Acne After Accutane

[heavybeard]

Dr.:

I have had mild to moderate acne for over 15 years.  I am now 28 and am pretty discouraged.  I have tried everything there is.  All the antibiotics and topicals.  My acne rarely got bad, but I almost always seem to have a few zits, few ingrown hairs, few blackheads, and a few inflamed whiteheads.  I do have periods when I am pretty clear, but this usually only lasts a few days.  My dermatologist decided it was time to give accutane a try.  I did a 7 month course and reached the target cumulative dose of 120 mg/kg.  I did not have much of an initial breakout, was pretty much clear for months 3 to 6.  Near the end of my course I started to get a few zits.  

It has now been three weeks post-accutane, and I am starting to get more and more whiteheads.  Not the big inflamed whiteheads I used to get but it looks like things are returning.  My dermatologist prescribed retin a micro.  I was really hoping accutane would finally be the answer and am reluctant to start another treatment that is said to cause initial breakouts and red, irritated, and peeling skin.  

Sorry for the long history, but I have two questions:
(1) Is it smart to start using retin a micro so soon after accutane?  My dermatologist prescribed it over the phone and I have not seem him for 1.5 months.
(2) Is a second course of accutane likely to do any good?  I am amazed how quickly the acne returned.  It didn't even work throughout the entire course.


I don't obsess about acne but it does put a damper on my personal and professional life.  I usually cope with it well, but occasionally it really gets me down.  I never pick at my face and always follow the doctor's directions.

I appreciate your response.

And by the way, I asked you a question about black oily spots appearing on my face back in 2007.  You figured it out when other doctors were stumped.  Great job!

[Alan Rockoff, MD]

(1) Is it smart to start using retin a micro so soon after accutane?  My dermatologist prescribed it over the phone and I have not seem him for 1.5 months.

Yes, I think this is a good idea.  This should not cause irritation, and it would be very premature to use oral medication so soon after stopping Accutane.

(2) Is a second course of accutane likely to do any good?  I am amazed how quickly the acne returned.  It didn't even work throughout the entire course.

I understand your frustration, but I think your assumption that Accutane has failed is very premature.  True, your acne isn't perfect and has returned to some extant--this is common, but it does not mean that your acne will come back to anything close to the degree you had before.  Try Retin-A and work with your dermatologist.

Take care.

Dr. Rockoff

[loiloi]

20% of Accutane patients require a second or third course. You must wait 8 weeks between courses since acne can continue to clear during this time.
If Retin-A does cause irritation try a gentler synthetic topical retinoid such as Differin (adapalene 0.1%) as this is very effective and generally well tolerated.
See the Acne forum for more advice.
Eloise.