Accutane flare-up

I am concerned about an intial flare-up of acne while on accutane. I am thirty, and I never had acne until 10 months ago when getting on birth control. Since then, I get three to four small cysts on my chin the week before my menstrual cycle every month. I have tried every topical and antibiotic without success. My cysts tend to break open and take three weeks to completely heal (in time for my next cycle); thus, my doctor said it was time for accutane.

I am on my third week, and I have only had one cyst along my jaw during this time (2 days before my period). I have never had acne on any part of my face ever. If I would flare, is it logical to believe it would be confined to the only place I break out. Also, how soon would I experience a flare if it is to occur? I am a professional who attends several meetings a week, and I voiced my fears to my doctor. She has opted to start me low at 20 mg (I weigh 124) for first two months, and continue to increase the dosage to 40 mg; I will probably be on it for 6-7 months.

I have read every journal and article I can find on the subject. Many doctors have found lower dose course of accutane to be successful as long as at the end of the treatment, the patient receives a total dose of 120-150mg/kg. Do you agree with this?

I also proceeded with accutane because cortisone injections are not an option (I get atrophy). How soon can I expect the indentations to fill in? Also, if I get cysts during accutane, are there alternative solutions to cortisone injections?

Thank you for your time and this website.

[Alan Rockoff, MD]

I don't think you need to be concerned about flaring.  I very rarely see anything of the sort.  Besides, it would have happened already, in all likelihood.

In addition, flaring--on those rare occasions when it occurs--doesn't seem to be dose-related.  Some doctors start at lower doses and build up; I've never found it necessary to do that.  In the end the results should be the same.

As far as atrophy, diluting the cortisone down to 1 mg/cc instead of the standard 2.5 mg/cc should make atrophy exceedingly unlikely.  The alternative to injections is to wait the cysts out, as they always go away in time.  Indentations take up to 6 months or so to fill in.

I would add that if you only had a few cysts a month to begin with, Accutane may not keep these flares from happening once you are off it.  The medication is very effective, but by no means does it always effect a permanent cure.

Take care.

Dr. Rockoff