ACCUTANE

[JACKIE1223]

MY 18 YEAR OLD DAUGHTER HAS BEEN ON ACCUTANE TWICE. AFTER THE FIRST COURSE(20WEEKS/WITH GRADUAL INCREASE FROM 20MG TO 60MG SHE HAD INCREDIBLE RESULTS AND A 2YEAR REMISSION. WHEN HER ACNE REOCCURED WE WERE ADVISED TO DO THE SECOND COURSE.  AGAIN 20 WEEKS WITH GRADUAL INCREASE IN DOSAGE FROM 40MG TO 60MG. THE RESULTS AGAIN WERE AMAZING, VERY CLEAR, PERFECT SKIN. SHE HAS BEEN LEFT WITH SOME SCARRING.  JUST RECENTLY, HER ACNE REAPPEARED
THIS TIME WITH ONLY A ONE YEAR REMISSION.  ONCE AGAIN, THE ACNE IS THE SAME..CYSTIC, PAINFUL AND PLENTIFUL.  SHOULD SHE PURSUE USING ACCUTANE AGAIN FOR A THIRD TIME AND IF SO SHOULD THIS BE MORE OF A LONG TERM TREATMENT WITH A LOWER DOSAGE. I HAVE RECENTLY READ ABOUT THE USE OF LASERS IN A NONABLATIVE FORM FOR THE CONTROL OF ACNE.  WOULD A TREATMENT LIKE THIS BE MORE EFFECTIVE FOR HER.  WE ARE DESPERATE TO FIND SOME TYPE OF RELIEF FOR HER AND A SOLUTION. ALSO, TOPICAL AND ORAL ANTIBIOTICS    WERE COMPLETELY INEFFECTIVE. THANK YOU

[beautifulface]

For what it's worth, stop having her take Accutane!  That drug is just too powerful to do more than once or twice.  I'm comforted by the doctor's post about antibiotics possibly working better than they did pre-Accutane, because I just now started antibiotics myself after having taken a course of Accutane four years ago with questionable results.  The idea of a year- or two-year-long remission sounds heavenly to me because I broke out in tiny acne all over my forehead the month after stopping Accutane.  Anyway, your daughter is lucky to have you helping her through this emotionally-draining effort to reclaim her beautiful face.  I wish you both luck!

[Alan Rockoff, MD]

This is a difficult problem.  It is possible to take Accutane a third time, but as you realize, the chances are that any remission will be short, and since your daughter is only 18, she can't very well keep taking Accutane over and over.  Lasers may be worth a try--they're safe, but results are often partial and brief.  Oral and topical antibiotics are probably worth at least a try.  Even though they didn't work before, they may be more helpful now that Accutane has modified the oil glands, at least partly.  Other possible therapies are oral contraceptives and the drug spironolactone.  Your daughter should take up these and perhaps other therapeutic possibilities with her dermatologist.

Best.

Dr. Rockoff