Accutane, preganacy(pregnancy)

Hi,

I have been on antibiotics on and off since adolescence. I am 31 years old. I also now have rosacea. I use doxycycline, metrogel, retin-A, and benzaclin. I am also now on spironolactone -- as of the past few months. I've been on antibiotics for at least the past 5 years straight without being able to pull off.

My skin is decent with all of this treatment -- although monthly I seem to get a bout of 4-5 cycstic acne nodules that often leave marks for awhile or permanently (mostly on my chin). This is why my dermatologist (a new one - I have seen him twice) has prescribed the spironolactone. He is also hoping to get me off of the antibiotics using this medication. My rosacea is reasonably controlled with these medications.

I am hoping to start trying to become pregnant in the next 2 years. I know I will have to go off essentially ALL of this then and I am TERRIFIED of what will happen to my acne and rosacea.

The doctor I have seen for years has not recommended Accutane - she has had me on antiobiotics for over 5 years without a break. Every time I try to take a beak, I see more regular cystic acne.

A new doctor suggested I think about Accutane SO THAT when I have to go off of EVERYTHING for pregnancy I will be clear (hopefully).

Does this sound worth the risks of Accutane given my moderate cystic acne? Also - there seems to be conflicting information in the world about how long one should wait after Accutane to try to conceive. 1 month? 3 months? 12 months or more?

With all of that background, my specific questions are:

1. Should a person with my history go on Accutane to pre-empt any bad, scarring flare-ups during the long road of trying to conceive, 9 months, 6 months of breast feeding? (a total of a minimum of 18 months or more)

2. If so, how long should I wait before trying to conceive?

Thanks a million.

[Alan Rockoff, MD]

Under the circumstances you outline, Accutane may be worth considering.  Once you stop that drug, you only have to wait one month before trying to conceive.  My only reservation would be that, although Accutane is wonderful and would most likely clear you up, it is no guarantee that you might not continue to break out with a few spots around your period even after you're done.  Of course, trhe same may well happen after stopping other medications.  Your best chance of getting a long-term break from acne would, I think, be Accutane.  If contraception is done and you're prepared to face the fact that improvement may not last, you may want to consider taking it.

Take care.

Dr. Rockoff