Accutane and seborrhea dermatitus on scalp

[momv630]

My son (13 yrs. old) started on Accutane 1 month ago.  While it has completely cleared up his cystic acne he started to get a very bad case of seborrhea dermatitis on his head along with some loss of hair.  He suddenly got this extremely bad case of dandruff with an itching inflamed scalp. The derm gave him selenium sulfide shampoo 2.5% and some betamethasone lotion for his scalp.  This helps but it just keeps on coming back. The itching gets so bad that he just can’t take it. The derm just said to stop the Accutane and come and see him in a week.

My questions… 1) Will the acne come back now since he was only on it for 1 month?  2) Since seborrhea is a side effect of Accutane (listed as a side effect on the patient material) and too much selenium sulfide shampoo can cause inflammation, itching and loss of hair (also a listed side effect).  What is one to do if they both cause the same problem?

I don't want the acne to come back but this seborrhea problem is really bad.

Thank you

[Alan Rockoff, MD]

I am very skeptical that the seborrhea is a side-effect of Accutane, not have seen it once in 21 years of using Accutane.  I am also perplexed by the statement that selenium sulfide can cause hair loss-after all, you can get Selsun Blue over the counter.  Many statements written in package inserts are more alarming than facts would justify.

Stopping Accutane after one month makes it very likely that the treatment will fail.  Since I assume that your son's case is severe enough to warrant this drug, I urge you to give serious consideration to working with your dermatologist to treat the seborrhea (there are lots of medications other than Selenium), and to complete the course of acne treatment.  I have never had to stop this drug because of seborrhea, not even once.

Good luck.

Dr. Rockoff

[momv630]

You seem to be very PRO Accutane.  Which I don't really mind because it does work but every pharmasist I have talked to and even the patient material states that YES this is caused by the Accutane. On all your Accutane questions you seem to state that there are NO side effects at all with this drug. I think from this site you will be able to see that yes people do have side effects. Please admit it.

[Alan Rockoff, MD]

I never said Accutane doesn't have side-effects--of course it does.  These include dry lips and dry patches on the arms.  You ask me to "admit it," as though you think I sell this stuff.  I am indeed pro-Accutane if someone has severe acne that's making them miserable and leaving scars.  The package insert says what it says, but I remain skeptical that this degree of seborrhea is caused by Accutane.  (When "every pharmacist" says "this is caused by Accutane," they can't possibly mean that your son's condition is certainly caused by it, since they haven't examined him.)  If I haven't seen such a thing--seborrhea of this severity-- in treating thousands of patients with this drug for over 20 years, I remain comfortable in my skepticism.

Dr. Rockoff

[momv630]

From MayoClinic.com....http://www.mayoclinic.com/invoke.cfm?objectid=E6BEA3B9-15FB-4E06-B5B099CB412A1F04

From Roche labs. Look under "Adverse reactions-Skin and Appendages" ...
http://www.rocheusa.com/products/accutane/pi.pdf

[Alan Rockoff, MD]

Though seborrhea is a listed side-effect, I have rarely if ever seen it in the many patients to whom I have prescribed Accutane.  If you think that your son cannot tolerate Accutane, please do your best to see that he is treated in some fashion that keeps cysts down and scarring away.


Good luck.

Dr. Rockoff

[momv630]

Just an update

My son stopped the Accutane and within 3 days all the itching and dandruff stopped. Now a few cysts look like they are coming back now. I sent an email to Roche labs and asked them if a 13 yr. old with 2-3 cysts on his nose only should be on Accutane.  Within 5 minutes the Roche nurse called me at my home and said "Accutane is not recommended for ages 12-17 and especially for kids who have just a few cysts".  The accutane did clear up the problem but that phone call convinced me not to put him on it again. Yes, I will try to find "something" to help, I don't know what, but until then I think I could sleep alittle better knowing he's not on such a stong drug.
Thanks for your input Dr.

[Red_riding_hood]

I think both points are valid here, At the same time, you came here for advise and the Dr gave his opinion, Choose to ignore if you wish.
I believe accutane is a drug that should only be used in extreme cases of acne. All other methods should be tested first.
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