Accutane again

Hi Again Dr. Rockoff,

I have written before. Am getting ready to start Accutane and have a remaining question.

As a reminder, I am 31, have had acne since adolescence, have laways had good luck with orthotricyclen and antiobiotics (although have moved through tetra, to mino, to doxy -- as one failed switched to another). Antiobiotics keep my skin pretty clear -- still the ocassional cystic acne due to pms or stress.  (I also use metrol gel for rosacea, retinA and benzaclin).

My current dermatologist wants me to get off of the antibiotics (has me on spironolactone) -- have been on them for 3-4 years without a break. So he wants me to do Accutane.

Should I first just try to go off of the antiobiotics and see if I can get by with spironolactone rather than risk the side effects of Accutane? (And how long would I need to be off them to see what would happen to me...) The side effects are so scary that I worry that my "moderate" cystic acne isn't worth the risks.

At the same time, I would like to think about pregnancy next fall or late summer so would need to get going on Accutane.

Any advice?

Thank you very much!!!

[Alan Rockoff, MD]

The decision to go on Accutane is a complex one.  I can't say too much about whether you should go off the antibiotics and try just spironolactone--apparently your dermatologist thinks you shouldn't do that, and he knows your case a lot better than I do.

What I can say is that the side-effects of Accutane are quite minor in most cases--just dry lips and perhaps a few aches.  You needn't be scared of them.

You really ought to discuss these issues more fully with your dermatologist.

Good luck.

Dr. Rockoff