Accutane: 5th month and not any better

[Ekw]

I am a second time user of accutane. The first time I took it I was 27, in 1999, and had been battling a severe bout of acne for a few years after having gone of the pill. After a 5 month duration of 60 mg/day, I had wonderful success. In fact, my skin cleared up within 2 months. My face remained clear until fall of 2002. It wasn't horrible, but my dermatologist (a different derm) decided to put me on accutane again. This time, I started out at 20 mg the first month, 40 for the next two months, and 60 for the 4th month. I am now 31, and halfway through my fifth month and am on 80 mg a day. Why? Because my skin continues to get worse. In fact, my skin overall looks much worse than it did when I started in December, including 1 or 2 cysts all of the time, and spotty, red marks that don't go away. Also, I had injections of coritizon into three cysts, and now they have left deep indentions in my skin. I am at my whit's end. Is this normal? My dermotologist would like me to stay on it through the 6th month. I am worried that my skin will just continue to get worse, not better. I have been on every medication in the book, so accutane really is my last option. I have read that it is wise to be patient. Accutane does work eventually. It's odd because my case isn't nearly as bad as others, so I really thought that the accutane would work. Should I just be patient? Is this normal for a second round of accutane? Can large amounts of stress affect how the drug works? My skin certainly doesn't need to look perfect, but I am quite frankly ashamed to have my skin seen in the daylight. I was hoping that at this point, it would have gone away. Should I continue to be patient, or call  it quits? Also, does the drug become more effective if the dose is taken each day all at once, or should it be split up into two doses?
Thanks for your help. Sorry about the long message!

[Alan Rockoff, MD]

If you remain patient, you will be rewarded.  Here's why:  The persistent red marks you still see can take up to several months after the Accutane is over to go away.  The fact that you can still see them is no reason to despair.  Also, the indentations from the cortisone have nothing to do with Accuatne, and those too will go away.  Finally, many patients keep getting occasional cysts right through the end of treatment and clear up anyway.  In fact, your rapid clearing first time around is the exception, not the rule.

My advice is to follow your dermatologist's advice and stay on the Accuatne for 6 months.

Take care.

Dr. Rockoff