. My skin got clear in about a week to. I was also put on 40 mg a day initially. I then lowered the dose myself because I was afraid of the side effects and didnt want the dry skin. The dose that was fine for me was actually as low as 30 mg a week!!! That´s quite a differance!! So i don´t see why your doctor would increase your dose to as high as 80 mg a day. Sounds a little risky to me. Why take more than you need of a drug that can have such severe consequenses?
I can´t explain why you still have dry skin. Ive just heard it normally takes about a year for the medicine to be completely out of your system. For me, that´s about the time that my skin have been fine without the pills and then Ive had to take another cure.
Have you asked your doctor about this?
/Jenna

[Noah_Goldstein]

Hi, thanks for the respnse.  I did ask my dermatologist and he said this was a normal course.  Did you say that your acne has come back and you;ve had to take another course? Maybe this means that you didn't take enought the first time.

[loiloi]

Hi Noah, it is really difficult for me to answer your question as patients respond differently to medication. Accutane does not permanently stop sebum production. It's effect is semi-permanent/ temporary in the long term. The medication is no longer in your body after 5 weeks of finishing the course. However, sebum production is diminished enough that 80% of patients never need another course of Accutane. There is not a way to stimulate the sebaceous glands internally. You will have to apply moisturizing products to the skin whilst the dryness persists.
I cannot accurately give you a time scale, as we have heard from other members -some relapsed after just 8 weeks whilst others are free from acne indefinately.
Eloise.

[Noah_Goldstein]

Thanks for responding once again. However, i respectfully disagree with you saying that there is no way to stimulate the sebaceous glands internally. I have read that these medications can increase sebaceous glands..
1. testosterone given to prepubertal males
2. Progesterones with androgenic properties such as medroxyprogesterone, levonorgestrel, Phenothiazines

[loiloi]

I meant there is not a way to stimulate the sebaceous glands without risking a relapse of acne, which presumably you don't want. Both testosterone and progesterones are major factors in acne. Patients who take these medications (for birth control, sex change etc) often experience acne.
Eloise.

[Hallie881]

When it comes to acne, skip the drugs. First and foremost drink lots of purified water and stay away from or limit the use of carbonated beverages and alcohol. Many of us with acne problems continue to drinks all of these sodas or drinks that contain a lot of acid, colors, etc. Soda can really mess up the face. Leave all sodas and other drinks on the market alone and stick to only purified water. Try these waters - Poland Springs, Volvic, Penta (expensive), Smart Water, or Dasani. These waters have all been thoroughly purified so as not to contain any contaminants. What they say really is true water does wonders to the body! Second drink some type of green tea (at least 1 to 2 times a day). Green tea contains many antioxidants that will help in decreasing your acne problems. Try purchasing the Celestial Seasonings Green Tea and if you’re not a teetotaler try drinking one of the sugar free green tea products put out by Lipton.

[loiloi]

Noah- Have you tried the Oilatum range for chronically dry skin, eczema, dermatitis etc?
Hallie- Noah is not trying to clear acne, he is suffering intolerably dry skin after Isotretinoin treatment.
Eloise.

[Noah_Goldstein]

No i have not tried that. Thanks. Additionally, i actually have read that sebaceous glands have nothing to do with having dry or not dry skin.  I have read that sebaceous glands do nothing but clog pores and contribute to acne. So obviously the sebaceous glands are not what i need to solve the dry skin. I have been told the reason that my skin is still dry 3 years post-accutane is because of this excerpt below, please tell me what you think about this since you are very knowlegeable on accutane and it's effects, once again thank you so much for trying to alleviate my problems, you are a very kind person...

"Accutane causes dryness but its not due to stopping sebum production. Retinoids are known to break down the skin barrier and thin the stratum corneum. It could also have an effect on the intra cellular matrix lipids(this is not sebum by the way)."