Accutane results and side effects

[guyonaccutane2010]

I am a 6'1 85 kg male who has been on accutane for 120 days (4 months). I started on 20 mg a day month 1, 40 mg month 2, and 60 mg months 3 and 4. 3 weeks ago I had my 1st eye infection of my entire life in my right eye so I went to an opthamalogist and he told me to stop taking the accutane for a week (which is what he says caused the infection) and put me on doxyclince hyclate 100mg twice a day and eurithromyocin gel to put on my eyelid that knocked the infection out. I did not tell my dermatologist this but I only stopped taking the accutane for 2 days instead of 7 because I didn't want to stop the accutane's momentum and took it in conjunction with the doxycycline. I have been taking 80 mg for the last two weeks but now I have developed the same infection but in my other eye.  Once again the doctor has orderd me to stop taking the accutane for a week and has lowered my dose to 40mgs a day once the infection has passed to try and get rid of these sides . I am at odds end about what to do because I am afraid about having long term, permanent eye problems and other side effects from this drug. I have a few questions:

Is it normal to still be breaking out at the beginning of month 5 on accutane?
How heavily do you believe that in order to acheive permanent remission that you have to take a high enough cumulative dose based on your body weight because I am not going to come anywhere close to this based on my weight and dose?
If I stop taking the accutane now will I lose all the progress made on my back?
Are eye infections a common side effect of people taking accutane or is this rare?
In your professional opinion, will the dry eyes and infections go away once I stop takign the accutane or should I stop taking it permanently because of the chance of developing permanent eye problems?

[Jasmina Jankicevic, MD, MSc, CCRP]

Welcome to the Dermatology Expert Forum!

Majority of cases of cystic acne can be successfully treated with one 4-6 month course of isotretinoin (Accutane) at a dosage of 0.5-2.0 mg/kg body weight per day (approximately 40-160 mg per day in your case). Continued recovery and prolonged remission after discontinuation of therapy is expected, so it is not required to maintain treatment until total clearance is achieved. Progress you made should not be lost. However, in some, most severe cases, second course of therapy may be needed.  

Isotretionin-induced blepharoconuctivitis (like yours) is frequently seen, and it is usually caused by bacteria Staphylococcus aureus. Artificial tears are recommended throughout the treatment with isotretionoin as first line of prevention of infection. Dry eyes and other eyes-related side effects rarely persist after discontinuation of therapy. Possibility of developing longer lasting ophthalmic (eye) problems has to be estimated by an ophthalmologist and will affect decision about further treatment with systemic retinoids.

FYI - Systemic retinoids (such as isotretinoin) should not be first line of acne therapy. Nowadays, we know way more about pathophysiology of acne and different therapeutic approaches are available. Treatment should be individualized and take patient's lifestyle (including nutritional habits, coping with stress, etc.) seriously into account.  

Wishing You Optimal Health,
Jasmina Jankicevic, MD, MSc, CCRP, IFAAD

[guyonaccutane2010]

By the way, when I say eye infection I am referring to styes in my upper eyelids. Are these common on accutane? From what I've read, a stye is bascially a blocked gland on your eyelid so is it basically your eye's version of a pimple?

[guyonaccutane2010]

I forgot to mention that the doctor wants me to go down to 40 mg and stay on that dose for another 2-3 months to try and acheive clearing because he said that he has been prescriping accutane for 25 years and he has never had ONE SINGLE patient that hasn't cleared but sometimes it takes longer than others.